Little Sisters of the Poor - St Peters Residence

The provider had appropriate arrangements in place to reduce the risk of infection. Visitors to the home were required to wear appropriate personal protective equipment (PPE) to keep people safe, and this was made freely available throughout the home. Signs were placed around the home to remind people, staff and visitors of the PPE required. The home was spotlessly clean when we inspected. The cleaning schedule had been adapted throughout the pandemic to reflect current guidance and changes to visitors being allowed into the home.

The provider ensured that all staff received appropriate training to manage coronavirus. Staff received training in infection prevention and control and the use of PPE. We observed that staff followed appropriate guidance when using PPE. Staff and the management team had worked hard to assist people with dementia to understand the virus and how to keep themselves safe.

When necessary to reduce the risk of cross-contamination, people were supported within an isolated unit with their own staff team. Staff supported people to quarantine and provided physical and emotional support to assist them to understand the requirements. People were not admitted to the home during the height of the pandemic, to reduce risks.

The home's large gardens and abundant space meant that furniture and equipment were easily rearranged to facilitate social distancing. Communal areas such as the chapel, dining room and activities rooms had signs indicating their reduced capacity, and changes had been made to the way these rooms were used. For several weeks during the height of the pandemic, these rooms were closed and religious services were streamed to people's bedrooms so they could still participate in aspects of religious life that were important to them. Staff supported people on a one-to-one basis with activities in their rooms during this period.

The provider ensured that people were able to keep in touch with their loved ones, and were able to be seen by relevant health professionals, through the use of video calling when visiting was restricted.

The management team ensured staff wellbeing was considered, and managed the staffing rota to maintain consistency for people using the service. Two volunteers lived at the home during the lockdown period to provide additional support to people who needed it.

Further information is in the detailed findings below.

Little Sister of the Poor – St Peters Residence accommodates up to 59 older people across four separate units, in one purpose built building. At the time of our inspection 56 people were living at the home.

People’s experience of using this service

Medicines were not always managed safely, with registered nurses not demonstrating full knowledge in medicines administration. Fire drill procedures were not always as robust as they could be to ensure safety was routinely checked.

Management quality assurance systems were not always effective in identifying issues in a timely manner. Improvements required in medicines and fire safety had not been previously identified by the provider.

The environment was not as dementia friendly as it could be, to support with orientation. We have made a recommendation in relation to reviewing appropriate dementia friendly environments.

Staff were safely recruited, with some improvements needed to ensure that full employment history was up to date. Incidents and accidents were appropriately responded to. The home was very clean and well maintained.

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 well supported with their nutritional needs and were able to access healthcare professionals when they needed to. Staff were well supported through induction, supervision and training.

People and relatives felt that people were well cared for, in a friendly and accommodating environment. Staff ensure they respected people’s privacy and dignity, whilst supporting them to be independent.

Complaints were responded to as necessary. People had their communication needs supported and received personalised care. There were a range of activities available for people to participate in if they chose to.

People, relatives and staff were positive about management support, and spoke highly of the teamwork approach to ensure people received good care.

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 16 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to good governance at this inspection.

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.

At the last inspection on 7 February 2015 the service was meeting all the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, inspected at that time. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Little Sisters of the Poor – St Peter Residence’ on our website at www.cqc.org.uk.

The service had a registered manager supported by unit team leaders. 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 and associated Regulations about how the service is run.

People, relatives, staff and professionals told us the service was managed well. The service operated in a way that demonstrated there was an open and transparent culture at the service. Staff told us they were happy working at the service and they felt valued and appreciated as a member of the team at Little Sisters of the Poor – St Peters Residence. The registered manager was visible and approachable, enabled and empowered staff to seek advice from her. The registered manager had worked at the service for a number of years so knew staff and people well. There were regular meetings and team building events where staff shared significant information and experiences together. Staff told us they received the leadership and direction they needed. Regular checks and audits of the quality of care were carried out to improve on service delivery.

The registered provider had systems and processes in place to protect people from harm People knew and were empowered to report any concern or abuse. Staff also had knowledge and understanding of the various types of abuse. They knew how to report an allegation of abuse and felt confident that any concerns they raised will be thoroughly investigated and addressed. Staff knew how to whistle blow if need be. Staff demonstrated that the protected people from harm and abuse while promoting their Human Rights.

Risks to people were managed in a way that promoted their health, well-being, individuality and independence. Staff knew the risks associated with people’s health and well-being and actions to take to manage them. The registered provider had innovative systems in place and guidance for staff to manage those risks safely. Positive risk taking was encouraged so people could live an independently as able.

