St Catherine's Care Home

We found the following examples of good practice.

• Service has invested to technology to help protect staff and residents against the risk of COVID-19. This included electronic temperature checking devices at entrances and whole room air sterilisation systems.

• The service had focused on supporting the mental health and wellbeing of staff throughout the pandemic. For example, the service provided all staff with a wellbeing support book at the beginning of the pandemic that provided staff with wellbeing support and advice. In addition, staff could obtain further wellbeing support through internal and external channels and helplines.

About the service

St Catherine’s Care Home is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 55 people in one adapted building.

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

People benefitted from improvements in the safety of the service and were protected from abuse and avoidable harm. There were enough staff to care for people safely and people gave positive feedback about staff. Staff administered people’s medicines on time and as prescribed and referred people to other healthcare services when necessary.

Improvements had been made to the provider's quality assurance systems. Managers carried out regular audits and checks which identified potential concerns and areas for improvement.

The provider had appointed a new manager who took a proactive approach to driving improvements in the service. The manager was a visible presence in the home and we received positive feedback from staff, relatives and professionals working with them.

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.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 October 2019). 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

The inspection was prompted in part due to the intelligence we held about potential risks to people’s safety. A decision was made for us to carry out this focused inspection and examine those risks.

This report only covers our findings in relation to the key questions, safe and well-led. 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Catherine’s Care 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 Catherine’s Care Home was providing personal and nursing care to 37 people, some of who were living with dementia. The service can support up to 55 people.

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

People had received or were at risk of receiving poor quality and unsafe care. Their health and wellbeing were not always monitored to ensure action was taken if they required additional support, for example; where they had not received enough to drink. Staff did not always follow the systems the provider had in place to protect people from avoidable harm. For example, the medicines management system.

Staff had not been trained in specialist areas to help them support people living with dementia who may become distressed. Staff intervened the majority of the time with kindness and compassion. However, due to lack of knowledge and confidence they may at times of high anxiety be at risk of treating people in an unprofessional or ineffective way.

The amount of staff on duty provided people with safety, but they did not receive care and support in a timely way. People felt rushed at times and also had to wait for support. Immediate action was taken to increase staff in the evenings. The provider completed a full review and following recruitment of new staff an increase in staff will occur.

Where incidents had occurred, people in distress or errors with medicines, there were no reviews to understand if any lessons could be learnt to prevent a reoccurrence.

The provider had a system to check the quality and safety of the service which had not effectively highlighted all of the areas for improvement.

The provider and registered manager displayed a commitment to improving the experience of people who used the service. They had an action plan to develop the staff through training and support, introduce better systems to ensure safety and quality and also develop a positive culture and morale of the team.

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 23 February 2018).

Why we inspected

We received concerns in relation to the management of people’s nutrition and hydration, safe moving and handling, staffing levels and support to people who exhibit distressed behaviour. As a result, we undertook a focused inspection to review the Key Questions of safe and well-led only.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider responded positively to our feedback and has already started to make improvements to the service.

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

Enforcement

We have identified breaches in relation to the safe care and treatment and 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building separated into two units called Harewood and Mews. Harewood provides nursing care, whilst Mews specialises in providing nursing care for people who may also be living with dementia.

This inspection took place on 13 and 15 December 2017 and was unannounced. At the time of our inspection, 39 older people with nursing needs were using the service. The service had a registered manager. They had been the registered manager since April 2016. A registered manager is a person who has registered with the CQC 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 in September 2016, we rated the service ‘Requires Improvement’. This was because we found issues relating to the home environment and people raised concerns about the lack of involvement in planning their care. At this inspection, improvements had been made to address these concerns. We rated the service ‘Good’ overall, but identified further improvements to auditing were needed to maintain and ensure consistently good practice.

Records were not always well maintained or lacked detail. We identified minor issues relating to the environment and infection prevention and control practices. The registered manager took immediate action to address these concerns during our visit, but more rigorous audits were required to monitor and ensure these improvements are sustained over time. We have made a recommendation about developing auditing and quality monitoring at the service.

People provided positive feedback about the registered manager and the service provided.

People told us they felt safe. Staff were trained to recognise and respond to safeguarding concerns to keep people safe. Care plans and risk assessments provided guidance to staff on how to safely meet people’s needs. Accidents and incidents were monitored to identify any lessons that could be learnt to prevent avoidable harm. Sufficient staff were deployed to ensure people’s needs were met. Medicines were managed safely, although more information was needed to guide staff on when to administer medicines prescribed to be taken only when needed.

