Archived: St Nectans Residential Care Home

We found the following examples of good practice.

There were adequate personal protective equipment (PPE) supplies in the service, this was located at designated points around the home to ensure staff had access to required PPE at all times. Staff used PPE appropriately. The registered manager had employed an extra member of housekeeping staff to ensure there was a designated housekeeper assigned to each floor of the home. Staff followed a cleaning schedule. All staff ensured regular disinfection of frequently touched surfaces of the home for example handrails and bannisters. Social distancing rules were being followed where appropriate.

The registered manager had followed current guidance in relation to infection prevention and control. Measures had been implemented to ensure people entering the home did so following current guidance regarding PPE and social distancing. This included temperatures being taken on arrival and the completion of a COVID-19 risk assessment.

Visiting for relatives was by appointment only. Creative measures had been implemented to support safe visiting for each person’s designated relative. Visitors entered by a separate external door to an enclosed porch. The inside door was opened, and a Perspex screen was in place to separate the visitor and resident. Visitors did not have to enter the home and the person being visited could sit inside in the warm without leaving the building. This meant that visits could continue throughout the winter.

Regular Covid-19 testing was taking place regularly for people and staff. Staff had access to guidance and policies regarding Covid-19 and infection prevention and control. The registered manager carried out checks and audits in relation to infection prevention and control and implemented any actions identified.

Further information is in the detailed findings below.

St Nectans Residential Care Home is registered to provide nursing, care and accommodation for up to 35 people. There were 24 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and Parkinson’s disease. Most people needed support with their personal care, eating, drinking or mobility.

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

People told us they experienced safe care. People told us, “I am comfortable here, it’s clean and I’m very happy here.” Another person said, “The staff are very caring, polite and respectful.” A relative said, “All the staff are very approachable, and I have got to know them well they will always make time to talk to us.” We observed, and people told us that staff met their needs with care and kindness.

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by suitably trained and knowledgeable staff, who had been assessed as competent.

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. Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were knowledgeable about the people they supported and had built trusting and meaningful relationships with them. Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s a lovely home, we are lucky because we have great residents and a really supportive team to work with.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One staff member described the service as, “Like an extended family, the atmosphere is good. We always find laughter is the best medicine and you hear lots of laughter here.” People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with family and members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as pictures and objects of reference, to gain their views. People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. End of life care was delivered empathetically and with respect and dignity.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

The provider used a range of quality assurance systems to check people and their relatives were satisfied and confident in the standard of care provided within the home. The service had systems to continuously monitor, assess and improve the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was Good (published 01 December 2016).

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.

The home is owned by St. Nectans Residential Care Home Limited and is located in the centre of Bexhill on Sea, East Sussex.

At a comprehensive inspection in June 2015 the overall rating was requires improvement. Breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found there were risks to people due to unsafe management of medicines and care plans that were not accurate and up to date. There were also some environmental issues that had had the potential to place people at risk. People in the service had not been protected against unsafe treatment by the quality assurance systems in place.

During our unannounced inspection 21, 24 and 26 October 2016, we looked to see if improvements had been made. We found that many improvements had taken place and the breaches of regulations had been met. There was still some embedding to do in respect of peoples care plans and the planned introduction of a new style care plan will assist this process.

At the time of the inspection there were 29 people living in the home with a further two people due to arrive for a short stay before returning home.

There was no registered manager in post. The registered manager resigned in August 2016. A new manager has been in post for four weeks and is in the process of submitting her application to 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 spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People had confidence in the staff to support them and we observed positive interactions throughout our inspection.

This inspection found that people were safe. Care plans and risk assessments were person specific and reflected peoples current needs. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs. Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. The environment was clean, well maintained and safe. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Since the last inspection, the provider had introduced robust systems for quality assurance reviews to measure and monitor the standard of the service and drive improvement. This included the employment of a quality assurance manager.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. It’s nice here.” A visitor said, “Lovely staff and it’s a real home here.”

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff retention was good and most staff we spoke with had worked at St Nectans for many years.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager and deputy manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and dementia. Staff had received both one to one and group supervision meetings with the manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “I like the food, its nice food.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People could choose how to spend their day and they took part in activities in the home when they wanted to. Staff told of peoples particular favourites, such as ball games. People themselves told us they enjoyed the activities, which included singing, puzzles and films. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat you well here.” Another said the staff supported them with their hair and make-up and it made them feel ‘good’.

People were encouraged to express their views and complete surveys, and feedback received showed people were satisfied overall and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, I tell the staff.”

Staff were asked for their opinions on the service and whether they were happy in their work. Staff enjoyed their work and felt that they were a family. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns.

People told us that they were treated with kindness and respect and that they had given consent to the care that was given.

We examined four care plans and saw evidence that delivery of care was person centred. Care plans and activities were designed and carried out to give people new experiences and independence while keeping them safe.

We found good management processes in place in relation to obtaining, storing, administering and disposing of medicines. Staff administering medication were appropriately trained and gave support to people where required.

We found there were robust recruitment processes that ensured there were sufficient experienced and qualified staff employed to meet people's needs.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints raised were resolved to people's satisfaction with information used to change practice where necessary.