Archived: St Bridget's Residential Home

St Bridget’s Residential Home is a residential care home providing personal care for up to ten people aged 65 and over. At the time of our inspection there were nine people using the service. Accommodation is provided over two floors of a converted house situated in a residential street.

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

People told us they felt safe and were happy. Relatives told us the staff were kind and caring. However, we found shortfalls that had placed people at risk of harm.

The service had not made many improvements since our last inspection where we found breaches of the regulations in relation to reporting incidents and risk to statutory agencies, making notifications to the care quality commission, record keeping of peoples’ care needs and governance. This had led to us finding ineffective systems and processes that had placed people at risk of harm.

The service had not appropriately identified risks to peoples’ health and safety and medicines were not managed safely. There were not sufficient staff to ensure peoples’ needs were met in the afternoons.

People had not had their needs robustly assessed before they were admitted into the building to ensure the service could meet their care needs. The adaptation and design of the building did not support people with disabilities and reasonable adjustments had not been made to ensure people could enter and exit easily.

People were not supported to have maximum choice and control of their lives; people were not supported in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans were not person centred and staff had not been provided with enough information to meet people’s individual care needs. This was identified at our previous inspection and no improvements had been made.

People had not been supported to take part in activities whether in a group or one to one that were socially or culturally relevant to them. This had been identified at our previous inspection and no improvements had been made.

There were no robust governance systems and processes in place to monitor and assess the quality of the service. This had led to shortfalls found in the inspection that had placed people at risk of harm. A lack of governance and oversight had been identified at our last inspection however no improvements had been made at the service.

People and relatives spoke positively about the staff and told us they were “kind and caring.” People said if they asked for something, for example a cup of tea, they didn’t have to ask twice.

Staff knew how to report signs of abuse and the registered manager had made appropriate safeguarding referrals; this had improved since our last inspection. We received positive feedback from one healthcare professional who told us staff listened to their instructions. People enjoyed the food.

People and relatives told us they found the registered manager approachable.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 August 2021).

At our last inspection we found breaches of the regulations in relation to reporting incidents and risk to statutory agencies, making notifications to the care quality commission, record keeping of people's care needs and governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve. At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We were prompted to carry out this inspection due to concerns we received about record keeping of people's care needs, medicine management, social engagement and governance. A decision was made for us to inspect and examine those risks.

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.

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 monitor the service and will take further action if needed.

We have found breaches in relation to keeping records to provide consistent and safe person-centred care, identifying and managing risks, providing support to people in a restrictive way, governance and having sufficient staff to meet people’s care needs.

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

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.

Follow up

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 will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

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

St Bridget’s Residential Home is a care home for older people providing personal care to six people aged 65 and over at the time of the inspection. The service can support up to 10 people. Accommodation is provided over two floors of a converted house situated in a residential street.

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

People were not always safeguarded as reportable incidents had not been shared with statutory agencies such as CQC and local authority safeguarding team.

Staff understood risks people lived with, such as skin pressure damage, and records showed they completed actions needed to reduce the risk of harm. Staff had been recruited safely and there were enough staff with the right skills to meet people’s assessed needs. People received their medicines from staff who had been trained in medicine administration, and had their competencies regularly checked. Infection, prevention and control practices were in line with government guidelines.

Staff knew people and their care needs well but care plans did not accurately record assessed needs and preferences and the actual care being provided. This placed people at risk of not receiving consistent person-centred care. A complaints policy was in place but had not been reviewed since September 2015. The registered manager updated the policy during our inspection.

Auditing processes had not been effective in highlighting shortfalls in meeting regulations. Legal requirements had not always been met as statutory notifications detailing incidents and risk had not been submitted to CQC. People, their families and staff spoke positively about the open, friendly culture of the service and felt communication with the home was good.

People were cared for by staff who had completed an induction and had on-going training and support that enabled them to carry out their roles effectively. 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. However, the policies and systems in the service did not always support this practice. People had their eating and drinking needs met. Working relationships with other professionals, such as district nurses, led to positive health outcomes for people.

People and their families described staff as kind and caring and told us they had their privacy and dignity respected. Staff understood the importance of supporting people to maintain as much independence as possible and involved them in decisions about their care.

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 8 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 reporting incidents and risk to statutory agencies, making notifications to the care quality commission, record keeping of people’s care needs and governance at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Bridget’s Residential Home is registered to provide accommodation and personal care for up to 10 people. 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.

At our previous inspection carried out in January 2018 we made three requirements for breaches of regulations. These were in relation to a failure to display the home’s CQC rating on their website, shortfalls and inconsistencies in the recruitment of staff and non-compliance with The Mental Capacity Act 2005 (MCA). Following the inspection, the registered manager submitted an action plan on how improvements would be made. At this inspection we found the requirements had been complied with.

The registered manager had worked at the service for many years. 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 protected from neglect and abuse. The registered manager had assessed risks both in respect of the environment and also the delivery of care to ensure that people were supported safely with the least possible restriction on their freedom. Staff had been trained in safeguarding of adults so that they were aware of safeguarding referral procedures and how to identify potential abuse.

