St Winifred's Dementia Residential Care Home

St Winifred's Dementia Residential Care Home is a residential care home providing personal and nursing care to 33 older people at the time of the inspection. The service can support up to 59 people in one large extended building.

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

People and their relatives told us they felt safe at the service. Allegations of abuse were reported to the local authority and investigated appropriately. Staff knew how to recognise signs of abuse and where to report them.

Improvements had been made to people’s care plans. People had risk assessments in place, and these gave staff the information they needed to safely look after people. Lessons had been learnt when things went wrong, and accidents and incidents were regularly analysed. People and their relatives felt there were enough staff to meet their needs. Staff were safely recruited, and pre- employment checks had been carried out.

People had their needs assessed before joining the service and care plans were put in place. Regular reviews of people’s needs were carried out and using recognised tools. Staff received training relevant to their job role. This was all up to date and staff felt confident within their roles. People were supported to have a healthy diet, given a choice of meals and where necessary adaptions were made based on individual needs.

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.

Improvements had been made to the quality assurance processes. The registered manager and provider had oversight of systems within the service and made improvements where necessary. Staff told us they felt confident to raise concerns and that they felt they would be listened to. Relatives spoke highly of the management team, especially through the current pandemic. Staff received support through meetings and supervisions and were able to give feedback. The registered manager had introduced a system called ‘interactive me’ to help people stay in touch with their loved ones. The registered manager and provider gave out thank you cards and vouchers to staff who went above and beyond during the pandemic.

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 09 January 2020) 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 01 and 03 December 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, person centred care 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 safe, effective and well-led which contain those requirements.

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 has changed from requires improvement to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St. Winifred’s Dementia residential home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Winifred’s Dementia Residential Care Home is a residential care home providing personal and nursing care to 40 older people at the time of the inspection. The service can support up to 53 people in one large extended building.

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

People told us they felt safe living at the service. However, lack of oversight by the registered manager and provider of the quality of the care and support people received had placed people at risk. Comprehensive checks and audits had not been completed until shortly before the inspection. Once concerns had been raised they were addressed.

Potential risks to people’s health and welfare had not been consistently assessed. There was not always guidance for staff to mitigate the risks. Records of the care people received were not accurate and had not been completed in a timely manner. Medicines were not managed safely. Accidents and incidents had been recorded and action taken but they had not been analysed to identify patterns and trends.

Staff were recruited safely, though improvements were required to the recording of information. There were enough staff to meet people’s needs. However, most of the nursing care was provided by regular agency nursing staff. Staff received training appropriate to their role, but staff had not received regular individual supervisions to discuss their development.

People were supported to eat a balanced diet. People had access to activities they enjoyed and were supported to stay as active as possible. The service had been adapted to meet people’s needs.

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.

People were given information in a way they could understand and where possible were involved in developing their care plan. People and relatives told us they knew how to complain, and any issues had been dealt with appropriately.

People, staff and relatives had been asked their opinion on the service. The registered manager attended local forums to keep up to date with developments and to continuously improve the service.

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 29 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, staffing, wound management and care planning. A decision was made for us to inspect and examine those risks.

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

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care 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 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.

St Winifred’s is a ‘care home’ for up to 65 people supporting them with nursing needs and dementia. People in care homes receive accommodation and 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.

There were 48 people living at the service at the time of our inspection. The service was set in a large house that had been extended which was based in a residential area. The accommodation was spread over two floors each floor having two lounges.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection the service had an overall rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed.

At this inspection, we found the service remained ‘Good’.

People continued to be protected from abuse. Staff understood how to identify and report concerns. Medicines were managed safely, and people received their medicines when they needed them. Risks were assessed and there were actions in place to minimise risk and keep people safe.

There continued to be sufficient numbers of staff who had the skills and knowledge they needed to support people living at the service. Staff were appropriately supervised and supported. New staff had been recruited safely and pre-employment checks were completed.

Peoples’ care met their needs. Care plans continued to accurately reflect people’s needs and included information on their religious and cultural needs. We observed that staff followed the guidance in people’s care plans. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of people’s decisions and these were respected.

