St Cecilia's - Care Home with Nursing Physical Disabilities

We found the following examples of good practice:

The provider screened all visitors for symptoms of acute respiratory infection before they could enter the service. Visitors were supported to follow current government's guidance on good infection control practices including hand washing, sanitising, wearing personal protective equipment (PPE) and maintaining social distancing within the service.

There were enough staff to meet people’s needs and staff had received training on COVID-19, infection control and the use of PPE. There was a COVID-19 testing program in place in line with current guidance and people or staff who showed symptoms of COVID-19 were required and supported to self-isolate.

We observed staff wearing appropriate PPE and socially distancing throughout our visit. We saw the service was well maintained and clean throughout. The service had a dedicated housekeeping team that facilitated frequent robust cleaning schedules.

COVID-19 risk assessments were conducted for people who were at higher risk to ensure they could live and work safely within the service. The registered manager told us they worked well with the visiting GP, health care professionals, the Clinical Commissioning Group (CCG) and Local Authority to ensure people received appropriate care and support.

The provider had a COVID-19 specific contingency plan in place which they had followed throughout the COVID-19 pandemic. The registered manager told us there were no restrictions on visiting at the service in line with current guidance.

We found the following examples of good practice.

Arrangements were in place for relatives to visit the home safely in line with national guidance. All visitors, including health and social care professionals were screened for symptoms of Covid 19 before being allowed to enter the home. Visitors were supported to follow national guidance, wearing personal protective equipment (PPE) and to observe social distancing. The conservatory had been made into a safe visiting space for people which had access for visitors via an external entrance limiting unnecessary contact with people. The visiting area was cleaned thoroughly and with a UV machine between visits. A UV machine is a device that is used to destroy, repel or mitigate any bacteria and viruses. People were also supported to maintain regular contact with their friends and family members using computer media-based programmes that used video and audio connections.

The service followed national guidance when admitting people to the service to reduce infection risks. Staff ensured they and the people they supported were socially distanced where possible within the service. Staff had access to PPE to support people safely whilst minimising the risk of the spread of infection. Staff understood how to put on and take off PPE safely and appropriately in line with national guidance.

There were appropriate arrangements in place to ensure people and staff were routinely tested for Covid 19 in line with government guidance on testing. Staff received infection control, Covid 19 and PPE training and followed safe hygiene practices within the service. The provider had infection prevention and control policies and procedures in place which were up to date and reflective of national government guidance. During our inspection we observed the home was clean and hygienic.

St Cecilia's Care Home with Nursing Physical Disabilities 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. St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing care and support to 29 people. The home had 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.

Risks to people were assessed, recorded and staff managed identified risks safely. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take if they had any concerns. There were systems in place to ensure people were protected from the risk of infection. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed to meet people’s needs.

There were processes in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals that enabled them to fulfil their roles effectively. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People told us staff treated them well and respected their privacy. People were involved in day to day decisions about their care and had care plans in place which reflected their individual needs and preferences. People were supported to maintain relationships with people that mattered to them. There was a range of activities available to meet people’s interests. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met and there were regular volunteers who supported activities within the home. There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered through meetings and satisfaction surveys. People, relatives and staff spoke positively of the management and the improvements that had been made.

We undertook a focused inspection on the 21 September 2016 to check that the provider had met legal requirements. At the focused inspection we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notices we served. However some of the ratings for the service at that inspection remained unchanged as improvements were still required.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing support to 26 people. The home had a registered manager in post. However an acting manager was in place at the time of our inspection. 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.

At this inspection on 24 and 25 November 2016 we found continued improvements had been made and some were on going. Medicines were managed, administered and stored safely. Staffing levels within the home had improved since our last inspection; however the service was still recruiting to vacant posts at the time of this inspection. Improvements in assessing and reviewing risks to people using the service had been made, however further continued improvements were required. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place and accidents and incidents were recorded and acted on appropriately.

