St Bernards Residential Care Home Limited

St Bernards Residential Care Home Limited is a care home providing personal care to a maximum of 43 older people. At the time of our inspection 36 people lived at the home and one person was in hospital. Some people lived with dementia.

People’s experience of using this service and what we found

Managerial oversight of the service required improvement. Some of provider’s systems and processes to monitor the quality and safety of the service remained ineffective and had not identified the shortfalls we found. Policies and procedures were not always followed. The management team needed to increase their knowledge of some requirements to ensure all regulations were complied with.

Risk management required improvement. Information staff needed to help them provide safe care was not always available to them and timely action had not been taken to ensure all fire safety risks had been mitigated to keep people safe.

That meant opportunities to make improvements had been missed. Whilst people told us they received their medicines we found they were not consistently managed in line with the provider’s expectations or best practice guidance.

The provider understood their responsibility to be open and honest when things went wrong. Responsive remedial action was taken following our visit to make improvements which demonstrated lessons had been learned. Two weeks after our visit the nominated individual told us actions taken including strengthening auditing systems had improved safety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People felt happy and safe living at the home. The culture of the service was inclusive, and people felt listened to and involved in the running of their home. Relatives shared that viewpoint. Staff felt supported and appreciated and spoke highly of their managers. The nominated individual was proud of the staff.

Staff had been recruited safely and there was enough of them on duty to meet people's needs. The home was clean, and visitors were welcomed. Staff worked in partnership with health professionals which supported people's health and wellbeing.

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

Rating at last inspection and update

The last rating for this service was good (published 21 June 2019).

At the inspection in 2019 we recommended the provider reviewed their quality assurance systems to ensure they were fully effective. The recommendation had not been acted up. We also recommended people's consent to their care and support was recorded. That had happened which meant improvement in that area had been made.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to staffing levels and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. The provider has taken action to mitigate the risks we identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Bernards Residential Care Home Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ When visitors arrived at the home they were screened for symptoms of Covid-19 to ensure their visit could take place safely in line with current guidance.

¿ People were supported to maintain contact with others who were important to them in a variety of ways including video calls. Relatives had opportunities to be involved in virtual forums which enabled them to maintain close links with the service.

¿There was a thoughtful approach to making lunchtimes special for people which had a positive effect on wellbeing. People's meals were accompanied with 'special touches'. For example, chocolates on Valentine’s day and daffodils on St David's day.

¿ A 'video tour' of their home had been created. The video had been shared with potential new admissions to help them decide if the home was the right place for them to live.

¿ The provider had offered staff who worked at the home accommodation to enable them to safely self-isolate away from their families.

¿ A relative had nominated the staff team for a 'Hamper for heroes' in recognition of their hard work during the pandemic which is part of a national initiative to support the wellbeing of staff. The staff team had received a hamper in February 2021.

¿ Staff including housekeepers worked in specific areas of the home which reduced the risk of cross infection. A dedicated area of the home was available for people to self-isolate safely in line with current guidance. This included people who lived at the home who were returning from hospital.

¿ The environment was clean and a 'fogger' cleaning machine was used to complete deep cleans. Use of the machine meant areas that were difficult to clean by other techniques were sanitised.

People’s experience of using this service:

People told us they felt safe and happy living at St Bernard’s Residential Care Home. Staff understood people’s needs, how to keep them safe and their responsibilities for reporting any concerns.

People told us they enjoyed the food and that staff helped ensure they remained healthy and received their medicines correctly.

People had been involved in developing their care plans, but recently, due to short staffing, these had not all been kept up to date and fully completed. A new key worker system was being implemented to resolve this.

People had several options regarding how and where to spend their time. People’s views on planned activities were sought and a new staff team was taking responsibility for ensuring people had meaningful days based on their individual preferences.

People and staff confirmed staff were competent and well trained. People described staff as professional and valued the way staff protected their dignity. People were relaxed in the presence of staff and shared laughter and jokes, as well as hugs throughout the day.

The provider was keen to identify ways to improve the experience of people living in the service. They spent time researching different ideas that might benefit people. They shared their philosophy of ‘feelings based care’ with staff by encouraging them to take time to sit with people or to sit observing people. This helped staff see where improvements could be made to people’s day.

Some checks and audits were completed of the service, however these did not always look at the detail of records and had not identified the gaps we found during the inspection. We have made a recommendation about this. We also made a recommendation about recording people’s consent.

Rating at last inspection: Outstanding. 25 June 2016.

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

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

St Bernards Residential Care Home Limited provides care and accommodation for up to 43 older people. There were 39 people living at the home at the time of our inspection, of which a small number of people lived with dementia. The home had recently been extended and refurbished to further enhance the living environment for people, to include people who lived with dementia. The extension had been designed based on research and best practice from national and international exemplar services in order to ensure best practice principles.

The home was compliant with our regulations at the time of the last inspection in August 2014.

A registered manager was in post. 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.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life. The provider and staff team were passionate about providing high quality care tailored around people’s individual needs and preferences and spent time to understand the experiences of people who lived at the home.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia and ‘person-centred’ care, to ensure best practice based on recent evidence based research. There were processes to monitor the quality and safety of the service provided and actions were taken to drive continuous improvement for the benefit of the people who lived there. This was through regular communication with people, visitors and staff, surveys, checks on the staff team to make sure they worked in line with the provider’s policies and procedures and a programme of other checks and audits.

