Archived: St Mary's Nursing Home

Updated 25 October 2016

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

This first day of this inspection was unannounced. The inspection took place on 12, 15 and 21 July 2016. On the 12 July the inspection team included one inspector, one specialist professional nursing advisor and one expert by experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of service. On the 15 July the inspection team included two inspectors. On the 21 July the inspection team included one inspector and one specialist professional nursing advisor.

As part of this inspection we reviewed relevant information, including notifications sent to us by the provider. Notifications are changes, events or incidents that providers must tell us about. The provider also completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with the local authority and health commissioning teams. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority or by a health clinical commissioning group.

We spoke with six people who used the service and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk to us. We spoke with seven relatives of people who used the service. We spoke with 13 members of staff, including care staff, domestic staff and the registered manager.

We reviewed six people’s care records. We reviewed other records relating to the care people received. This included some of the provider’s audits on the quality and safety of people’s care, staff training, recruitment records, medicines administration records and minutes of internal meetings.

Updated 25 October 2016

This inspection took place on 12, 15 and 21 July 2016. The first day was unannounced.

St Mary’s Nursing Home is required to have a registered manager and a registered manager was in place. 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 service is registered to provide accommodation and nursing care for up to 35 older people, however the service operates to take up to 32 people. On the first day of our inspection 31 people were using the service.

Risk assessments and care plans were not always in place to ensure people received safe care. Where care plans and risk assessments were in place, they were not always up to date or accurate and not all risks to people’s health and safety were identified and reduced. People had access to healthcare services, however people sometimes experienced delays to receiving their treatment.

Staffing arrangements had not been calculated based on meeting the needs of people using the service. Staff were not always deployed in a way so that people received timely support. Staff recruitment practices had not recorded how gaps in staff employment histories had been considered satisfactory.

The proper and safe management of medicines were not followed and therefore risks associated with medicines were not reduced. Records did not support that people received their medicines as prescribed.

Staff training records did not always identify which staff required refresher training in certain areas. Records did not demonstrate staff had or were completing training expected of them by the provider. Not all staff received supervision on an individual basis.

The principles of the Mental Capacity Act 2005 (MCA) were not fully understood and embedded in the service, nor had the principles of the MCA been followed for people’s decision making. The service did not assess people effectively for Deprivation of Liberty Safeguards (DoLS) applications.

People felt listened to however we found people were not always invited to contribute to improvements at the service. Staff interactions with people were mixed. We saw some staff always spoke with people as they walked past, however other staff gave no greeting or acknowledgement to people seated in the main hallway.

Audits and systems designed to check on the quality and safety of services people received were not always effective at identifying shortfalls in the quality and safety of services. Records were not complete, accurate, stored securely or completed at the time care was provided. In addition, the provider had not fulfilled its responsibilities to send statutory notifications about events that they are required to tell us about.

Where people had expressed a preference for a female carer this had not always been respected. People were not always given support when they raised issues of concern. People had opportunities to take part in activities organised by the activities coordinator or to spend time in their own rooms as they chose.

Not all people had the support to eat in a stimulating dining environment and some people fell asleep without eating their meals when they were hot. People’s views on the quality of food were mixed with some people commenting on food being cold when it arrived. People’s choices for food and drink were respected. Menu options offered a healthy and balanced diet, however not all people ate their meals.

The registered manager was supported by a Deputy manager and a supportive staff team.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.