People received their medicines according to instructions. Only trained and competent staff administered medicines to people. Medicines administrations records were correctly completed. Staff undertook regular checks to ensure people received their medicines as prescribed. Medicines were stored safely.

People received support from a sufficient number of staff with suitable skills and experience to meet their needs. Staff told us they had sufficient time to enable them to meet people’s needs safely. Appropriate recruitment procedures were followed to recruit staff to ensure only suitable applicants worked with people.

People had access to a range of healthcare services and to maintain their well-being and good health. Staff acted on recommendations of professionals to meet people health needs. This helped to improve of maintain people’s health. The service had close working partnerships with healthcare professionals and with external agencies.

People received care from staff who were effectively trained, supported, supervised and appraised in their role. Staff received regular supervisions both formally and informally. Training and developmental needs were reviewed with staff to identify gaps in their knowledge and experience and these were appropriately addressed.

People’s care was delivered in line with the requirements of the Mental Capacity Act 2005 (MCA). People were asked for their consent before care was provided and staff respected their decisions. Relatives and healthcare professionals were involved in the best interest process to support people who were unable to make decisions about their care. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People enjoyed their freedoms in line with the restrictions placed on them by the Deprivation of Liberty Safeguards (DoLS).

People enjoyed the food provided at the service. They told us they had plenty to eat and drink to support their nutritional and dietary requirements. Staff supported people who required support to eat their meal. Dieticians were involved where required to maintain people’s nutritional needs. People had access to drinks, fruits and snacks available if they wanted throughout the day.

People who used the service commended the excellent quality of care they received. People, their relatives and professionals told us staff were kind, compassionate and extremely caring. People told us they felt comfortable with staff. We saw positive interactions existed between people and staff.

The atmosphere within the service was friendly and peaceful. People were involved in their day to day decisions. People were supported to maintain relationships which mattered to them. Staff celebrated people’s lives in a unique way that made them feel extra special. Their cultural, social and religious were maintained and respected. They were supported to attend events and meetings which promoted their beliefs and values. Staff understood the importance of respecting people’s dignity and privacy.

End of life care at the service was excellent People were given the end of life care they wanted. Their wishes were respected. Staff cared for people well and ensured they were comfortable and their pain managed as much as possible. The care people received at the end of their lives was exemplary. Staff displayed care, compassionate and empathy that showed all people who lived and died at the service mattered.

People’s needs were assessed with their involvement and that of their relatives and healthcare professionals when appropriate. Care plans were developed from information gathered during assessments and reflected people’s individual needs and preferences. People received individualised care in a manner that achieved the best possible outcomes for them. Staff knew people well and understood their needs, likes, dislikes and preferences.

People were engaged in activities they enjoyed. Activities were of wide range, tailored to reflect people’s interests and therapeutic needs. This demonstrated diversity and social inclusion. People visited a variety of community groups and organisations who volunteered at the service and delivered activities.

People knew how to make a complaint. Complaints were resolved in line with the registered provider’s procedures. People’s feedback were obtained and used to plan and improve the service.

People living in the home were complimentary of the service and expressed their satisfaction with the quality of care, they told us they were happy and felt privileged to be at this home.

A person said, "Caring and compassionate staff, we are well looked after and people feel safe, everyone knows you cannot find a more caring home."

People told of a lifestyle that offered solace and fulfilment to people in their advancing years. One person told of the wide range of activities provided in the home, from daily worship and family entertainment to visiting the Christmas Lights in London's Oxford Street.

Another person said 'there is never a dull moment here we have plenty of worthwhile things to do, some of us may be old but we still enjoy sewing and crafts, and helping to prepare the vestments for the chapel.'

A relative visiting told us 'Mum settled in and adapted to her new home very quickly, staff reassured her and made her feel at home, she loves the spiritual side of the home, and this is most important to her.'

Staff told of their satisfaction from working in this home, they spoke of the caring culture that was fostered, and felt that there was clear guidance and support on providing "a good quality of care."

A person living in the home for many years said, "People feel valued and safe here, the home is well run and run in the best interest of people that use the service, we can relax in the pleasant surroundings or join in the events that take place, people from all walks of life are provided for".

A person told us that staff were compassionate and supportive, they found their kind words and deeds provided emotional support that helped them get through a difficult period after losing their spouse.

A person using the service told us that at 98 years of age they were no longer able to remain independent and safe in their own home and moved to live at St Peter's. They said "I made the right decision and choose to spend the rest of my time here; I like this service and was familiar with it from my involvement with a friend who lived here happily for many years".

A relative visiting their mother told us of significant improvements to their health since they came to live at St Peter's Residence, they contributed this to the good meals and the consistently high standard of care delivered.