St Anthony

Updated 4 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 home, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 30 and 31 January 2018 and was unannounced. The inspection was carried out by one inspector 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.

Before the inspection we checked the information that we held about the service and the provider. The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the home, what the service does well and improvements they plan to make. This included previous inspection ratings and statutory notifications sent to us by the registered manager that tell us about incidents and events that had occurred at the home. A notification is information about important events the service is required to send to us by law. We used all this information to decide which areas to focus on during our inspection.

During the inspection we observed care and support in the communal spaces and people’s rooms. We read five people's care records and three medicine administration records. We care pathway tracked people living at the service. This was so we could look at people’s care planning in depth and match this with their experiences and our observations. We also read other records which related to the management of the service such as staff files, training records, policies and procedures and quality assurance information. We spoke with eight people who use the service, four care staff, the acting manager, the director of operations, the head of care and the head of another service who was supporting the acting manager and observed how people were supported during the day and with their meals. We also spoke with three relatives, one adult social care professional and a music therapist so that we could further understand their experiences and those of people who could not talk with us. We have included their feedback in the main body of the report.

The last inspection of the home was 23 February 2017 where we found a breach of the Health and Social Care Act 2008 (Regulated activities) 2014. The service remained rated as ‘Good’ overall and rated Requires Improvement for the ‘safe’ domain.

Updated 4 July 2018

The inspection took place on 30 and 31 January 2018, the first day was unannounced.

St Anthony’s 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. The care home can provide accommodation and personal care for 29 people in one adapted building. The service is accommodated over three floors and arranged into three flats, ‘Beacon View’ accommodated six people; ‘Forest View’ accommodated six people and ‘Tree Tops’ accommodated five people. the service also had single studio rooms and flats which people lived in. There were 25 people using the service at the time of the inspection. The service provides support for people who have a learning disability living with some with mobility and sensory needs.

St Anthony’s was designed, built and registered before the Care Quality Commission (CQC) ‘Registering the Right Support’ policy and other best practice guidance was published. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and other complex needs using the service can live as ordinary a life as any citizen.

The service did not have a registered manager at the time of inspection, but a manager has subsequently been registered. An acting manager was appointed in July 2017 and had begun the process of registering with the Care Quality Commission (CQC) at the time of the 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.

At the last focussed inspection on the 23 February 2017, the service was rated Good overall and was rated Requires Improvement in the ‘safe’ domain. A breach of legal requirements was found. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet legal requirements in relation to a new breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulation 2014, Safe care and treatment. They provided an action plan on 28 April 2017 detailing what they would do and by when to meet the breach. We undertook a comprehensive inspection on 30 and 31 January 2018 to check whether the required action had been taken, improvements made and the breaches met. We found that they had. The overall rating for St Anthony’s remains Good. This report discusses our findings in relation to this.

Risks to people had been assessed and there was clear guidance for staff in how to support people. Care plans and risk assessments were comprehensive and provided detailed guidance for staff in how to support people with their needs including; moving and handling, skin integrity, bathing, nutrition and choking. Staff received the training they needed to support people and worked closely with healthcare professionals completing assessments relating to the risks that were managed.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar incidents occurring. Risks associated with the environment and emergencies including fire and infection control were identified and managed. People were supported to have their medicine safely when they needed it. The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to maintain good health and had access to health care services.

People and relatives told us they felt the service was safe. One relative told us, “My relative has been here a long time, we have no concerns about their safety, and it gives us peace of mind.” People were protected from the risk of abuse because staff understood how to identify and report it to their managers and the appropriate authority. Staff had completed training and demonstrated they understood the different types of abuse people may experience such as physical and financial abuse. Staff understood the importance of protecting people who were at risk of discrimination and were confident any concerns they raised with the provider would be acted on.

People, relatives and staff told us there were suitable levels of skilled staff available to meet people’s needs safely. Staff received an induction and training to ensure they understood how to support people living with complex needs and behaviours that could put them or others at risk. Staff told us they felt well supported through supervision, appraisal and training and could demonstrate how to work with people’s complexity of need. Staff received suitable specialist training including; Parkinson’s awareness, epilepsy, medicines, Mental Capacity Act 2005 (MCA) and positive behaviour support. The provider ensured that when new staff were employed, safe recruitment practices were followed to ensure they were suitable to work with people.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions had been assessed. People were supported to make choices and take decisions where they could. Staff supported people in the least restrictive way and when required they had access to advocacy services.

People were encouraged and supported to eat and drink well. One person told us, “The food is awesome. If I don’t like what’s on the menu, they will bring me something else, and the cook will ask me what I want before he cooks it.” Special dietary requirements were met. People’s weight was monitored with their permission if, for example, they were at risk of weight loss.

Staff were caring and respectful. One person told us, “Yes staff are caring they are there when I need to talk to someone.” Care and support provided was personalised and met people’s diverse needs. People and their relatives were included in the assessments of their needs and development of care plans.

People’s difference, individuality and preferences were respected. People were encouraged to be as independent as possible and had access to meaningful leisure, vocational and community and service based activities that reflected their interests and abilities.

Quality assurance audits completed by the provider were embedded to ensure good levels of quality was maintained. The provider was committed to improving the service through external audits, satisfaction surveys and was active in local forums for providers.