St Anselm's Nursing Home

St Anselm’s Nursing Home is a residential care home providing personal and nursing care to up to 26 people. The service provides support to adults who have mental health needs. At the time of our inspection there were 25 people being supported in one large adapted building.

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

People told us they felt safe, and staff were kind. Relatives told us, they were happy with the support people received and their relatives appeared happy and content.

Medicines management had improved since the last inspection, medicines records were accurate, and people received their medicines as prescribed.

Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to mitigate the risks. Accidents and incidents had been recorded and analysed to identify patterns and trends, action had been taken to reduce the risk of them happening again.

There were enough staff to meet people’s needs, who had been recruited safely. People and relatives told us, staff supported them to go to church, out to appointments and shopping trips.

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.

Checks and audits had been completed on the quality of the service. People, staff and relatives had been asked their opinion of the service and to make suggestions. There were systems in place to protect people from abuse and discrimination, the registered manager understood their responsibility to report any concerns to the local safeguarding authority.

People, staff and relatives told us the provider and registered manager were approachable and they were comfortable to raise any concerns with them. Relatives confirmed they were kept informed of any accidents or changes to their relative’s needs.

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 requires improvement (published 29 April 2022). 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

We received concerns in relation to how people were supported to make decisions about sharing bedrooms with people they did not know. We carried out an unannounced focused inspection of this service on 15 March 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Anslem’s Nursing Home is a residential care home providing personal and nursing care to up to 26 people who have mental health needs. At the time of our inspection there were 24 people being supported in one large adapted building.

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

The service had improved since the last inspection. However, medicines were still not managed safely, some people had not received their medicines as prescribed. Medication audits had been effective in identifying shortfalls, but action taken had not rectified them.

Checks and audits were now completed on all areas of the service including the environment. Accidents and incidents had been recorded and analysed to identify any patterns and trends. These checks had been effective in driving improvement within the service including clinical practice and environmental safety.

The environment had been improved. Carpet had been replaced with washable flooring throughout the corridors, communal areas and some bedrooms.

Staff were now recruited safely, and there were enough staff to meet people’s needs. People were protected from discrimination and abuse. Staff understood their responsibility to report any concerns they may have.

Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to mitigate the risks. People were referred to healthcare professionals when their needs changed.

Relatives told us their loved ones were safe and received person centred care which improved their wellbeing.

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 and update

The last rating for this service was requires improvement (published 26 April 2019). 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 the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 1 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, premises and environment, good governance and fit and proper persons employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remained Requires Improvement. This is based on the findings at this inspection.

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

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 service was clean and extra cleaning duties were being carried out such as regular deep cleaning and cleaning of areas that were often touched. Such as door handles, stair rails and light switches.

We saw staff using PPE appropriately. Fully equipped PPE ‘stations’ had been distributed around the service to ensure PPE was available to staff when needed.

People had been given information to help them understand the changes that had been made due to the pandemic. Changes included staff wearing personal protective equipment (PPE), such as masks, aprons and gloves and the importance of social distancing and isolating in their rooms when necessary.

The provider and registered manager were following advice and guidance from other agencies about infection control and prevention and had updated staff training and practice accordingly.

Further information is in the detailed findings below.

St Anslem’s nursing home is a care home that was providing personal or nursing care to 26 adults who have mental health needs and may be living with dementia.

People’s experience of using this service:

• People indicated and told us they felt safe living at the service, however, not all areas of the service were consistently safe.

• Staff administered people’s medicines, but these were not managed safely, putting people at risk of not receiving their medicines as prescribed.

• People were supported by sufficient numbers of staff who knew them well and their choices and preferences, however, staff had not been recruited safely.

• People were living in an environment that smelt of urine and the carpets were worn and stained.

• Environmental checks and risk assessments were not consistently recorded or updated, to make sure that the environment was safe for people.

• Checks and audits on the quality of the service had not been consistently completed and were not effective in identifying the shortfalls identified at this inspection.

• When accidents and incidents occurred, action was taken to reduce the risk of them happening again and these actions had been effective. However, they had not been analysed to identify patterns and trends.

• Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to manage behaviour and keep people safe.

• Staff and the registered manager understood their responsibility to protect people from abuse.

• People’s needs were assessed creating a detailed care plan, which was reviewed regularly. Where possible people were involved in planning their care.

• People were encouraged to make decisions about their daily lives and supported to live their lives with the least restrictions possible.

• People benefited from access to healthcare professionals and staff followed their guidance to keep people as healthy as possible.

• People knew how to complain, their concerns were investigated and used to develop their care plans.

• We observed people being treated with kindness and respect. People were supported to be as independent as possible.

• People benefited from an open and relaxed atmosphere in the service. They appeared to be comfortable in the company of the registered manager, who knew and understood their needs.

