Archived: St Teresa's Care Home

We found the following examples of good practice.

There were robust procedures in place to ensure visitors could enter the home safely, with checks made upon entry, including temperature checks and a requirement to provide a negative lateral flow device (LFD) COVID-19 test result.

Relatives were given information about visiting and were kept updated about any changes in visiting guidelines in the home. Relatives were supported to become essential care givers in line with current guidance. This ensured people would be able to have a visitor even if the home was advised to restrict visits in the event of a COVID-19 outbreak.

There was a designated testing area for staff and visitors. The service was taking part in regular COVID-19 testing for people and staff in line with current guidance.

The home was clean, hygienic and free from odour. The home was kept clean by an external cleaning company who visited the home on a daily basis. Along with the care staff, the home was supported by a team of 'sisters' who lived in the home and supported staff were needed, including cleaning across the home.

The head of care carried out daily checks across the service, which included reminders in daily handovers and observations across the home to help ensure staff understood their responsibilities and were following best practice. A staff member said, "Along with the IPC training we have, we discuss in the handover and get reminders. We are supported well and if we see staff not wearing a mask properly, I would feel comfortable challenging them about it as we are regularly told."

Staff had ongoing IPC training and we observed staff following best practice throughout the inspection. Staff confirmed they had enough PPE and there were posters displayed across the home with reminders about PPE requirements and regular hand hygiene. We saw COVID-19 guidelines and IPC measures were also discussed in team meetings.

The staff team used the COVID-19 outbreak as a learning experience and discussed how they could improve their everyday IPC practices. We saw the provider had worked closely with the local authority and public health team to discuss the outbreak and had supportive meetings for further advice and guidance.

Staff told us they felt well supported in their role and highlighted the positive working environment across the home. One staff member said, "We support each other and help each other, it is very good. We can also contact the regional manager as well."

As there was no current registered manager at the home, the head of care also told us they had been well supported by the quality assurance team and they had always been available for advice if needed.

St Teresa's Care Home provides accommodation and support for up to 26 people. At the time of our inspection 25 people were living there. The home was adapted from several neighbouring properties with accommodation over four floors. The home has been run by the Sisters Hospitallers of the Sacred Heart of Jesus for nearly 90 years.

People’s experience of using this service

People, relatives and staff all gave us positive feedback about their experiences here.

Comments we received from people and their relatives about the staff and the sisters were universally positive and included, “They are fantastic and will help with anything” and “I couldn’t single anyone out, they are generally wonderful people”.

Staff understood the risks faced by the people they cared for and people’s risk assessments were documented and updated regularly. However, we have made a recommendation that the home’s falls prevention and management policies and procedures are reviewed.

People's medicines were safely managed and stored. Records were kept and checked daily.

The home was clean and well-maintained. Fire safety checks and drills were regularly completed. There were regular, documented safety checks and external assessments of safety and equipment.

People's independence and dignity was promoted. Their risk assessments and support plans were written in a positive, person-centred way in their own voice. There were regular reviews involving the person and their relatives or representatives appropriately.

Some people had lived in the home for many years and there was a low turnover of staff. This meant people had continuity of care and were supported by staff who knew them well and understood their needs. A staff member said, “It's like a family. It's like home here.”

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 enjoyed working here. They told us, “I love it” and “It’s the best place to work.” They had regular training, supervision and appraisal. Staff we spoke with were knowledgeable and confident in their roles.

At the time of our inspection, the registered manager was on authorised leave and was unavailable. There was an effective senior team in place led by the head of care who were managing the service effectively in the absence of the registered manager.

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 24 December 2018) and there were multiple breaches 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.

Following our last inspection in April 2016 we rated the service ‘good’ overall. At this inspection, we found concerns in areas relating to safe premises, medicines management and record keeping. As a result, we rated the service ‘requires improvement’ overall.

St Teresa’s is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home has been run by the Sisters Hospitallers of the Sacred Heart of Jesus for more than 85 years and provides residential care for 26 older people. The building has three floors and a basement and is fully accessible, with a ramp to the main entrance and a lift serving all floors. Most rooms have en-suite bathroom facilities. There were 24 people living at the home on the day we visited.

The service has 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.

People's needs were assessed before they moved into the service and further assessments were conducted once people were living in the home and feeling settled. This information was used to develop individual support plans. People and their relatives were involved in decisions about how care and support was provided.

