Archived: St Helens

St Helens is a residential care home providing personal and nursing care for up to 28 older people, some of whom have mental health conditions or dementia. At the time of this inspection 18 people were using the service.

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

Robust quality assurance systems were not established or operated to monitor the quality and safety of the service provided. There was ineffective provider oversight and where concerns had been found, timely action had not been taken to address them.

The provider failed to follow their own improvement plan to ensure they were meeting regulations and providing safe care.

People were not always safe. The provider had not taken action to address maintenance, safety and infection prevention and control issues around the service. Risks to people were not always recognised or appropriately assessed. Medicines storage was inappropriate, and prescriber instructions had not always been followed.

Safe recruitment processes were not always operated. Staff had not received consistent support or had their competencies assessed to ensure they had the appropriate skills and knowledge to carry out their role.

Appropriate support had not always been provided to ensure people’s nutritional needs were being met. Monitoring documents had not been completed sufficiently.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Signed consent was not always in place. Where people lacked capacity appropriate capacity assessments had not been completed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 November 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the safety of the building, risk assessing and nutrition management as well as the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety of the service and risk assessing, nutrition, consent, safe recruitment and governance systems at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to ensure a manager registered with the Care Quality Commission was in post. This was a breach of regulation and we are dealing with this outside of the inspection process.

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

St Helens is a care home providing personal and nursing care for up to 28 older people who may be living with mental health needs or dementia. The service was supporting 18 people at the time of our inspection.

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

People remained at increased risk of malnutrition and dehydration. Effective systems were not in place to monitor and make sure people had enough to eat and drink.

Further improvements were needed to manage and minimise infection prevention and control risks associated with COVID-19, and to address risks within the home environment.

The provider was receiving intensive support from the local authority and other healthcare professionals, to make improvements. This included staff from the local authority and other key personnel, working alongside staff in the care home and carrying out welfare checks of people using the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was Inadequate (published 19 July 2021).

Why we inspected

We undertook this targeted inspection to follow up on concerns we received about the service, including information that people were not having enough to eat and drink.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

CQC did not follow-up the breaches of regulation identified at the last inspection during this visit. Full information about CQC’s ongoing regulatory response to the concerns about the care and support provided at St Helens is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Helens on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive further concerning information, we may inspect sooner.

Special Measures

The overall rating for the service has not changed following this targeted inspection and remains 'Inadequate'. This means the service remains in 'special measures'. We keep services in ‘special measures’ under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

St Helens is a residential care home providing personal and nursing care to older people some of whom are living with a dementia or mental health condition. The service can support up to 28 people in one adapted building. At the time of this inspection, 16 people were using the service.

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

The quality assurance processes in place were not robust to ensure all areas of the service were monitored. When concerns were identified, timely action had not always been taken to address the issues.

There had been some delays with safety checks of equipment due to COVID 19. Regular checks of areas such as water temperatures and fire equipment had not been completed. The manager took action to address this.

People felt safe. Safeguarding concerns had been reported appropriately and risks assessments were in place. Good infection prevention and control practices were in place. We have signposted the manager to appropriate guidance in relation to assessing risk around COVID 19.

A safe recruitment process was operated. Medicines were managed safely; staff had been trained and their competency regularly checked to make sure people received their prescribed medicines. Appropriate guidance was not always in place for medicines prescribed ‘as and when required.’ We have made a recommendation about medicine records.

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.

Improvements had been made to training provided to staff although COVID 19 had caused some delays. Staff told us they felt supported in their role.

People and staff spoke positively of the manager. The manager was passionate about ensuring people received the support they required. People were encouraged to provide feedback on the service provided.

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 requires improvement (published 20 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 5 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to effective quality assurance process and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were at increased risk of harm because the provider and registered manager had not done everything they should to assess and manage risks.

Records about people’s needs and in relation to accidents, incidents, mental capacity assessments and best interest decisions did not support staff and management to effectively manage risks.

Audits had not always been effective in monitoring the quality of the service and identifying where improvements were needed. Although the registered manager and provider were responsive to feedback and started to deal with concerns during the inspection this was reactive rather than proactive management.

CQC had not been notified of the outcomes of applications to deprive people of their liberty as legally required. It is important to send these notifications so that we can check appropriate actions had been taken. We are dealing with this matter further outside of the inspection process.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment and the governance of the service. Details of action we have asked the provider to take can be found at the end of this report.

Staff were kind and caring in the way they supported people. They were person-centred in their approach and showed genuine concern for people’s wellbeing. People’s personal care needs were met by attentive staff who listened to people and made sure they were comfortable and felt well cared for.

People responded positively to staff and enjoyed their company. Staff encouraged and supported people to take part in a range of activities.

There were effective systems in place to support staff to assess and meet people’s wishes and needs approaching the end of their life.

The environment was warm, welcoming, clean and free from malodours. Improvements were being made to ensure there were appropriate facilities to dispose of waste and clean equipment.

People had access to a varied and balance diet, which included regular drinks and snacks. Staff monitored people’s weights and worked with healthcare professionals to make sure people received medical attention when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were encouraged to make choices about their care. Staff were respectful in their approach, they explained what they were doing and listened to people. People felt confident speaking with staff or the registered manager if they wanted to complain.