Staff received supervision and support on a regular basis and had received an appraisal of their performance. Staff training had improved, however we will continue to monitor the progress of staffs completed training. There were processes in place to ensure staff new to the home were inducted into the service appropriately. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. However some of these systems were newly implemented and so we will continue to monitor these to ensure continued good practice. People’s views about the service were sought and considered through residents meetings and satisfaction surveys when conducted.

As the provider had demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is therefore no longer in special measures.

We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to those regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Cecilia's - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection there were 28 people living at the home.

At this focused inspection on the 21 September 2016 we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were complaint with the warning notices we served. However some of the ratings for the service at this inspection remain unchanged as improvements are still required which we will follow up at our next comprehensive inspection of the service.

At the last comprehensive inspection the service was placed into special measures by CQC. At this inspection we found that there was not enough improvement to take the service out of special measures at this time and we will check on other breaches and improvements required at the next comprehensive inspection of the service.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing support to 29 people. The home had 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.

At this inspection on 3 and 4 May 2016 we found continued breaches in relation to staffing levels and the failing to provide staff with support, supervision and appraisals and a new breach of legal requirements in respect of the safe management of medicines. We served Warning Notice’s against the provider and the registered manager for some of the breaches found and will re-inspect the service to check they have complied with the notice. You can see information about action we have asked the provider to take at the back of the full version of this report.

There was not sufficient numbers of suitably qualified staff to meet people’s needs safely and in a timely manner. There had been no review of staffing levels and no increases in staffing levels following our last inspection on 17 and 18 June 2015. Medicines were not always managed safely. Risks to people’s physical and mental health needs were not always assessed and reviewed in line with the provider’s policy. People's care needs were not always reviewed in line with the provider’s policy and in response to their identified needs. Staff did not receive appropriate support, training, supervision and appraisal in line with the provider’s policy and to enable them to carry out the duties they were employed to perform. The provider did not have an effective system in place to regularly assess and monitor the quality of service people received or to address the improvements required as a result of our last inspection on 17 and 18 June 2015.

There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a social care environment. There were safeguarding adult’s policies and procedures in place and staff were aware of the potential types of abuse that could occur and the actions they should take. Accidents and incidents were recorded and acted on appropriately and there were suitable arrangements in place to deal with foreseeable emergencies. There were systems in place to monitor the safety of the premises and equipment used within the home.

There were systems in place to ensure staff new to the home were inducted into the service appropriately. The service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods to meet their needs and ensure well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff worked with people in a friendly and respectful manner and care plans contained guidance for staff on how best to communicate with people. People were supported to maintain relationships and independence. People were provided with appropriate information that met their needs and were supported to understand the care and support choices available to them.

People’s diverse needs and independence was supported and promoted. People had access to specialised equipment that enabled greater independence and met both their physical and emotional needs. People were supported to engage in a range of activities that met their needs and reflected their interests. People and relatives told us they knew who to speak with if they had any concerns or complaints. However the response to complaints requires some improvement. The provider took account of the views of people using the service through surveys.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found that people's support plans had been agreed by them and or their next of kin and demonstrated their involvement in the planning and delivery of their care. We saw that people's nutrition and hydration needs were being met, and we observed positive interactions between staff and residents during the lunchtime meal. The provider had systems in place to monitor equipment and support staff with relevant training to ensure the safe use of equipment. People that we spoke with told us they had observed an improvement in staffing levels due to recent recruitment of staff. We saw that the provider had systems in place to monitor staffing levels to ensure people's care needs were met. We found the provider had a complaints procedure in place and appropriate actions had been taken to address people's individual complaints.

One person we spoke with was not happy with the service, for example they waited a long time for their meals and for help changing the TV channel. They said there had been a lot of meetings but that things had not got better.

At our last inspection on 05 March 2012 we found improvements were needed in the planning of advanced care and the formal supervision and appraisal of staff. These improvements had been made at our inspection on 05 December 2012. We also found arrangements were in place for obtaining consent to treatment and care, and acting in people's best interests; ensuring people experienced care and treatment that met their needs and people were protected from the risk of infection; supporting staff to be competent in their jobs; and maintaining accurate and appropriate records.