Archived: St Bathens Care Home

Updated 21 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on the 3 February 2015 and was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with three people living at St Bathens Care Home and two visiting relatives about their views on the quality of the care and support being provided. After the inspection, we spoke to a further three relatives on the telephone. We spoke with the registered manager and three staff including the chef. We looked at four people’s care records and documentation in relation to the management of the home. This included staff supervision, training and recruitment records, quality auditing processes and policies and procedures. We looked around the premises and observed interactions between staff and people who used the service.

Before our inspection, we looked at previous inspection reports and notifications we had received. Services tell us about important events relating to the care they provide using a notification. We asked the registered manager to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The registered manager returned the PIR but apologised that it was not completed in as much detail, as they had wanted it to be. This was because the home was experiencing staffing shortages and the registered manager was undertaking care shifts, to help cover the home.

Updated 21 April 2015

We carried out this inspection on 3 February 2015. Our last inspection to the service was in November 2013. The visit in November 2013 was to check that the provider had made improvements to the management of medicines. The provider had taken action to address all shortfalls we previously identified.

St Bathens Care Home provides accommodation to people who require personal care without nursing. The home is registered to accommodate up to 16 people. On the day of our inspection, there were eight people living at the home. St Bathens Care Home is a large, three storey Edwardian building consisting of single bedrooms, each with an en-suite facility. Some rooms are on a split level and can be accessed by a stair lift. A passenger lift is available to access the main floors for people with mobility difficulties. There is a spacious lounge leading to an enclosed garden and a separate dining room. There is a shower room on the first floor and an assisted bathroom on the ground floor.

There was a registered manager in post. 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 during the inspection.

The registered manager was open and transparent and explained the challenges the home was facing. This included general lack of investment and unclear future direction and vision. There were eight people living at the home and eight vacancies. This meant that the home was running at low occupancy, which lessened the income available to support the service. The environment was not well maintained with chipped paintwork and wall paper coming off the wall. Carpets were stained and frayed in places. The stair lift to access rooms on the mezzanine floor was taped up as it was not working. It had not been repaired. The registered manager was aware that investment was required to enhance the general environment. However, this was not forthcoming and action plans to address the issues were not in place. The environment did not attract new people to the service. The manager told us that this and insufficient marketing of the service did not enhance the home’s future.

Audits to monitor the service in terms of quality and risk were not in place. Risks associated with hot surfaces, hot water and falling from a height had not been identified and addressed.

Staffing levels were maintained at two care staff on duty throughout the waking day. Feedback indicated that these levels were sufficient to meet the basic care needs of people currently in the home. However, the lack of a cook after 2pm, impacted on the care staff as they were responsible for all teatime arrangements. There was no activities organiser which compromised the social opportunities available to people. There was only a small team of care staff which impacted upon the registered manager’s ability to ensure staffing levels were maintained. There was no flexibility to manage staff sickness or annual leave. Staffing levels were insufficient in the event of occupancy increasing within the home.

Staff told us they felt well supported by the registered manager and the team. However, formal systems such as staff supervision and appraisal to discuss work performance and development, were not in place. Staff had undertaken some training in 2014 but this was limited. Training in topics such as manual handling and infection control and those areas associated with older age had not been undertaken.

Arrangements had not been made to ensure the safe storage of people’s medicines, as the medicine trolley was stored in the shower room. This environment was too damp and warm, which presented a risk that the quality and effectiveness of the medicines, would be compromised.

People told us they felt safe and were happy with the care they received. Staff were attentive to people’s needs and showed consideration and respect. Staff undertook natural conversation and spoke to people in a polite, friendly and caring manner. They showed a desire to ensure people’s wellbeing and were clear about the ways to promote rights such as privacy and dignity.

People were encouraged to make decisions within their daily lives. Individual preferences and the support people required were clearly detailed within individual care plans. These were well written, up to date and easy to follow. Care charts were consistently completed and demonstrated areas such as adequate food and fluid intake and effective bowel management.

People were offered nutritious food, which was appetising and of a good quality. Snacks were served between meals and drinks were available at regular intervals and when requested. There were no meal or dessert choices routinely offered but people were offered alternatives if they preferred something different. Those people at risk of malnutrition were appropriately assessed and supported to gain weight by high calorie snacks and drinks.

You can see what action we told the provider to take at the back of the full version of the report.