Staff continued to support people to maintain their health and wellbeing. People had access to healthcare services. People were supported to eat and drink safely with a variety of choice.

People were treated with respect, kindness and compassion. Their privacy was respected, and they were supported to lead meaningful and dignified lives. People were supported to maintain their independence. There were systems in place to seek feedback from people to improve the service. People were encouraged to express their views and were listened to.

The building had been adapted to meet people’s individual needs. People had been involved in the decoration for their room. Staff were aware of infection control and the appropriate actions had been taken to protect people.

The service was well-led. People knew the registered manager well. Staff told us that they were happy at the service and were proud to work there. The service was regularly checked to identify where improvements were needed, and actions were taken.

Incidents were recorded, investigated and acted upon. Lessons learnt were shared and trends were analysed. The service worked in partnership with other agencies. The registered manager was well informed about best practice and shared this learning thought the service.

Further information is in the detailed findings below.

St Winifred’s Dementia Residential Care Home is a service that provides accommodation and personal care for up to 59 older people with dementia. The service is wheelchair accessible. All bedrooms have a wash basin and a large proportion of the single bedrooms have en-suite facilities. The home has five lounge/dining areas. Service users also have the benefit of well-maintained and accessible gardens. At the time of the inspection, 39 people were living at the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People were protected against the risk of abuse. Relatives told us they felt people were safe. Staff had been trained and recognised the signs of abuse or neglect and what to look out for. The registered manager, deputy manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Staff were recruited using procedures designed to protect people who need safeguarding. The registered manager had ensured that they employed enough staff to meet people’s assessed needs. Staff were available throughout the day, and responded quickly to people’s requests for help. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by the registered manager and deputy manager and felt able to raise any concerns they had or to make suggestions to improve the service for people.

Staff were trained to meet people’s needs. They met with management and discussed their work performance at one to one meetings and during annual appraisal, so they were supported to carry out their roles.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

We observed staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. People demonstrated that they were happy at the service by smiling and chatting with staff who were supporting them. Staff interacted well with people, and supported them when they needed it.

People were supported to eat and drink enough to maintain their health and wellbeing. People were provided with a diet that met their needs and wishes. Staff ensured people had access to food, snacks and drinks during the day and at night. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

Staff encouraged people to undertake activities. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. Relatives knew how to raise any concerns and were confident that the registered manager dealt with them appropriately and resolved them where possible.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; questionnaires; and daily contact with the registered manager, deputy manager and staff. Information seen showed that people’s views were positive about the service.

The provider and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the Commission.

During this inspection we found that improvements had been made and the provider was compliant.

We visited the office and spoke with the Registered Manager and four members of staff. We also spoke with three people using the service.

We found that new systems had been implemented to make sure people were receiving their medication safely. People told us that they received their medication on time each day. One person was able to tell us about the medicines they took and how they were supported to take them safely.

People said: 'The staff are polite and friendly, I would recommend the home'. 'The staff are very careful with my medicines they help me take them. I have monthly blood tests to make sure I am OK'. 'I am comfortable here; my medicines are always available when I need them'.

Staff told us that the management of the medication had improved and the new systems in place made sure the medicines were being given to people as safely as possible

We observed that staff spoke with people in a positive manner and supported them in their daily lives, such as moving around the premises, chatting, watching television, playing games or eating and drinking.

The staff told us that consent for care and support was obtained from people using the service or their representatives during discussions about the care and support the person needed.

People's needs were assessed before and when they first started to use the service. We found that people's health care needs were monitored and community health professionals were involved to provide advice and support when needed.

People were not protected against all the risks associated with medicines because appropriate arrangements were not always in place in relation to obtaining medicine.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

People and relatives told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

We saw that people were responsive in the company of staff and smiled as they walked through the unit. We observed people drinking tea and coffee and chatting with staff and each other. People were not rushed and were supported to do things in their own time. A relative told us "They don't hurry my relative".

People told us that staff were polite and cheerful and they responded quickly if they needed any help. People said they felt safe using the service

They told us that the home was very clean and the food was good. People said: 'This is an excellent home. I love it here, the food is good, it's very clean and the staff are very polite and cheerful. I have been here a long time'.