Accidents, incidents or near misses were recorded and monitored for developing trends. Pre-employment check procedures had been reviewed so ensure that regulations would be met in terms of staff recruitment. No new staff had been recruited since the last inspection. There were sufficient appropriately trained staff on duty to support people in a person-centred way.

Medicines were managed safely ensuring that people had medicines as prescribed by their doctor.

The service had made improvements so that they were now compliant with The Mental Capacity Act 2005. People’s physical, mental health and social needs were comprehensively assessed, and care and support was planned and delivered in a personalised way to meet those needs. Staff were appropriately trained and received support and supervision from the registered manager.

The premises were clean and well maintained. Individual bedrooms were furnished according to people’s preferences.People were provided with a good standard of food and their dietary needs had been assessed.

People, and where appropriate their families, were involved in decisions about their care and support. People were treated with kindness, respect and compassion, and their privacy and dignity was upheld. Relatives and friends could visit when they wished without notice.

Care plans had been developed for each person providing guidance to staff on how to meet their personalised needs. People had access to activities and encouraged to follow interests and hobbies. There was a well-publicised complaints procedure in place and a log of any complaints to evidence how complaints had been managed.

People were supported with their health care needs.

The home had a registered manager who had worked at the home for a long period, providing good leadership. A system of audits and surveying of views of the service was in place that sought to drive improvements and customer satisfaction. The provider had updated their website to display the CQC rating, meeting a requirement from the last inspection.

This unannounced comprehensive inspection took place on 3,4 and 5 January 2018.

St Bridget’s Residential Home is in Bournemouth and can accommodate up to ten older people. At the time of the inspection eight people were living at the home.

The home had a registered manager 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.’

At this inspection we found three breaches of the regulations.

The provider had an established system for ensuring people were recruited to work in the service safely. However, the system had not always been followed. Staff recruitment records did not always include a full employment history and some recruitment checks and employment references were inconsistent. This was a breach of the regulations.

People’s rights were not always protected because staff had not acted in accordance with the Mental Capacity Act 2005 (MCA) in regard to and following conditions placed on their Deprivation of Liberty Safeguard. This was a breach of the regulations.

The provider had not displayed their current Care Quality Commission rating on their website. This was a breach of the regulations.

People felt they were safe and there were systems in place to safeguard people. Staff had completed training in safeguarding people and spoke knowledgeable about how to raise concerns if they suspected people were being abused.

People told us they enjoyed living at St Bridget’s Residential Home and said the staff treated them with kindness and warmth. Relatives were very happy with the care and service provided by the home. Staff knew people well and cared for them in the way they preferred.

Risks to people and the service were managed and planned for. People’s medicines were stored safely and administered as prescribed.

There were enough appropriately trained staff available on each shift to ensure people were cared for safely. Staff received appropriate training which was refreshed at regular intervals. Staff told us they felt well supported by the management team.

People’s needs were assessed and planned for. People had good access to healthcare and staff referred people appropriately to health care professionals. Health professionals supplied positive written feedback on the service people received at St Bridget’s Residential Home.

People told us they knew how to make a complaint and said staff listened to them and took action if they needed to raise concerns or queries. Records showed complaints were investigated in accordance with the provider’s complaint policy.

People were provided with a choice of healthy home cooked food and drink that ensured their nutritional needs were met.

People, relatives and staff told us they felt the service was well led, with a clear management structure in place. There were governance systems in place to assess and improve the quality and safety of the service. However, the systems in place were not fully effective as they had not identified the shortfalls and breaches of regulation found at this inspection.

Everyone we spoke with was complimentary about the home's staff. They told us that the staff ensured their privacy and dignity was promoted. They described the the staff as 'very helpful', 'kind', and 'fantastic'.

People said they were involved in making decisions about the care and treatment they received. They told us there were no rules and regulation that constrained their day to day lives.

People said the food the home provided was good, varied and plentiful. They told us they thought there were always enough staff on duty and they were all trained and competent to meet their needs.

There were measures in place to prevent and control infections.

There were arrangements in place that ensured people's prescribed medication was managed safely and securely.

The provider ensured that equipment required to promote the welfare of people living in the home was serviced in accordance with relevant regulations and safe to use.

We saw that checks were carried out that ensured the provider's procedures were followed. There were also systems in place to identify where the quality of the service could be improved.

People's needs and wishes had been assessed and plans had been put in place to meet them. We found that people who were at risk of falls had been identified and their moving and handling care plans had included the measures to be taken to minimise the risk.

Records showed that staff had received the training and support they required to be able to provide the care and support people required. We saw that records showed that staff had received regular supervision and annual appraisals. Staff we spoke to confirmed this.

We observed that prescribed medication stored in people's rooms could be easily accessed as the keys were 'hidden' on top of the lockable metal cabinets. We also found that when a person did not accept medication as prescribed staff had not fully discussed the implications with them, or informed the doctor.

We found that the home had conducted an annual satisfaction survey in July 2012. The manager had analysed the results and had addressed the points which had been raised.