About the service St Martin’s Care Home is a residential care home providing personal care and accommodation to 15 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one house and is situated in a residential area. Some people living at St Martin’s Care Home were living with dementia and others had high dependency needs due to reduced mobility.
People’s experience of using this service and what we found
People did not always feel there were enough staff working at St Martins Care Home Ltd. Staffing levels in the evening meant people were left unsupervised or supervised by visitors to the home whilst staff attended to other people’s needs. Daily checks of the premises and oversight of the building’s maintenance to ensure its safety were not routinely carried out, which exposed people to unnecessary risk. There were missed opportunities to interact and staffing levels meant care workers did not always have time to spend with people engaged in meaningful activity or conversation. Although staff could tell us how to respect people’s dignity and privacy, care practices did not always support this.
Referrals to healthcare agencies to improve people’s outcomes was inconsistent. People were referred to some health professionals including district nurses, their G.P, and speech and language therapists. However, the provider had not always referred people for assessments following declines in their mobility which meant them needing to be cared for in bed. There were not enough activities for people to help stimulate, engage and minimise isolation. Activities were not planned in partnership with people to make them responsive to people’s enjoyment.
Systems to monitor and improve the safety and quality of the service were not effective. Tools were used to calculate staffing numbers, but lack of oversight meant staffing levels did not always safely meet the needs of people. Maintenance of the building and its safety was not monitored effectively which meant people were exposed to unnecessary risks. There was no system to safely store people’s confidential information. Audits were carried out but not always recorded and failed to identify the issues discovered during the inspection.
People felt safe living at St Martins Care Home Ltd, and risks to people’s health were assessed with risk management plans for staff to follow. Accidents and incidents were recorded and monitored by management to learn from them. Staff were confident reporting safeguarding concerns and contact information for reporting concerns was located on people’s bedroom doors. Medicines were administered and stored safely.
Staff had access to online training relevant to their roles and some had completed vocational qualifications in health and social care. People were supported by regular care workers who knew them, because staff had worked at St Martins Care Home Ltd for a long time. People enjoyed the food and were given options and choices. Staff understood people’s needs relating to their eating and drinking and provided appropriate support and encouragement for those who needed it. Overall, 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. However, staff did not always respond to the needs of one person living with dementia in a positive way. This person liked to explore their environment but was sometimes told to sit down rather than being encouraged to interact or engage. However, people said staff were kind and caring and the atmosphere at St Martins Care Home Ltd was homely and friendly. There were friendly and warm interactions between staff and people.
Staff were fully engaged in a game of ‘bingo’ and supported people to take part. Internet access was installed throughout the home so people could maintain contact with others through social media or video calls. The internal decoration had been improved in response to feedback, but further improvement was needed to address the quality and maintenance of people’s environment and make it more conducive to the needs of people living with dementia. Care plans were personalised and included guidance for staff to support people who experienced distress. Complaints were responded to promptly and in writing.
Staff described the registered manager as approachable and supportive and were confident sharing their concerns if they needed to. Meetings for people who used the service and annual questionnaires were used to encourage views and opinions. However, improvements were needed to promote and value people’s engagement in these. The provider had plans to improve the garden and internal decoration.
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 17 January 2019) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of Regulation 12. However, enough improvement had not been made in relation to Regulation 17 and the provider remained in breach of this regulation.
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 Safe 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. The provider has taken some immediate action to mitigate the risks relating to staffing and introduced daily checks of the premises to ensure its safety. Gas and electrical inspections were also completed immediately following our inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins Care Home Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe staffing levels and their knowledge of fire safety and evacuation, and management systems which oversee the quality and safety of the service at this inspection.
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
We will request an action plan for 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.