St Martins

St Martins is a residential care home providing accommodation and personal care to up to 21 people. At the time of our inspection there were 15 people living the service. The property is a 2-storey building with a large rear communal garden.

People’s experience of using this service and what we found

People were at risk of infection due to poor infection control practices. Premises and equipment were not clean or hygienic and staff were not clear on their responsibilities. People were at risk from health and safety concerns which had not been identified or acted upon in a timely manner.

Whilst people told us they felt safe, risks had not always been assessed or monitored. Whilst attempts were made to reduce risks, the actions had not been clear or co-ordinated. Identifying and reporting of risks, issues and concerns were unreliable and inconsistent. Where issues had been highlighted action was slow to be taken. The provider did not have the appropriate policies and procedures in place to guide staff on how to deliver person centred care in line with latest legislation and best practice guidance.

Medicines were administered safely and in line with people’s wishes. People were supported to eat and drink enough to maintain a well-balanced diet. People were supported by trained and experienced staff who were recruited safely. Safeguarding systems and processes were in place and people were protected from the risk of abuse, harm and neglect.

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.

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 23 February 2023).

Why we inspected

The inspection was prompted in part due to concerns received about health and safety concerns related to the premises and fire safety. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the health and safety of the premises. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had a booking system for visitors in place to ensure the visits were facilitated safely and in line with the government’s guidelines. Visitors were supported to wear a face covering when visiting and sanitise their hands upon entering the home.

During an active COVID- 19 outbreak the provider supported people with using alternative forms of maintaining social contact with friends and relatives; for example, meeting at closed windows and using a phone to communicate with them.

The provider ensured sufficient supplies of personal protective equipment (PPE) were made available to staff and visitors. We observed staff wearing correct PPE.

People were admitted to the service safely. The provider ensured people had been tested for COVID-19 before the service agreed to admit them.

The provider supported staff and people to access testing for COVID-19, as per the Government guidance.

Staff were up to date with COVID-19 related training.

St Martins Care Home is registered to provide accommodation and personal care for a maximum of 21 people, including people living with dementia in one adapted building. There were ten people living at the service at the time of our inspection visit.

People’s experience of using this service and what we found

Since the last inspection, there had been changes in the management of the service and positive improvements being made. A decoration and refurbishment plan had commenced. Improvements to the safety of the environment had also been completed and in line with recommendations made by the fire and rescue service. Support and oversight by senior managers had significantly improved. People, relatives and staff were positive and complimentary of the current management team, leadership and support.

People were supported by staff who knew how to protect them if they suspected they were at risk of abuse or harm, and how to report any safeguarding concerns. Risks associated with people’s care needs and health were known and understood by staff. Guidance for staff however, lacked detail in places, but the manager took action to address this. There were enough staff to meet people’s current dependency needs and recruitment checks were completed before staff commenced their employment. People received their prescribed medicines when they needed them. Staff followed best practice guidance in the prevention and control of infection. Lessons were learnt when things went wrong, and improvements were being made to the analysis of incidents to understand any themes and patterns.

Recognised assessment tools were used to assess and monitor people’s ongoing care needs. Staff received an induction, and improvements were being made to staff training and support. 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 received care from staff who knew them well and understood their routines and what was important to them. Staff were kind, caring and compassionate, and they provided care that respected people’s dignity and privacy. Independence was encouraged and supported.

Staff had guidance about people’s social history, including work, family, pastimes, interests and hobbies. This included people’s diverse needs and information about their preferred ways of communicating and any sensory needs. People had access to the provider’s complaint procedure. Consideration of people’s wishes regarding their end of life care had been discussed with them.

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 Requires Improvement (published 22 March 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People were not always kept safe. People were not always kept safe due to environmental risk factors not being managed effectively.

Staff were well trained and training was kept up to date and monitored by the registered manager. Staff knew people who they cared for well and were aware of their likes and dislikes. Staff treated people with dignity and respect and provided care relevant to their needs.

Staff showed a genuine motivation to deliver care based on people’s preferences and likes. People were observed to have a good relationship with the staff team.

The provider supported staff in providing effective care for people through person centred care planning, however supervision was not being carried out on a regular basis. The registered manager was starting to make some positive changes to systems and processes.

People had good healthcare support from professionals. When staff noticed a concern they involved healthcare professionals, this included support in nutrition and pressure care.

The registered manager started in November 2018 and had not received the support or training to give them the skills and knowledge on all aspects of the role. However, they were passionate about care and keeping people safe from avoidable harm. They had also formed good relationships with people, relatives, staff and visiting professionals. People spoke highly of the registered manager and were comfortable discussing anything, being assured that any concerns would be taken seriously and resolved where possible.

Most of the service of equipment was carried out within timescales and checked regularly. However, some safety checks were not. This posed a risk to the overall safety of the home.

About the service:

St Martins is a care home that provides personal care for up to 21 people, some of whom were living with dementia. At the time of the inspection there were 10 people living at the service. Most people were living at the service permanently and some spent short periods there for respite.

Why we inspected:

This was a planned comprehensive inspection which was unannounced. This was the first inspection at St Martins since it was registered in September 2017 by the current provider.