The inspection took place on 2, 15 and 28 November 2017 and was unannounced. At the last inspection in December 2016, we found six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because peoples’ risks assessment were not up to date; care plans did not describe how to support the person and reduce the risks; staff had not been adequately trained; staffing levels were insufficient to meet people’s needs; recruitment procedures were not robust; people had not been protected from the risk of abuse, governance systems and quality assurance had not identified issues and concerns. The service was rated as requiring improvement overall. Following the inspection, we also met with the provider and asked them to complete an action plan to show what they would do, and by when, to improve the key questions ‘Is the service safe?’; ‘Is the service effective?’; Is the service responsive?’ and ‘Is the service well led?’ to at least good. After the meeting, the home submitted an action plan showing how they were going to address each of the breaches. The action plan recorded that they expected to have completed all the actions and be compliant with the regulations by the middle of June 2017. This inspection was carried out to see whether they had made the necessary improvements to meet the relevant requirements.
St Denys 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.
The care home accommodates 12 people in an adapted building. At the time of inspection, there were 11 people living at St Denys.
At this inspection, we found there were some improvements to the service, which meant the provider was now meeting some of the regulations. However, some improvements were still needed as we identified continuing breaches of three regulations. We have therefore rated the service as still requiring improvement overall. This is therefore the second consecutive inspection where the service has been rated Requires Improvement. The breaches of regulation at this inspection were related to quality assurance, staff recruitment and safe care, particularly in relation to infection prevention and control.
People and their relatives said they liked the home and the staff. Comments included “Won’t hear anything but good from me about this place”; and “Made friends so I’ve got company. Excellent food. Can’t think of anything to improve.” A relative commented “Very lovely staff…always helpful and chatty.” Health and social care professionals who visited the home said they thought there had been improvements to the home. A professional commented they thought the home was “Very good.”
The service had a registered manager who was also one of the providers. 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 registered manager was present in the home on most days of the week. They worked alongside staff which gave them an insight into working practices. The registered manager provided supervisions and appraisals to staff. This gave staff an opportunity to reflect on their work as well as identify training needs. The other provider visited the home each week and also worked in the home on some weekends. They provided a second tier of quality assurance in the home.
There were sufficient staff to meet people’s needs. The provider kept staffing levels under review to ensure they were able to support people to go to appointments and other events, when needed. However staff had not always been recruited safely. There was insufficient evidence to show that new staff’s employment history had been checked including any gaps in employment. References had not always been checked to ensure they were genuine. After the inspection, the registered manager sent us a new policy and procedure for recruiting staff which addressed these issues.
Staff had undertaken training to support them in their roles. New staff had received an induction which included training and working alongside experienced staff, shadowing to gain experience.
Staff had received training on how to safeguard vulnerable people and knew how to safeguard people from abuse. Staff understood how to report any safeguarding concerns they had. The registered manager understood their responsibilities to inform the local authority safeguarding team and submit notifications to CQC in line with regulations.
Most areas of the home were well maintained and kept clean and hygienic. However some areas needed refurbishing, including the laundry room, which posed a risk of infection. There were infection control risks as there were not appropriate procedures for staff to follow when undertaking laundry duties. By the end of the inspection, some improvements to the laundry area and the laundry procedures had been implemented.
Medicines were generally administered, stored and recorded correctly. However, the registered manager had not taken action when the temperature of the medicines room had been above the recommended storage temperature.
People had care plans which they had contributed to. Care plans were personalised and described people’s risks, needs and preferences. They gave guidance to staff about what they should do to support people with their care. Staff were very knowledgeable about people’s background, history and current presentation. Staff were able to describe how they supported people with their care which reflected what was in the care plans. Staff had received training in, and were aware of, the requirements of the Mental Capacity Act 2005; staff were able to describe what they needed to do to work within the Act. -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
Throughout the inspection, staff showed concern and patience with people. Staff interacted with people in a kind and friendly way. Staff respected people’s dignity and right to privacy. People said they liked and felt supported by staff. Staff communicated using signs and by writing information down for one person who was unable to communicate verbally. There were regular resident meetings where people were able to put forward suggestions and ideas about the home and the activities they wanted to do.
People were supported to have a varied and healthy diet, eating food of their choice. People were involved in menu planning and choice of dishes offered. People were encouraged to get involved in food preparation. People were able to access drinks and snacks throughout the day. Where they were unable to get their own drinks, staff regularly offered them refreshments. People were supported to access their GP and other health professionals. Where necessary, people were supported to attend appointments.
The home had a procedure for staff to report incidents and accidents. These were reviewed by the registered manager, who considered ways to reduce the risks of recurrence. There was a complaints policy. People and relatives said they knew how to complain, but said they had not needed to. There had been one complaint which had been investigated and resolved.
We found continued breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. We have also made recommendations about assessing environmental risks and the medicines policy. We will arrange to meet with the provider to discuss the findings and explain the actions we may take if the service continues to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.