Staff understood how to identify and respond to safeguarding concerns. Staff were safely recruited, and enough staff were deployed to meet people’s needs.

The registered manager was approachable and supportive of the staff team. They were responsive and keen to continue to improve the service in response to feedback.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: The service was rated Good (report published 7 September 2016).

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

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also 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.

The service is registered to provide nursing care for up to 28 older people who were living with dementia or had a mental health condition. On the day of the inspection there were 24 people living at the service. The service is situated on the south side of Scarborough, close to bus routes and shops. There is a small garden area where people can sit and the service is very close to public gardens. There is a passenger lift so people can access the upper floors of the premises.

There was a manager who was registered with the Care Quality Commission (CQC) employed at the service. 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at St Helens

People and their families told us that they were safe living at the service. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager, nursing and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. The staff worked within the principles of the Mental Capacity Act (MCA) and we saw that where it was necessary applications had been made for deprivation of liberty safeguards to be put in place.

Risk assessments identified any areas of concern in respect of people’s care and support needs, and there were management plans in place to reduce these risks and inform staff.

Staff received thorough induction training when they were new in post and told us that they were happy with the induction and on-going training provided for them. Training included fire safety, moving and handling people, dementia awareness, nutrition and health and safety.

We checked medication systems and saw that medicines were recorded, stored, administered and disposed of safely. Staff who had responsibility for the administration of medication had received appropriate training and people received their medicines safely.

People who lived at the service and their relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the service, visitors and staff. Visitors told us they were made welcome at the service and kept informed about their relative’s well-being.

Care plans recorded people’s individual needs and how these should be met by staff. Staff had a good understanding of people’s specific needs and how they wished to be supported.

We saw that people’s nutritional needs had been assessed and we observed that people’s individual food and drink requirements were met and that they were offered a choice.

The complaints procedure was available to people. No complaints had been received by the service. There were systems in place to seek feedback from people who lived at the home, relatives and staff.

There was an effective quality assurance system in place at the service. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety and well-being.

We considered our inspection findings to answer questions that we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

We observed that people were treated with respect and their dignity was respected. We observed staff asking people what they wanted to eat, drink and how they wanted to spend their time.

When concerns were raised staff followed an effective policy and procedure. We saw evidence of alerts that had been raised with the local authority. The service made appropriate notifications to the Care Quality Commission as required by law.

The manager was aware of the requirements of the Mental Capacity Act 2005 and associated deprivation of liberty safeguards(DOLS). They were aware of how to make a request to deprive someone of their liberty but none had been made. The manager was aware of the recent judgement in the Supreme Court March 2014 which gave guidance about who may be considered to be deprived of their liberty. They told us that they were going to speak with the local authority's DOLS officer to gain clarity on how to proceed following that judgement.

The service had maintained equipment to ensure people were safe. The service had been inspected by an Environmental Health Officer and was satisfactorily meeting Food Standard Agency standards in the kitchen.

Staffing levels were sufficient to meet the needs of the people who used the service and the service followed safe recruitment practices.

Is the service effective?

People's relatives told us that they were satisfied with the care provided to their family member and that their needs were been met. One person said"They are meeting my dad's needs here".

It was clear when we spoke with staff that they understood people's needs and preferences. The provider and manager had undertaken to complete a course which specifically looked at ways of working with people who had a dementia. They were sharing their knowledge with staff which meant that people who used the service benefited from staff who were up to date with current legislation, guidance and practice.

Is the service caring?

Staff demonstrated kindness and patience towards people. They responded quickly and politely when people wanted something. We observed that staff engaged with people throughout the day in a positive way. They smiled at people and chatted to them.

A visitor told us, "I used to come more often but I don't feel that I need to come as much as I'm confident about the care he gets".

Is the service responsive?

We could see during this visit that the service had responded when we had asked them to improve at an inspection in January 2014. We could see that there were activities going on throughout the day. One relative told us, "There is more going on here".

No complaints had been logged since the last inspection but there was a clear policy and procedure for the manager to follow if a complaint was received. People told us that they would know who to complain to if they had any concerns.

We looked at a person's file which showed a recent admission to hospital. The records showed that this was well planned with the persons family and the person had been supported well by the staff at this service.

Is the service well-led?

All the staff we spoke with had a good understanding of how the provider and manager wanted the service to change and improve particularly in relation to care of people with a dementia.

The service had a quality assurance system which was being improved to reflect emerging practice. The manager was aware of changes to the way in which CQC were developing inspections and recent judgements about deprivation of liberty safeguards. The manager was maintaining and developing their knowledge and practice and people who used the service and staff were benefiting from a change in practice and culture.

Overall people's physical health needs were well met but the service was not reflecting research evidence and guidance in relation to dementia care.

We could see when we looked at the care files that the service had exchanged information with other providers of care services that a person had needed to use.

The service had systems in place to prevent and monitor the risk of infection. We saw that the service followed the North Yorkshire and York Infection Control policy and guidance and that the service had a named infection control lead person.

However when we visited the kitchen we found that some areas were not clean.