Archived: St Catherines House

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

St Catherines House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Catherines House accommodates 16 people in one adapted building. At the time of this inspection there were 15 people living at the home.

There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and registered manager carried out several audits and checks to monitor the quality of the service. However, we found that these audits failed to identify any of the issues that we identified as part of this inspection. Where issues were found, there was no record or action plan in place stating how the issues were to be addressed or resolved and by when.

Certain aspects of medicines management and administration was not safe. We found numerous omissions in recording, issues with the storage of controlled drugs, lack of ‘as and when required’ medicine protocols and incomplete paperwork confirming the safe and appropriate administration of covert medicines.

We found issues relating to the health and safety of people in relation to the fabric and condition of the home. Radiator covers were broken and not securely fixed to the wall, wardrobes were not stable and were leaning to one side and not safely secured to the wall. Although the provider addressed these issues during the inspection, the provider’s lack of awareness of these issues placed people at risk of harm.

Infection control processes were not in place to prevent cross contamination. Red bags were not available to care staff in order to safely clean soiled clothing and linen.

Staffing levels were not sufficient to safely meet people’s needs. Throughout the three days of the inspection we observed numerous times where the main lounge was left unattended. This was because care staff had to either support people who remained in their bedrooms or where other daily tasks such as laundry, cooking or cleaning had to be undertaken.

Care plans did not always contain appropriate documentation confirming people's consent to care. Where people had been assessed as lacking capacity we saw documents confirming they had signed consent to the care and support that they received. Where people had capacity, they had not been asked to consent to their care.

People ate well. People and relatives confirmed that they and their relative enjoyed the food that was presented to them. However, people were not always offered a choice of meal. Menus were not displayed and alternative meal options were not always available. Drinks were available to people throughout the day, however, we did not always see the availability of snacks including fresh fruit and biscuits for people.

The home monitored every person’s food and fluid intake to ensure people were eating and drinking sufficiently. However, the charts were just a formal record of what the person had eaten or drank. Amounts of fluid intake were not recorded and totalled to determine whether a person’s fluid intake was sufficient over a 24-hour period.

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 relatives all told us that there was very little provision of activities taking place within the home. Throughout the inspection we observed very little taking place in relation to activities and stimulation.

Results of satisfaction surveys initiated by the provider and completed by people and relatives was not shared with the registered manager and the service. Therefore, the service was unable to learn or implement improvements in response to the contents of the survey.

People and relatives told us that they felt safe living at St Catherines House. Processes and systems in place protected people from the risk of abuse or harm.

Care plans identified risks associated with people’s health and social care needs and gave guidance to care staff on how to reduce or mitigate known risk to keep people safe and free from harm.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Care staff were clearly able to explain their understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and how this impacted on the care and support that they delivered.

Records confirmed and care staff told us that they all received an induction when they began their employment at the service followed by regular training and refresher training. Care staff also confirmed that they were regularly supported through supervision and appraisals.

We observed people had developed positive and caring relationships with the care staff that supported them. People were treated with dignity and respect.

We observed care staff involving people in all day to day decisions and responding to people’s individual requests. People and relatives confirmed that they had been involved in the planning of their care.

Care plans were detailed, person centred and listed people’s likes, dislikes and their wishes on how they wanted to receive their care and support.

The registered manager confirmed that the service had not received any complaints since the last inspection. The providers complaints policy detailed the steps that should be taken if people, relatives or visitors had any issues or concerns to raise.

People, relatives, care staff and visiting professionals were highly complementary of the registered manager. They found them to be very approachable, hands on and very caring.

At this inspection we found breaches of Regulation 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were being cared for in an environment that was clean, hygienic and tidy. The records we read showed the home was cleaned daily. People told us they felt safe in the home. One person said, “I feel safe here, I would speak to someone if I didn’t.” We saw the service had effective infection control procedures. Equipment in the home included fire hydrants and a stair lift. The equipment had been well maintained and serviced on an annual basis under maintenance agreements.

The staff records we read showed appropriate checks had been made to ensure staff were suitable to work in care. Staff had received appropriate training to keep people safe. Training included health and safety, infection control and manual handing training. Staff were able to explain how this training kept the people who used the service safe.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing, first aid trained staff and a call alarm people could use to call for assistance.

The CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us they were happy with the care they received and felt their identified needs were being met. One of the health and social care professional we spoke with told us the service had met the needs they identified when they referred people to the service. They told us the service provided was, “second to none.“ We observed staff’s interaction with people and saw they were attentive to their needs.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, “All the staff here are lovely.” We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw people’s care plans had been regularly updated and people were given the opportunity to change their mind about what they wanted to do. People we spoke with told us the service was responsive to them when they changed their minds about what they wanted.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw people were regularly asked what they thought about the service and the manager took action to resolve any issues. We saw senior management of the home regularly receive quality reports and acted upon them. People told us the management had consulted with them before implementing changes to service the home provided and their views had been taken into consideration.

People told us that staff knew how to meet their needs. We saw that staff understood people’s needs. One person said, "staff understand my needs and do a good job." People told us that staff listened to them and responded to the requests. Staff responded to any suggestions they made about the service. People told us that there had been meetings where they could discuss their views of the home.