Archived: St Catherines House

Updated 19 September 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

This inspection team consisted of two adult social care inspectors and two experts-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

St Catherine’s House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. St Catherine’s House can accommodate up to 16 people in one adapted building.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did:

Prior to the inspection, we reviewed the information that we held about the service and the provider including notifications affecting the safety and well-being of people who used the service. We had also received monitoring information from one local authority. We looked at the action plan that the provider had submitted following the last inspection in June 2018 which listed the improvements they planned to make. We had not received a Provider Information Return (PIR) from the provider. A PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make.

During the inspection we spoke with five people using the service and eight relatives of people using the service to obtain their feedback on the care and support that they and their relative received. We also observed interactions between people and care staff.

We spoke with the nominated individual (the responsible person on behalf of the company running the home), the registered manager, four care staff, the chef and a volunteer.

We looked at the care records of four people who used the service and medicines administration records (MARs) and medicines supplies for seven people. We also looked at the personnel and training files of five staff. Other documents that we looked at relating to people's care included risk assessments, medicines management, staff meeting minutes, handover notes, quality audits and a number of policies and procedures.

Updated 19 September 2019

About the service: St Catherine’s House is a residential care home that was providing personal and nursing care to 13 people aged 65 and over at the time of the inspection.

People’s experience of using this service: The provider and registered manager had failed to make any improvements to the identified issues found as part of the last inspection in June 2018.

Furthermore, we identified additional issues around the safety, fabric and condition of the home as well as poor recruitment practices. The quality of care had deteriorated since the last inspection. People were not experiencing a good standard of care.

Management oversight processes in place were ineffective and did not identify any of the issues we found as part of this inspection.

Medicines management and administration was unsafe. People did not always receive their medicines on time and as prescribed.

Risks associated with people’s individual health and care needs were not always assessed and guidance was not available to staff on how to minimise known risks to keep people safe.

Recruitment checks were not fully completed to ensure that only those staff assessed as safe to work with vulnerable adults were recruited.

The safety and condition of the building and the equipment used was not always safe. Significant issues found with cleanliness, infection control and the environment meant that people could be placed at risk of harm.

People did not receive appropriate person-centred care that promoted their dignity.

Staff did not receive appropriate training and support to safely and effectively carry out their role.

People were not stimulated or involved in activities that promoted their well-being.

The registered manager could not locate records relating to accidents and incidents that had occurred within the home. Therefore, we were unable to assess whether the service analysed accidents and incidents to enable them to learn and improve to prevent future re-occurrences.

Poor staff deployment and availability meant that people’s needs were not always safely met.

The service did not always work within the principles of the Mental Capacity Act 2005. Care plans did not evidence consent to care had been obtained. Capacity assessments had not been completed where required and where decisions had been made in people’s best interests these had not been documented.

People's individual needs were not always met by the adaptation, design and decoration of the home. The home had not been decorated and designed in a way which supported people living with dementia.

People and their relatives told us that they and their relative felt safe living at St Catherine’s House. Overall, feedback about the service and the care people received was positive. However, our findings did not support this positive feedback.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to ensure that:

• Providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We have also informed the local authority of our concerns who are currently in the process of reviewing each person’s placement at the home.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report was published on 6 November 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We are taking enforcement action and will report on this when it is completed. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closed and discuss ongoing concerns with the local authority.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk