St Mary’s is a residential care home providing personal and nursing care for 56 people aged 65 and over at the time of the inspection. The care home can accommodate up to 74 people on three separate units, namely St Mary’s, St Alexius and St Joseph’s, each of which has separate adapted facilities and communal areas. Two of the units specialise in providing care to people living with dementia. There are additional kitchen and laundry facilities in the home, a small church and surrounding garden space outside.
People’s experience of using this service and what we found
At this inspection we found improvements were still required in areas such as infection prevention and control and with the home’s auditing and quality monitoring processes. The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection. A previous manager had left the service shortly before this inspection; they had not been registered with the CQC. Management and oversight was being provided by a clinical lead, supported by a member of senior management. We identified two regulatory breaches and have made a recommendation regarding the premises. We identified improvements had been made in the management of medicines.
People were not always protected against the risk of infection. Policies and procedures in place were not always adhered to by staff and housekeeping staff were not always effectively deployed.
People’s needs were met safely with appropriate staffing levels; previously furloughed staff had returned to work and the use of agency staff was minimal. People were supported by staff who understood how to identify and report potential abuse. Checks were carried out on new staff to ensure they were suitable to work in the home. Handovers ensured information was communicated to all staff to ensure people received safe support however, one person had some clinical information missing from the handover record. We made the nurse and manager aware of this.
The concerns we identified at the last inspection in relation to medicines had been addressed. The provider was investigating concerns raised about medicines at the time of this inspection and had taken appropriate action. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.
There was evidence of monitoring and review of care. We identified some recording issues and brought these to the manager’s attention. There had been some improvements made to the building since our last inspection, however further work was needed.
Contact with health professionals had been maintained during the COVID-19 pandemic; some guidance and advice had been received over the telephone. People’s specific dietary needs were communicated to staff employed in the kitchen, who were aware of recommendations made by health professionals. The manager was aware of their responsibilities in respect of consent and involving people as much as possible in day-to-day decisions.
Systems and processes to monitor the quality of the service had been introduced recently by the manager but these were in their infancy. Support for the manager was available from nurses and unit leaders and the Deputy Lead of Nursing was based in the home during the week to offer help and guidance.
Relatives we spoke with told us communication during the pandemic had not been consistent. The manager outlined how the service planned to improve how it engaged with people, relatives and staff. Plans were in place to improve the meal time experience for people and a ‘resident of the day’ audit had been adopted to ensure regular reviews of people’s care and experiences.
The provider needs to build on the progress made, ensuring this is fully embedded into practice and also make the required improvements identified in this report.
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 8 August 2019) and there were multiple breaches of regulation. 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 and complaints in relation to the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
After the inspection our findings identified a specific incident. This incident is potentially subject to a criminal investigation. Our enquiries are on-going and therefore this inspection does not examine the circumstances of the incident.
We carried out an unannounced comprehensive inspection of this service on 26 and 27 June 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 safe care and treatment and good governance.
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 of Safe, Effective and Well led which contain those requirements.
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 coronavirus and other infection outbreaks effectively. We were not assured that the provider was effectively managing infection prevention and control and brought this to the manager’s attention. Following the inspection, the manager was able to demonstrate the actions taken to mitigate the risks.
Please see the safe sections of this full report.
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 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 remains requires improvement. 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 Mary’s Nursing Home on our website at www.cqc.org.uk.
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 infection prevention and control and management of the service at this inspection.