Archived: St Catherine's Manor

St. Catherine’s Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St. Catherine’s Manor provides facilities and services for up to 34 people who require personal or nursing care. At the time of our inspection there were 26 people living at the service. The majority of people living at St. Catherine’s Manor are living with dementia. The accommodation is provided over two floors which are accessible by stairs and a lift.

Since our last inspection a new manager had been appointed who had registered with CQC. 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 were protected from the risk of abuse as staff understood their responsibilities in safeguarding people. The provider had systems in place for reporting concerns and records showed that these were followed. Risks to people's safety were assessed and control measures implemented in order to keep them safe. Accidents and incidents were recorded and monitored. Action was taken to minimise the risk of reoccurrence and an analysis completed to identify possible trends. The provider had developed a contingency plan to ensure that people would continue to receive their care in the event of an emergency. The service was clean and well maintained. Staff understood their responsibility to protect people from the risk of infection and followed safe procedures.

People were supported by sufficient staff to meet their needs and did not need to wait for their care to be provided. Prior to staff starting their employment robust recruitment processes were completed to ensure they were suitable to work within care services. Staff received an induction when starting work at the service and did not work without supervision until they were confident in their role. Staff received regular training and supervision to support them in their role.

People received their medicines in line with prescription guidelines and medicines were stored safely. Healthcare professionals were positive about the service and care records showed the service worked with a range of healthcare professionals. People's weight was regularly monitored and a choice of nutritious food provided. People were involved in decisions regarding their care and the principles of the Mental Capacity Act 2005 were followed by staff.

Staff treated people with kindness and had formed positive relationships with people. There was a relaxed atmosphere in the service and staff spent time socialising with people. People’s dignity and privacy were respected and people were encouraged to maintain their independence. People’s religious and cultural needs were respected. Visitors were made to feel welcome and there were no restrictions on visiting times.

People's needs were assessed prior to them moving into St. Catherine’s Manor and people's care records were regularly reviewed. Guidance was available to staff regarding how people preferred their care to be provided and we observed this was followed. The care people received at the end of their life was person centred and reflected their wishes. A range of activities were provided although people told us there had been a reduction in the quality of these. We have made a recommendation regarding this. There was a complaints policy which gave guidance on how to raise concerns which was prominently displayed. People and relatives told us they were confident that any concerns would be addressed by the registered manager

There was an open culture within the service and staff felt able to discuss any concerns openly with the registered manager and provider. Quality assurance systems were in place to monitor the service provided and action was taken where shortfalls were identified. People, relatives and staff were asked for feedback on the service provided and suggestions were acted upon. The service worked with external agencies to ensure service development and learning.

The inspection took place on 30 August 2017 and was unannounced.

Since our last inspection a new registered manager had been appointed and was present on the day of the inspection. 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 our inspection in February 2017 we identified concerns relating to providing people with safe care and treatment, insufficient skilled staff deployed, identifying and reporting safeguarding concerns, protecting people’s legal rights, providing person centred care in line with people’s needs and a lack of effective leadership and good governance. The service was placed into special measures and warning notices were issued with regards to safe care and treatment and good governance. The provider wrote to us to tell us what action they intended to take to be compliant with regulations.

We undertook this inspection to check that the provider had taken action to meet their responsibilities. We found that improvements had been made in all areas and no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. The overall rating for the service is requires improvement to ensure that the changes in the care people receive and the governance of the service are sustained and embedded in to practice.

There were sufficient staff deployed to meet people’s needs safely. Staff had time to spend with people and the registered manager completed regular reviews of people’s needs. New staff completed an induction process which included shadowing more experienced staff members to help them understand their roles. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of the support people required to manage risks and relevant healthcare professionals were involved when appropriate. Staff were aware of their responsibilities in keeping people safe from abuse and any concerns were reported to the appropriate authorities. Accidents and incidents were monitored by the registered manager and action was taken in a timely manner to minimise the risk of reoccurrence. The provider had developed a contingency plan to ensure people would continue to receive safe care in the event that the building could not be used.

Safe medicines systems were in place to ensure people received their medicines in line with prescriptions. Medicines were stored securely and regular stock checks were completed. People had access to healthcare professionals when required and advice given was followed by staff. People were provided with a choice of nutritious food and their weight was kept under regular review.

