St Faith's Nursing Home

Updated 25 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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and an Expert 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. In this case caring for older people.

Service and service type

St Faith’s Nursing Home 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.

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 before the inspection

We reviewed information we held about the service since the last inspection. This included information of significance reported to us by the provider, such as, a death, allegation of abuse, an incident involving the police, serious injury to people and any other event which prevented the service from delivering services to people. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We sought feedback from commissioners of services.

We used all this information to plan our inspection.

During the inspection

We spoke with nine people who used the service and two relatives about their experience of the care provided. We spoke with eleven staff which included the nominated individual, the registered manager, two deputy managers, two nurses, two care assistants, an agency care assistant, one member of staff who supports people with eating and drinking, the activities co-ordinator and the maintenance person.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included six people’s care files which included care plans and risk assessments and six people’s medicine administration records (from different units across the home). We reviewed four staff recruitment records. We also reviewed records relating to the management of the home. This included a selection of audits, complaints records and the maintenance records.

After the inspection

We continued to seek information from the provider in line with evidence reviewed and gathered during the inspection. The provider forwarded information to us about what they had put into place to address the shortfalls identified in monitoring medicines. This included a copy of the provider’s amended medicines policy and procedures.

Updated 25 September 2019

About the service

St Faith’s Nursing Home is a residential care home which can provide personal and nursing care to 69 people aged 65 and over. At the time of the inspection 59 people lived in the home.

People are accommodated in one adapted building. Each person is provided with their own private bedroom with toilet and washing facilities. Additional toilets and bathrooms are available and are adapted to accommodate people’s needs. A choice of communal areas provides additional places to sit, eat and take part in social activities. There is easy access to a garden with adaptions to the home’s entrances to accommodate wheelchairs. Car parking is on site.

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

The process for monitoring the administration of people’s medicines had not been effective enough to identify that two people, had not been receiving some of their medicines as prescribed. A delay in senior managers being aware of this meant action was not taken in a timely way to review this and ensure, these people, were protected against the potential risks associated with not receiving medicines as prescribed. A process for identifying gaps in staff signatures, on people’s medicine administration records (MARs), was in place. However, this was not leading to effective action being taken, in a timely manner, to follow these recording errors up and to ascertain if people had received their medicines or not. No harm had come to people, but these processes were not robust enough to protect people from, potential risks, associated with not receiving their medicines as prescribed.

During the inspection and after, immediate action was taken to ensure these two people’s medicines management was reviewed. Action was also taken to improve the monitoring of people’s medicines administration and the action taken when recording errors were identified. It was too early for us to make a judgement about whether the action taken would be effective in reducing risks to people.

The provider’s quality monitoring processes, for monitoring other areas of the service and making improvements where needed was working well. In all other ways the service was being well managed. People told us they would recommend the service to others. A senior management structure was in place providing consistent leadership for staff who were being supported to work in such a way which resulted in good outcomes for people. There were effective communication processes in place to ensure people, their relatives and staff felt well informed of any changes to the service.

An open and transparent culture had been developed where staff were confident to challenge poor practice and people and their relatives felt able to report any concerns they may have. Staff felt well supported and valued by both the registered manager and provider. They told us they felt proud to work at St Faith’s Nursing Home. People considered the home to be well-led and they confirmed senior managers were visible and approachable. Managers engaged with people and their relatives to seek their views on the services provided to them. They were keen to learn from areas of dissatisfaction or when things did not go to plan.

Other medicines had been administered to people as prescribed. Medicines were received into the home in time for administration and they were stored according to pharmaceutical guidelines. Risks to people’s health and potential environmental risks were identified, assessed and managed to reduce or mitigate risks altogether. People lived in a clean home where arrangements were in place to prevent and control infection. There were processes in place to learn from errors and near misses, so staff practice, and the service people received could continually improve.

People told us they were well looked after, and they had confidence in the staff to meet their needs. Staff received training and support to be able to meet people’s needs safely and lawfully. People told us they received plenty of food and drink and had a choice in what they ate and drank. People’s nutritional health was supported, and any associated risks to this assessed and managed.

People confirmed they had access to healthcare professionals who helped them maintain their health. Staff worked with commissioners of adult social care and acute health care to ensure people could access support when they needed it. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive was possible and in their best interests. The policies and systems in the service supported this practice.

People told us staff were kind, caring and supportive. Care was delivered in a way which maintained people’s dignity and privacy. People told us staff explained things to them in a way they could understand. Staff supported people to maintain their independence and, where possible, to retain skills they already had. Those who mattered to people, family, representatives and friends were made welcome and could speak on behalf of people where needed. There were no restrictions on visiting.

People’s care was planned and designed around their needs and personal preferences. People or their representatives were included in this planning and in the review of their care. Care was reviewed and altered to accommodate changes in health, abilities and risks. People told us they were treated as individuals and their care was personalised.

People had access to social activities and supported to take part in activities which suited their abilities and preferences. There were arrangements in place for people, their representatives and others to raise a complaint and for this to be investigated and addressed. People’s end of life wishes were explored with them, or their representatives, and they were supported to have a dignified and comfortable death.

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

Rating at last inspection

The last rating for this service was Good (published 17 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the ‘Is the service well-led?’ section of this full report. Effective action was taken during the inspection to reduce and mitigate potential risks to people.

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

Follow up

We will discuss with the provider their progress on the improvements they made during and after the inspection, about the monitoring of people’s medicines administration, to ensure this action leads to the service improving their rating in well-led to at least Good. We will continue to monitor information we receive about the service. We will return to visit the service as per our re-inspection programme. If we receive any concerning information we may inspect sooner.