Staff completed a range of risk assessments in relation to skin integrity, mobility, nutrition and continence. However, risk assessments were not always being reviewed on a regular basis and related contemporaneous monitoring records were not always in place.

Staff were not always following safe practice regarding the management of people's prescribed medicines. Staff competency in relation to safe medicines practice was not being regularly assessed.

The provider was in the process of carrying out maintenance works as recommended by the London Fire Brigade. Not all staff were aware of the correct fire evacuation procedures.

The provider had policies and procedures in place that ensured staff had guidance if they needed to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation to restrict a person's liberty in their best interests. However, applications were not always being reviewed and renewed when needed.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe and told us they would report any concerns they may have to the management team.

People felt the service was safe and homely. People liked their rooms and told us the home was clean, spacious and comfortable. Most of the relatives we spoke with provided positive feedback as to the way care was delivered to their family members and the way in which the home was managed.

Staff were mindful of people’s need for privacy, promoted their independence and encouraged people to do the things that were important to them.

People had enough to eat and drink although views about the meals served were not always positive.

There was an activities co-ordinator in post and a programme of activities on offer to ensure people were able to maintain their hobbies and interests.

Staff recruitment processes were followed ensuring people received care and support from staff who were suitable for employment at the service. Sufficient numbers of staff were deployed to the service to meet people's needs and staff felt supported in their roles.

Staff completed an induction and were required to attend training and supervision sessions throughout their employment. However, the training matrix showed that some mandatory training was now overdue.

People and their relatives were provided with information about the service which included details of how to make a complaint. There were systems in place to investigate and resolve complaints, and where applicable to learn from these incidents.

Staff worked closely with healthcare professionals and made appropriate referrals when needed. People were supported to discuss their end of life wishes when they felt comfortable doing so.

Systems were in place to improve the safety and quality of the service but there were gaps in these systems. Quality audits were not always identifying, managing and resolving issues we highlighted during the inspection process.

We found breaches of the regulations relating to premises, safe care and treatment, consent and governance. You can see the action we have told the registered provider to take at the end of this report.

We made two recommendations in relation to infection control and prevention and staff training.

St Teresa’s Care Home was last inspected in April 2013 where we found that the provider was meeting the regulations checked.

The service had a manager in post who had completed the application and interview process to become the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received excellent care in a way that was personalised and responsive to their changing needs. Risks to people were managed in a proactive way which enabled them to live independent and fulfilling lives. Staff worked closely with community health professionals and therapists to maximise people's well-being.

People had confidence in the staff and the sisters who supported them and felt safe in their care. Staff treated people with kindness and took steps to promote their privacy and dignity at all times.

People had control over their lives and spent their time as they wished. The provider offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives.

People were provided with a variety of meals and kitchen staff catered for any specialist dietary needs or preferences. Mealtimes were viewed as a social occasion, but equally any choice to dine alone was fully respected.

Staff enjoyed working at the service and felt well supported in their roles. They had access to training which equipped them to deliver their roles effectively. Staff ahd supervision and appraisals. However, these sessions were not always taking place in line with the provider's policies and procedures.

The culture of the home was open and people felt confident to express their views and opinions. The manager and head carer provided clear leadership and direction to staff and were committed and passionate about the quality of care provided.

Quality assurance processes were in place and action plans to improve the service were prioritised and completed quickly. However we found that Do Not attempt Resuscitation (DNAR) orders in place were not always completed in full and that these records were not always consistent.

Staff completed risk assessments for people in relation to falls, moving and handling and nutrition. People had individual care plans that were based on their risk assessments. Each person had a named keyworker and where possible, people had signed their care plans.

People told us that they were "satisfied" with the quality of care that they received. One person said that they were "duly impressed" and another said that the home was "well managed".

There was a policy in place on safeguarding vulnerable adults. This included the contact details of who to contact should there be concerns for a person's welfare. Most staff had attended safeguarding training knew how to recognise the signs of abuse.

Recruitment procedures for new staff included an application and interview process, pre-employment checks, including Disclosure and Barring Service (DBS) checks. People were complimentary about the care staff. One described staff as "kind and understanding" and other said 'they are always professional'.

St Teresa's had a policy for the maintenance of care records. Records were kept securely on a password protected computerised system, which staff could access from a variety of locations in the home.