Archived: St Anne's Residential Home

Updated 12 August 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We visited the home unannounced on 8 July 2015 and 9 July 2015. The inspection team consisted of three adult social care inspectors, a pharmacy inspector and an expert by experience – this is a person who has personal experience of using or caring for someone who uses this type of service.

During our inspection, we spoke with sixteen people living at the home, six relatives, eight members of care staff, the chef, and the receptionist. We spoke with the registered manager, the registered provider and a district nurse. We carried out a Short Observational Framework Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed how people spent their morning in the main lounge and watched how staff interacted with people during this time.

We observed care and support in communal areas, spoke with people in private and looked at nine care plans and associated care documentation. We also looked at records that related to medicines as well as documentation relating to the management of the service. We looked at policies and procedures, staffing rotas, the accident book, six staff recruitment and training files and quality assurance and monitoring paperwork.

Before our inspection we reviewed the information we held about the home and spoke with the local authority. We reviewed notifications of incidents that the provider had sent us since the last inspection and previous inspection reports. A notification is information about important events, which the service is required to send us by law. After the inspection we contacted the local authority service improvement team. We also contacted six health and social care professionals who supported people who lived at St Anne’s Residential Home to obtain their views. We spoke with two district nurses, and contacted a psychiatric nurse, and three GPs.

Updated 12 August 2015

This was an unannounced inspection on 8 July 2015 and 9 July 2015. St Anne’s Residential Home provides accommodation for up to 36 older people who require support in their later life or are living with dementia.

There were 25 people living at the home at the time of our inspection.

The home is on two floors, with access to the upper floors via a passenger lift, chair lifts, or wheel chair lift. All bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets. Communal areas include four sitting areas, a conservatory and a dining room. The home is in a rural location, with country views and outside courtyard space.

After our last inspection in March 2015 we took enforcement action. We told the provider to take action to make improvements to how risks to people’s care was managed and reviewed, how people’s consent to their care was obtained, and how people’s care plans were reviewed and updated. We also told the provider to take action in relation to how people’s medicines were managed, to address the dignity and respect of people and review staffing numbers. The provider was also asked to make improvements to how the quality of the service was monitored.

The provider sent us an action plan on 8 June 2015 and confirmed on 25 June 2015 all the improvements had been made. During this inspection we looked to see if these improvements had been made. We found some improvements had been made, however further action was required.

People told us staff were kind and caring. People told us there were sufficient numbers of staff to meet their needs and we found staff had time to speak with people. People had call bells which they could use to ask for assistance. However, people told us their call bell was not always answered quickly which meant they could be waiting for a long time for assistance. Staff told us the position of the call bell system meant they may not always hear the call bell ringing which caused delay.

There was a clear management structure in place and staff received training and supervision to carry out their role. However, some staff had not completed the required training to ensure they had the skills and knowledge to effectively care for and support people. Staff told us they felt supported by the registered manager. Staff, were able to explain what action they would take if they suspected abuse was taking place. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people. People told us, if they had any concerns or complaints, they would speak with the registered manager, staff or their relatives. People told us they felt confident that their complaints would be listened to. There was a complaints policy which outlined the procedure which was to be followed and complaints were recorded so themes could be identified and action and improvements taken.

People told us they lacked confidence in the laundry service, because their clothes had been lost or damaged. People’s privacy and dignity was not always protected as there were no locks on people’s bedroom doors and some bathroom locks did not work.

The registered manager and staff did not fully understand how the Mental Capacity Act 2005 (MCA) and deprivation of liberty safeguards (DoLS) protected people to ensure their freedom to make decisions and choices was supported and respected. This meant decisions were being made for people without proper consultation.

People’s independence and social life were promoted. People told us there were enough social activities. People’s end of life wishes were not documented or communicated. People’s care planning documentation was not reflective of their wishes. This meant people were at risk of not having their choices and wishes for the end of their life met, because there was no written information for staff to follow.

People’s individual nutritional needs were known and taken into consideration and associated risks were monitored. People were supported to eat and drink, but at times staff were not always focused on the person they were helping, which resulted in the person loosing interest and not eating all of their meal. People had access to health care services. However, services were not always contacted in a timely manner because of communication difficulties between the staff team and the registered manager. People’s medicines were managed to help ensure they received them safely; however, documentation was not always accurate or robust.

People and their families were involved in their care plans to help ensure their care plan included their wishes and desires for later life. Care plans and risk assessments were in place, reviewed and updated. However, they did not always give clear direction to staff about how to meet a person’s needs. This meant the care being provided was inconsistent between staff. People had personal evacuation plans in place which meant in an emergency, peoples individual care needs, could be shared with emergency services.

Falls and accidents were monitored and were used effectively to identify required changes. The quality monitoring systems in place did not help to identify concerns and ensure continuous improvement. People’s confidential records were stored securely. The Commission was notified appropriately, for example in the event of a person dying or experiencing injury.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.