People’s legal rights were protected as staff understood their responsibilities regarding the Mental Capacity Act 2005. Staff ensured that they sought consent from people before providing their care. People and their relatives were involved in developing care plans which were individualised and person centred. Regular reviews of the care people received were completed and changes in people’s needs were responded to in a timely manner. People had access to a range of activities and there was positive interaction between people and staff.

People received support from staff who knew them well and treated them with kindness. Staff demonstrated understanding of people’s individual needs and preferences. People were encouraged to maintain their independence and staff supported people in a respectful and dignified manner. Relatives told us they were made to feel welcome and there were no restrictions on the times they could visit.

The registered manager had had a positive impact on the culture of the service and staff told us they felt supported in their roles. Quality assurance systems were in place to monitor the service provided and action was taken where concerns were identified. People, relatives and staff had the opportunity to contribute to the running of the service and their views were listened to. There was a complaints policy displayed in communal areas and records showed that complaints were responded to promptly. Records were securely stored and well- maintained.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The inspection took place on 23 February 2017 and was unannounced.

There was no registered manager in post. 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. A manager had been appointed and had begun the process of registration with the Care Quality Commission (CQC). They supported us during the inspection.

At our last inspection in November 2015 we found breaches of the legal requirements. The provider wrote to us to inform us of the action they planned to take to address the concerns. This comprehensive inspection was conducted to check that the action had been taken by the provider and that they were now meeting their legal requirements. We found that the provider had failed to make the changes required and there were continued concerns relating to providing people with safe care and treatment, insufficient skilled staff deployed, identifying and reporting safeguarding concerns, protecting people’s legal rights, providing person centred care in line with people’s needs and a lack of effective leadership and good governance.

Sufficiently skilled staff were not provided throughout the service. There was a high level of agency staff used which impacted on the care people received. Some people and their relatives felt there were insufficient staff to respond to people’s needs in a timely manner and call bell audits showed that staff did not respond promptly.

Safeguarding incidents had not been reported to the local authority to enable them to investigate and ensure people received safe care. The service had not always informed the CQC of significant events to enable us to monitor the service. Risks to people’s safety were not consistently identified and acted upon to keep people safe from harm. Where incidents and accidents had occurred appropriate action was not always taken to prevent them being repeated. Improvements had been made to the way in which medicines were managed although there were on-going concerns regarding how people were supported in this area.

People did not receive consistent care in line with their needs. People’s care plans contained conflicting information and were not always followed by staff. This meant that people were at risk of their needs not being met in a responsive manner.

Staff had not completed all training required to support them in their role. Where training had been completed this was not always effective in ensuring that staff understood their responsibilities. People’s rights legal rights were not always protected as staff were not working in accordance with the Mental Capacity Act 2005.

There was a lack of consistent leadership and management oversight of the service. Systems in place to monitor the quality of the service provided were not effective in ensuring people received a safe, effective and responsive service. Staff were not clear on the values expected of them and were not involved in the development of the service.

Safe recruitment practices were followed to ensure that people were supported by staff who were safe to work in the service. Staff received regular supervision to monitor their performance and any concerns identified were addressed.

People’s nutritional needs were met and there was a choice of foods available to people. Where people required support to eat this was done in a respectful manner. People had access to a range of healthcare professionals. People and their relatives told us that staff responded to healthcare concerns promptly and informed them of any changes. Staff respected people’s dignity and spoke to people in a caring manner. Welfare checks were completed on a regular basis to monitor people’s comfort. The provider had a contingency plan in place to ensure people would continue to receive care in the event of an emergency.

There was a range of activities for people to take part in and people were supported to maintain their hobbies and interests. However, people who needed to spend the majority of time in their rooms were not provided with activities or company. The provider had a complaints policy in place and relatives told us they were confident that any concerns would be addressed. Relatives told us they were made to feel welcome and there were no restrictions on the times they could visit. People and their relatives were given the opportunity to give feedback on the service provided.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. We spoke with family members and they felt that their relatives were very well cared for and that they were involved in making decisions about their relative's care and treatment.

People's bedrooms were personalised and met the individual needs of people using the service. We saw that people's likes and preferences were reflected in their individual bedrooms. People had pictures and art work displayed and their own personal furniture items from home. People and relatives that we spoke to told us that they could choose how they wanted their bedrooms.

We saw staff supporting people to make their own choices about what they had to eat and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

Staff that we spoke to felt very valued and supported and said that supervision and training provided was great.

During our visit we observed the nurse dispensing and administering medication. We saw that procedures were followed and that records had been completed accurately.