Staff received regular training; supervisions, observations and appraisals were used to monitor their performance and support their continued professional development. Staff told us they felt supported by management.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff ensured people ate and drank enough and had a good understanding of people’s needs and the risks associated with supporting them. We received generally positive feedback about the quality and availability of food on offer. Staff monitored people’s nutritional needs and responded appropriately to minimise the risk of dehydration or malnutrition.

Staff monitored people’s health and well-being and sought advice from healthcare professionals where necessary. The environment was adapted for people who may be living with dementia or a physical disability. We spoke with the registered manager about using dementia friendly menus at mealtimes.

Staff were kind and caring, respected people’s privacy, and supported people to maintain their dignity. People were supported to make decisions and have choice and control over their daily routines.

Activities coordinators arranged a varied programme of activities and supported people to engage in meaningful activities.

Care plans contained person-centred information about people’s needs and guidance to staff on how best to support them. People were involved in planning their care and support.

Staff explored people’s wishes about how they would be cared for at the end of their life.

The provider had systems in place to respond to complaints about the service.

Our previous inspection of St Catherine’s Care Home took place in February 2016, when the service was given an overall rating of requires improvement. Warning notices were issued regarding failures to ensure people received person centred care and to ensure effective systems to monitor the safety and quality of the service. Improvements were required to ensure people received safe care and treatment, that there were sufficient, appropriately trained and supervised staff, and that complaints and safeguarding issued were reported and responded to appropriately.

St Catherine’s Care Home is registered to provide personal and nursing care for up to 55 people, including older people, people living with dementia and people living with physical disability.

At the time of our inspection the service was providing care to 43 people. The home was divided into two distinct units: The Mews provided care for people living with dementia, while Harewood provided nursing care. At the time of our visit 21 people had been assessed as needing care because they were living with dementia and were cared for in The Mews, while 22 people had been assessed as needing nursing care and were cared for in Harewood.

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.

People and their relatives told us people were safe at St Catherine's Care Home. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring.

Staff knew what to do if they had concerns about someone’s welfare or had suspicions of abuse. The service had made safeguarding alerts to the local authority in response to concerns appropriately when needed.

The staffing levels were monitored to ensure enough staff were on duty to support people safely. If needed agency staff were used to cover any staff shortages and recruitment of new staff was taking place to fill vacancies. The registered provider’s recruitment process reduced the risk of unsuitable staff being employed.

People’s medicines were managed safely. However, a homely remedies policy was still not in place and we have recommended that the provider reviews this using the NICE guidelines: Managing medicines in care homes.

Our observations during the visit showed the premises to be generally well maintained, clean and safe. However, we noted some areas for improvement, such as maintaining a comfortable ambient temperature and worn carpets, which we discussed with staff during our visit.

Improvements had been made to the training and support of staff. Staff received training in relevant areas and were supported through regular supervisions and observations of practice.

Staff worked within the principles of the Mental Capacity Act 2005. Where appropriate the service had sought authorisation under the Deprivation of Liberty Safeguards when it was necessary to deprive people of their liberty.

People received a variety of meals and drinks throughout the day and their dietary needs and risk of malnutrition were assessed and monitored. Where staff had concerns about people’s nutritional wellbeing they had sought support from the doctor and other professionals.

Staff supported people to access other healthcare professionals to maintain and improve their health.

People and their relatives spoke positively about the care they received, describing the service and staff as kind and caring. People and their relatives told us staff treated people with dignity and respect and we saw examples of this during our visit.

Since our last visit improvements had been made to the format and quality of care records. Care plans provided information about people’s individual needs and preferences and the care they received.

Some people and their relatives had been involved in reviewing their care plan. However, others were unsure or did not feel they had been involved. We have recommended that the provider review their arrangements for involving people in care plan reviews to ensure that they are consistent and effective.

We observed that staff involved people in day to day decisions about their care and lives, and generally received person centred care. However, we have recommended that the provider review's arrangements for meal times on The Mews, to ensure offer person centred and individualise care.

People spoke highly of the activities coordinator, who demonstrated a great empathy and understanding of the people they supported. A variety of group and individual activities took place, including trips outside of the home.

A complaints procedure was in place and records showed that recent complaints or concerns had been responded to appropriately. People and their relatives said they were confident to raise any issues if needed.

People who used the service, relatives and staff spoke positively about the registered manager and changes that had been made in the home. Staff morale had improved and there was a positive atmosphere when we visited.

The provider had overhauled their governance and quality assurance systems. An action plan was in place and progress was being monitored. There was evidence of effective managerial support systems being implemented and developed.

The standard of record keeping had improved.

