This announced inspection took place on 15 and 23 November 2017. This was the provider's first inspection since they became registered providers for St Clare’s Court. St Clare’s Court is a ‘care home’. People in care homes 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. St Clare's Court is registered to provide accommodation and personal care to 58 people.
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.
The service provided outstanding end of life care that had a positive impact on people and their relatives at this sad and distressing time. The provider supported relatives and friends in a caring way offering practical support and accommodation when necessary. Staff provided on-going support for bereaved relatives to return to the home whenever they wished to.
There were systems in place to keep people safe. We found staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the registered manager’s audit process.
The provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and portable appliance tests had been completed. A contingency plan was in place to ensure staff had information and guidance in case of an emergency. People had up to date personal emergency evacuation plans (PEEPs) in place that were available to staff.
There were robust recruitment processes in place with all necessary checks completed before staff commenced employment. The registered provider used a dependency tool to ascertain staffing levels. We found staffing levels to be appropriate to needs of the service, these were reviewed regularly to ensure safe levels.
Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. We found some gaps in medicine administration records (MAR). Medicine audits were completed regularly. Policies and procedures were in place for safe handling of medicines for staff to refer to for information and guidance. The registered manager addressed the gaps in the MAR with staff during the inspection.
People’s physical, mental and social needs were assessed on admission and used to develop plans to support people’s outcomes. Care records contained information which took into account current legislation and national guidance.
Staff training was up to date. Staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development.
People’s nutritional needs were assessed and we observed people enjoying a varied diet, with choices offered and alternatives available. Staff supported people with eating and drinking in a safe, dignified and respectful manner. People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice
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People were supported by kind and attentive staff who clearly knew people well. Staff discussed interventions with people before providing support. Advocacy services were advertised in the foyer of the service accessible to people and visitors. Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people.
Care plans were individualised and person centred. Plans were reviewed and evaluated regularly to ensure planned support was current and up to date.
The registered provider had an effective quality assurance process in place to ensure the quality of the care provided was monitored. People and relatives views and opinions were sought and used in the monitoring of the service.
People, relatives and staff felt the registered manager was open and approachable. The provider recognised the value of staff and gave regular achievement awards.