Rating at last inspection:

Good (report published 25 October 2016).

Why we inspected:

This was a planned inspection planned on the rating of the last inspection. We found that the service no longer met the characteristics of Good. The domains of safe and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

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

St Anselm’s Nursing Home is an Edwardian style property situated in Walmer, near Deal. The service provides accommodation, support and nursing care for up to 26 people with a variety of mental health and physical health needs. At the time of inspection there were 25 people living at the service.

A registered manager was in post. 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. St Anselm’s is owned by a partnership of four people, two of whom work on a daily basis at the service. The remaining two partners visit regularly.

At the last inspection in July 2015, the service was rated ‘Requires Improvement’, there was a breach in the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider had not consistently notified CQC of the outcomes of Deprivation of Liberty Safeguards (DoLS) applications made to the local authority. We asked the provider to make improvements. The provider sent CQC a plan of actions to address the shortfall. The provider had submitted DoLS applications to the relevant authority. The provider had notified CQC when DoLS applications had been authorised. At this inspection the actions had been completed and the breache had been met.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Some people had an authorised DoLS in place and these were regularly reviewed.

People told us they felt safe living at St Anselm’s Nursing Home. Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

The provider had a recruitment policy and processes in place to make sure that staff were of good character. Staff completed regular training and had one to one meetings to discuss their personal development. There were consistent numbers of staff deployed to meet people’s needs.

People enjoyed a choice of healthy food and told us they had enough to eat and drink. People’s mental and physical health was monitored and staff took prompt action if they noticed any changes or a decline in health. Staff worked closely with health professionals and followed and guidance given to them to ensure people received safe and effective care.

People said they were happy living at the service and that their privacy and dignity were respected. Staff spoke and engaged with people in a caring and compassionate way. People were involved in the planning or their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them. People’s choices regarding their end of life care was recorded and regularly reviewed.

People told us they had no complaints about the service and that they would speak with staff if they were concerned about anything. There was a complaints system and people knew how to complain. People’s friends and family could visit when they wanted and there were no restrictions on the time of day.

There was a range of activities available on a group and a one to one basis. People were supported to continue with their interests. A wheelchair accessible vehicle was used by staff to support people to medical appointments, trips out and visits home. People were encouraged to maintain links with the local community.

People, staff and health professionals felt the service was well-led. There was effective and regular auditing and monitoring. People, relatives and health professionals were asked their views on the quality of the service provided.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We last inspected St Anselm’s Nursing Home in July 2015 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. At this inspection this breach had been met and no further breaches were identified.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe. People told us that they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of the inspection, one person was subject to Deprivation of Liberty Safeguards authorisation.

The provider had taken action to address the areas of non-compliance found at the last inspection of July 2013, when people were not protected from the risks associated with medicines.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and their representatives were involved in the writing of their care plans. People said that they had been involved in writing their care plans and that care plans reflected their current needs.

Is the service caring?

The service was caring. People told us, "I love it here. It's my home". A visitor told us, "They (staff) are so caring".

People who use at the service and their families were asked to complete a satisfaction survey by the provider. Results from surveys were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive. The home worked with other agencies and services to make sure people received care that met their needs.

People knew how to make a complaint if they were unhappy. Complaints were managed in a satisfactory and timely manner.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service was well-led. The service operated a quality assurance system which identified and addressed shortcomings.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

We saw some medicines were not administered to people as they had been prescribed. For example one person who had been prescribed a strong painkiller every three days, had on two occasions, had four days between doses. Records showed that the person had received this medication correctly following these two events.

The staff told us that consent for care and support was obtained from people using the service or their representatives during discussions about the care and support the person needed. We saw signatures confirming people's agreement within the care plans.

Friends, relatives and visiting professionals told us that the staff at St Anselms were kind, considerate and helpful to the people who used the service.

We saw that there was enough equipment to help people with their daily lives. The equipment was serviced and checked regularly to ensure it was fit for use. The staff were able to demonstrate knowledge about the equipment and what to do when problems with the equipment occurred.

There were effective recruitment and selection processes in place. The service had systems in place for the recruitment and management of staff. Staff working at the service had had the necessary recruitment checks.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These checks included asking relatives for their views about the new staffs performance.

A carer said, "I am very happy with the care (my relative) receives. The staff are really, really kind in their manner and I always have complete confidence that (my relative) is okay here. It's got a nice homely atmosphere."People looked happy and relaxed.

People promptly received the help they needed including being assisted to use the bathroom. When the call bell rang from people's rooms it was answered quickly.

People's relatives told us that they thought the service was 'Excellent'. They said that they had seen improvements in their relatives since they had been at the service. We were advised of one particular person who had come to the home with a life expectancy of a few months: this person had been living at the home for three years.