The registered manager had informed CQC of significant events by submitting notifications in line with legal requirements. The provider had also clearly displayed their inspection rating since the last inspection.

St Catherine’s Care Home is registered to provide personal and nursing care for up to 55 people, including older people, people living with dementia and people living with physical disability.

The service did not have a registered manager at the time of the inspection. There was a manager working at the service who had been confirmed in role during January 2016 and have since registered with us. 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 time of our inspection the service was providing care to 43 people. The home was divided into two distinct units: The Mews provided care for people living with dementia, while Harewood provided nursing care. At the time of our visit 21 people had been assessed as needing care because they were living with dementia and were cared for in The Mews. 22 people had been assessed as needing nursing care and were cared for in Harewood.

We found that there had been occasions when people had not received safe care and treatment and this had impacted on their wellbeing. Several of these matters are still under investigation.

During 2015 incidents had not always been reported to the local safeguarding authority appropriately. Recent improvements in reporting had been made and staff now understood safeguarding processes and their reporting responsibilities.

There had not always been enough suitably competent, skilled and experienced staff on duty to meet people’s needs. Recruitment of new staff was in progress, with existing and agency staff being used to cover shifts wherever possible. Recruitment checks were being completed before new staff started work, to ensure they were suitable.

Medicines were being stored and administered safely. However, there was no system for the use of homely remedies so that these medicines were available to people who used the service when needed.

We found that staff training and supervision systems had not been effective at ensuring staff had the competence and skills they needed to meet people’s needs. Improvements were being made, with new systems being put in place to support staff.

People’s nutritional needs were being assessed and monitored. Some people at the service had lost weight, but information about the actions taken to ensure people’s nutritional wellbeing, including involvement of other professionals, was available and being monitored by the manager on a monthly basis. We saw that mealtimes on The Mews were noisy, cramped and chaotic. The current arrangements did not support people living with dementia to have a pleasant meal time experience.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and where appropriate had sought authorisation to deprive people of their liberty. However, individual care plans did not contain a lot of information about capacity, consent or decision making in relation to each person or the support they required.

The majority of staff treated people kindly and were caring in their approach, although feedback from relatives suggested some staff were less proactive and interactive in the way they supported people than others. This suggested a lack of consistency, depending of the competency and skill of individual staff members. We observed people being treated with respect and staff we spoke with understood the importance of maintaining people’s dignity while providing care.

Assessments, risk assessments and care plans were in place, but it was difficult to gain a complete understanding of people’s care needs and it was difficult to follow through people’s care and understand what had happened to them. Some individual needs had not been identified or planned for and we found examples where identified care needs had not been followed through.

A complaints process was in place but people had not always been satisfied with the response they had received when raising issues or concerns. Records of past complaints and the actions taken were not available, although we could see that recently improvements had been made to the way complaints were recorded and handled.

Individual staff were responsive and tried hard to offer choices and meet people’s needs and requests. The activities coordinator was well thought of and people enjoyed a variety of activities and events.

CQC had not received all of the required statutory notifications during 2015 and we are pursuing this separately with the provider. The new manager was aware of notification requirements and appropriate notifications had been made in 2016.

Governance systems had not been effective at assessing, monitoring and improving the quality and safety of the service or mitigating risk. This was demonstrated by our inspection findings, particularly in relation to people’s care. Records relating to people’s care were not maintained to a suitable standard. We found records that were incomplete, not accurate and in some cases difficult to understand or illegible.

The culture at the service had not always been open and transparent. Staff described a past culture of ‘sugar coating’ or ‘hiding’ things and during 2015 incidents had not always been appropriately reported to external organisations. The new manager was open and honest about the service and the improvements that were needed. People using the service, relatives and staff were complimentary about the new manager, their approach and the changes and improvements they were making.

There had been a period of management change and instability. There was a new manager in post, who has now registered with us. They had a challenging role and needed additional senior management support to help them achieve the required improvements.

We identified five breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report. Where more serious breaches have been identified we have taken enforcement action.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were seen to be treated with respect and dignity by the staff. People we spoke with said they felt staff listened to them and acted upon what they said. We saw this was the case.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There was no one currently using the service who had a DoLS in place. The manager knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity Act training. This helped to protect people.

The provider had effective systems in place to deal with any emergency.

Staff told us that they felt there were enough staff. However, we have asked the manager to monitor night shifts to make sure night staff meet people's needs.

Is the service effective?

People's health and care needs were assessed and detailed care plans and risk assessments were in place. This helped the staff to understand people's care needs. A person we spoke with said 'If I weren't well and wanted the GP they would get them for me. They (the staff) are very helpful.' Another said 'I get the care I need.' We observed that the manager and staff spent time with people and knew people's individual needs well.

