The inspection took place on 5 and 6 December 2018 and was unannounced.People living at St Martin’s Grange receive accommodation and nursing or 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. The service is registered to accommodate 75 people and specialises in providing care, treatment and support for older people. The service was split over three floors which were all accessible by stairs or a lift. There were 57 people using the service at time of inspection.
We last inspected St Martin’s Grange in November 2017. At that inspection the service was rated overall requires improvement with a rating of good in caring. At our last inspection we found that there were breaches in regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the third consecutive time the service has been rated requires improvement.
At this inspection we found the provider had made improvements to meet the requirements of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some improvements had been made but further improvements were required to demonstrate how the provider was meeting the requirements of regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People were not always protected from avoidable harm as safeguarding concerns had not been identified by management staff and referrals were not made to the local authority in a timely manner.
The registered manager had left the service and we had not received notification of this.
Accidents and incidents were not always reviewed and analysed to identify actions or trends.
There were quality assurance and auditing processes in place but they were not always effective. The service carried out a number of audits including infection control and medicines management, However, some audits had not always been completed or actions carried out fully. Following the inspection the interim manager supplied evidence that the outstanding audits had been completed and were up to date.
Improvements had been made to infection control procedures. However, actions identified in the audit were not carried out. People knew their responsibilities about the prevention and control of infections within the service. Staff had received training and there was protective equipment readily available.
Improvements had been made to risk assessments and they were individual and detailed which meant that staff understood safe practices which helped keep people safe.
Improvements had been made and medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with regular audits undertaken by clinical staff to ensure safety with medicines.
Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Registered nurses had the necessary permissions to practice.
The service understood their legal responsibilities for reporting and sharing information with other organisations but this was not always identified and done in a timely manner.
People had been involved in assessment of their care and support needs. They had their choices and wishes respected. The service had made improvements to work in partnership with professionals.
People were involved in what they had to eat and drink and were encouraged to do this independently. People were happy with the quality, variety and quantity of the food.
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 supported this practice.
The service actively sought to work in partnership with other organisations to improve outcomes for people using the service.
Care and support was provided by staff who had received an induction and continual learning that enabled them to carry out their role effectively including clinical training for registered nurses. Staff felt supported by their colleagues and were confident in their work. However, supervisions with management staff were not regular in some cases.
People, their relatives and professionals described the staff as kind and caring. People had their dignity and privacy respected and their independence promoted.
People had their care needs met by staff who were knowledgeable about their individual needs and how they communicated.
People had access to a wide range of both group and individual activities within the service. The service was working to involve people in the community.
The service had a complaints procedure and people were aware of it. People knew how to make a complaint and felt comfortable to do so.
The service had made improvements and a variety of activities were available and people could decide what they wanted to do. The service actively encouraged people to be involved.
Relatives were happy with the service. Professionals told us their confidence in the service was improving. The interim home manager and had an open, honest and positive culture that encouraged the involvement of everyone.
The service had undergone recent changes to the senior management but leadership was visible within the home. Staff spoke positively about the new management team and felt support was improving. The senior nurse actively kept themselves updated. The service was being supported by a peripatetic home manager who was supporting training within the service.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.