St Fillans Care Home

Updated 8 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 Fillans is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Fillans is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post. A new manager had been recruited and was in the process of applying to CQC to be the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed the care provided to help us understand the experience of people who could not talk with us. We spoke with three people who used the service, and 10 relatives about their experience of the care provided. We spoke with 17 members of staff including the manager, three nurses, three team leaders, four care staff, two house keepers, the cook, activities person. We also spoke with three agency care staff employed to provide one to one support to designated people who use the service.

We also spoke with the regional quality and development manager and the nominated individual responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records including nine people's care and medicines records. We looked at three staff files and one agency profile in relation to recruitment and a variety of records relating to the management of the service.

Updated 8 November 2022

About the service

St Fillans is a residential care home providing personal and nursing care up to 71 people. The service accommodates people across four separate units, each of which has separate adapted facilities. At the time of our inspection there were 65 people using the service.

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

Our visits on 21 and 22 September 2022 found poor infection prevention and control (IP&C) practices relating to the wearing, storage and disposal of personal protective equipment (PPE). The cleanliness of the premises and equipment needed to improve, including the main and satellite kitchens. We wrote to the provider on 23 September 2022 to request an update on the action taken to address the infection control and cleanliness issues identified.

The provider took immediate action to purchase additional clinical bins, provide plastic wipeable boxes to contain PPE, and confirmed a full programme of cleaning had been completed, including a deep clean of kitchens. Guidance was provided to staff, and spot checks were being carried out to ensure the correct use of PPE, including wearing of masks. Our follow up visit on 30 September 2022 confirmed the above action had been taken to prevent the spread of infection and ensure the premises were clean.

Although the provider had taken immediate action to address the issues above, the governance systems were not always being used effectively to identify and drive the required improvements. The IP&C audit had not identified the issues we found during the inspection. The dementia audit had not identified the issues we found, relating to the complex care unit, Charter. There was no clear direction for staff, and minimal attempts to divert people’s behaviours using meaningful activities.

People’s care records contained conflicting information which exposed them to the risk of not receiving safe care. Behaviour support plans did not provide sufficient guidance for staff on how to support people to manage times of distress and anxieties.

The service was divided in to four units, St Johns, Castle, Dutch and Charter. Dutch and Charter on the first floor were not decorated consistent with the standard in St Johns and Castle on the ground floor, especially Charter the complex care unit. The environment in Charter did not always promote people’s quality of life and help them live well with their dementia.

We have made a recommendation about improving the environment for people living with dementia.

People were not always supported to have choice and control of their lives. People’s mealtime experience differed depending on which unit they resided. On Dutch and Castle units’ people were supported to choose when, where and what they wanted to eat. In St Johns and Charter people were not always offered a choice of meal or drinks. Staff were observed assisting people to eat from a standing position and getting up and down during mealtimes doing other tasks. This did not make the mealtime a sociable experience.

We have made a recommendation about staff training on the subject of dementia and improving people’s mealtime experience.

People, relatives and staff told us the frequent changes of managers had been unsettling and disruptive but were positive about the new management team. They told us communication and staff morale had improved. Managers and staff worked well with health professionals and other networks, such as Essex FaNs who had supported people to engage in personalised activities.

The service reviewed staffing levels regularly and had recruited new staff, reducing the need to use temporary agency staff. People had good access to healthcare and their medicines were managed safely. Systems were in place to safeguard people from the risk of abuse. Where things had gone wrong, investigations had been used as an opportunity to learn lessons, change practice and drive improvement.

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 04 April 2018).

Why we inspected

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.

The inspection was prompted in part due to a number of concerns raised about management of the service about poor standards of care, lack of behaviour support plans, lack of staff training and the environment. A decision was made for us to inspect and examine those risks. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good 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 continue to monitor information we receive about the service, which will help inform when we next inspect.