People and their relatives told us that staff were extremely kind, caring, thoughtful and compassionate, people were afforded privacy and treated with dignity and respect. They told us they believed this constituted outstanding care. People told us they had formed excellent relationships with the provider, staff team and other people who lived at the home, built on trust and respect.

The provider and staff team were passionate about ensuring people were involved in decisions about their care and how they led their lives. Staff took time to understand people’s life stories, so that people received support in the ways and at the times they preferred. Staff were creative in supporting people in ways that supported their individual needs. Should people lack capacity to make their own decisions, staff understood the principles of the Mental Capacity Act (MCA) and their advocates or families and other health professionals were involved in making decisions in their best interests. Staff obtained people’s consent before they provided care and support.

Staff with a range of skills were available at the times people needed them to receive support in all aspects of their lives. Staff had received training so that people’s specific care and support needs were met and we saw that this was put into practice. Staff told us the provider proactively ensured they had many opportunities to further develop their skills and knowledge. Staff told us they felt supported and valued by the provider and that they prided themselves on providing high quality care. They told us they were able to share their views and opinions about the service and any suggestions put forward were acted upon.

Staff understood their responsibility to safeguard people from harm and had a good understanding of who to report concerns to both within and outside of the home. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence. Staff had a good understanding of how to support people at these times.

People told us that staff encouraged them to remain as independent as possible and that they were supported to pursue their hobbies and interests. People were supported to maintain relationships with people important to them. Visitors were welcomed at the home and were encouraged to be actively involved in people’s lives.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. The provider and staff team worked closely with external healthcare professionals to ensure people’s health and wellbeing was promoted and maintained. Wherever possible staff supported people to retain responsibility for their own health. Medicines were managed so that people received their medicines as prescribed.

At St. Bernards, there were 32 people at home on the day of our inspection. We observed people during the day. We talked with the manager and the owners of the home. We looked in detail at the care records of four people. We visited on a weekday and we spoke with three relatives. We spoke with three people and three members of staff. One person told us, 'It is perfectly lovely here, the staff are very kind.'

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

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

Is the service safe?

Staff understood their role in safeguarding the people they supported. This meant people were kept safe. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse. The staff and manager had a good understanding of the safeguarding procedures.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which ensured people's rights and choices were protected.

We saw that risk assessments and health and safety measures were in place to keep people safe.

Is the service effective?

The service worked well with other agencies and services to make sure people received their care safely and effectively. A relative told us, 'Nothing is too much trouble for the managers.' We saw that people were treated with dignity and care. Care plans specified people's individual needs, for example, a person's mobility, or food requirements. One member of staff told us, 'I think we treat people beautifully, I'm supported to do my job.' All the people we spoke with told us they were satisfied with the care and support they received.

Is the service caring?

We saw the staff and manager were patient and gave encouragement when they supported people. All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with dignity and respect. A person told us, 'They are very kind. They do what I want and talk to me. I'm quite alright.' We observed people during the day and saw that people were treated kindly and affectionately. We saw that people looked comfortable and relaxed in their home.

Is the service responsive?

There were cooks and domestic staff to ensure good food was provided and the environment was clean. We saw clear and detailed recording that ensured the manager could make timely and informed decisions about a person's care and support. A relative told us, 'Staff are very understanding of individual needs. They tell me straight away if there's a problem and they are on the ball.'

Is the service well-led?

The manager was aware of their responsibilities in meeting the essential standards of quality and safety. We looked at quality assurance systems. There were systems in place to ensure the quality of the service was regularly assessed and monitored. There was a clear structure of supervision responsibilities within the staff team. Staff had regular training and learning opportunities. Staff we spoke with told us they thought the manager was approachable and provided good support. One member of staff told us, 'The manager is lovely. They know what it's like here and they help me to do my job.'

'It is a very homely and caring atmosphere.'

'Excellent. I think the carers are absolutely first class. They are always caring.'

Comments about staff included:

'Super ' they can't do enough for you."

'Tremendously helpful."

'Lovely, very caring, very nice."

Staff demonstrated a good understanding of people's needs and their individual likes and dislikes. We saw staff interacted with people in a kindly and reassuring manner. There were sufficient numbers of suitably qualified staff on duty to meet the needs of people. A visiting relative told us, 'The owner has got a good quantity and quality of staff. There is always a lot of staff.'

We saw people were provided with a range of suitable and nutritious food and regularly offered drinks through the day. There was a relaxed atmosphere at lunch time and people were not rushed.

We checked how the service managed the administration of medicine. We found some improvements were required to ensure people's safety.

People we spoke with told us that if they had to complain they would talk to senior staff. We saw any complaints had been dealt with appropriately.

We spoke to five people who use the service. All were highly complimentary of the provider and amongst comments they made were 'the staff are brilliant', 'it's always very friendly' and 'nothing is too much trouble.'

One person living at the home called back the staff member who served her dinner after she walked away from the table and said 'thank you, dinner is lovely'.

Other comments included: "They always ask me what I would prefer" "They are very kind and helpful" "It is lovely here" "The staff look after me very well" "They know what I like" "They are so kind to me" "Nothing is too much trouble for them" "I have no

complaints".

They told us they felt safe there. They said: "It's very secure here, I feel safe" "I know the staff look after me well" "I could talk to any of them if I had a problem".