St Mary's Nursing Home

Updated 1 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors 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.

Service and service type

St Mary’s Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 23 August 2022 and ended on 3 October 2022. We visited the home on 23 August 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We received feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with twelve people who used the service and four relatives about their experience of the care provided. We spoke with fourteen members of staff including the registered manager, care coordinator, administrator, nurses, senior care workers, care workers, ancillary staff and the nominated individual, The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included five people’s care records, medication records and weight records. We looked at staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service.

Updated 1 November 2022

About the service

St Mary’s Nursing Home is a care home providing personal care and nursing. It can accommodate up to 56 people. Some people using the service were living with dementia. There were 42 people using the service at the time of the inspection.

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

Risks to people were identified, however these were not always effectively managed to ensure people’s needs were met and safety maintained. For example, people’s nutrition needs were identified, but fortified snacks and fluids were not always recorded, and people were not always given their preferred choice of drink. Infection prevention and control (IPC) practices and policies were not always followed. We found many areas that were not clean and areas that were not well-maintained to be able to be effectively cleaned. We have made a recommendation about IPC to ensure the improvements made following our site visit are maintained and sustained.

People were not supported to have maximum choice and control of their lives. The policies and systems in the service did not support this practice. We found most people were cared for in bed, and this was not always the persons choice. Staff told us there was not always enough staff on duty to ensure people could get up safely because many people required two staff to move and handle them safely. The registered manager showed us a dependency tool, but it was not clear how the hours were calculated to ensure adequate staff were on duty to meet people’s needs. We observed call bells ringing for long periods of time and a lack of staff available in communal areas. People told us staff were caring and kind. However, we observed staff did not always support people appropriately; their approach was not always person-centred and at times was task orientated.

Staff told us they did not feel supported. Staff said there was lack of effective communication from management. Systems and processes used to ensure the service was running safely were not robust or effective. Parts of the premises were not being used for their intended purpose. Environmental alterations were taking place, there was no evidence received from the provider these alterations were compliant with fire safety or building control regulations. During our inspection we identified many shortfalls had not been identified as part of the providers quality monitoring. For example, IPC practices, person centred care, staff deployment and safe working practices.

Feedback from people varied, there were some very positive comments about staff along with some negative feedback. Some people said communication was poor. One person said, “I speak with [registered manager] who is very nice by the way, about it but I don’t think she listens.”

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 requires improvement (Published 20 August 2020).

The service remains rated requires improvement. Although there were some improvements at the last inspection, the overall rating for this service has been requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This was a planned focused inspection.

We undertook this focused inspection to check they had continued to maintain improvements. This report only covers our findings in relation to the key questions safe and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

We have found evidence the provider needs to make improvement. 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 Mary’s Nursing Home on our website at www.cqc.org.uk.

Enforcement and recommendations

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 safe care and treatment, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about infection prevention and control.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.