People we spoke with said 'The food is good.' and 'I have had toast, tea and scrambled eggs. I eat well here.' Food and drinks were seen to be available to people at any time. Staff knew people's dietary needs, likes, dislikes and preferences. People were supported to remain as independent as possible with eating and drinking but were given assistance, where necessary. We observed that people looked hydrated. Food provided was home cooked and appeared to be nutritious. This helped to ensure people's nutritional needs were being met.

Is the service caring?

People we spoke with said that the staff were patient and kind. They told us they were supported to live the life they chose. We observed this was the case. People were seen undertaking various activities such as painting and doing jigsaw puzzles. Relatives we spoke with said 'We have had a couple of extra years with X that we would not have had. Staff are lovely they give the personal touch. Staff make that extra bit of effort.'

We saw from the care records we inspected that people's preferences, interests and life histories were recorded. Information such as 'This is me' and 'Five things you should know about me' was recorded so that staff could help people talk about their life. Changes to people's needs were recorded and were acted upon by staff to help to maintain people's health and wellbeing. Daily entries made by staff confirmed that care was being provided in accordance with people's wishes.

Is the service responsive?

There was a complaints policy in place which people were made aware of. People we spoke with said they would raise issues with the staff or manager if they wished too. The manager was available for people or their relatives to speak with at any time.

The manager and staff told us how they would act on any changes in people's condition, informing their relatives or health care professionals as necessary. This was confirmed by people we spoke with.

Is the service well led?

Systems were in place for the manager to monitor the quality of the service provided. The manager and senior manager assured us that they would make further checks about the service provided to people on a night time. We saw that action was taken to address any issues that the management team were made aware of.

The manager led the staff team by example and prided themselves on taking all relevant action required to ensure people were cared for. Detailed audits were in place which helped the manager monitor the quality of the service being provided. The manager and senior manager carried out visits at different times of the day and night to undertake observations and to speak with people and with staff.

There was a clear message given to us about the ethos of this service. This was to provide people with individualised care and support. Staff we spoke with told us the manager listened to them and acted upon what they said.

Compliments, comments and complaints were encouraged. People and their relatives told us they could speak with the manager at any time. People we spoke with said I love living here. Everything is alright for me.' And 'It is very nice here I cannot complain, they care for me.'

People told us they were well cared for. Care records were being reviewed and updated to make sure that people's care needs were appropriately met. One person said "I am well looked after here."

People told us that they liked the food. They said they received a choice and we saw that appropriate advice from professionals was sought where concerns had been identified.

The home was clean and smelt pleasant throughout. We saw that a major programme of redecoration and refurbishment had been completed since our last visit. This helped to ensure that the home was pleasant for those living there.

Medication was given to people safely. All of the medication had been reviewed since our last visit and regular checks were now completed. One person told us "I get my medication when I am meant to."

In the main we found there were sufficient staff on duty. We identified some issues with staffing on the Mews unit, however the manager agreed to increase staffing in response to our concerns immediately. People told us they liked the staff. Comments included "I feel there are enough staff to meet my needs if I want something."

Quality monitoring systems were in place so that people could be assured that their views and wishes were taken into account in the way the service was managed and ran.

People told us that they liked living at the home, however we saw practices which did not promote their health or wellbeing. Care records required development and staffing numbers were impacting on the quality of care being delivered.

Although people received a choice of food and drink, the time spent in the dining area impacted on their well being.

People were not prevented from the risk of infection because appropriate guidance had not been followed and there were inefficient systems in place to reduce the risk and spread of infection.

The time taken to administer medication meant that people did not always receive their medicines in a timely way which meant that people may not receive their medication as required.

Although the provider had systems in place to carry out quality checks we found that these were ineffective.

People said they were well cared for and liked living at the home. One person said "I get well looked after and my family visit." Although we observed some very positive interactions during our SOFI observations. We also found that some people experienced fewer interactions than others, staff should be mindful of this as this could have a negative impact on an individual's wellbeing.

The home had systems in place to help safeguard people and people told us they felt safe. One person told us "I feel safe and well cared for."

People told us that they liked the staff who supported them. Comments included "I like all of the staff who work here" and "All of the staff are kind, I like them all." Staff were recruited safely with relevant checks being completed before they started work and they received regular training to help keep their knowledge and skills up to date.

All of the people we spoke with said that they would feel confident in raising any concerns. People told us that they could attend meetings and were asked for their views and opinions. They told us that staff were friendly and approachable.