St Paul's Residential Home

Updated 14 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 Inspectors 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.

Service and service type

St Paul’s residential Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Paul’s Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. Whilst the provider remained the registered manager, the new manager had remained in post since our last inspection and anticipated applying for registration with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who use the service and 2 relatives. We also spoke with the provider, manager and 7 care staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. These included 7 people's care records and multiple medication records. We looked at 4 staff files in relation to recruitment and supervision. A variety of records relating to the management of the service, including governance systems, policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at policies and procedures and quality assurance records. We gathered feedback from 3 professionals, 10 relatives and 1 person who used the service.

Updated 14 June 2023

About the service

St Paul's Residential Home is a residential care home providing care and support for up to 32 older people across four adapted buildings. At the time of our inspection, 29 people were living at service.

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

We saw substantial improvements had been made since our last inspection. Since the last inspection, quality assurance systems to monitor the safety of the home through audits, had been strengthened. However, we found some more time was needed to ensure the recording of the provider's medicine systems, repositioning records and recruitment processes were effectively implemented and embedded in practice.

We have made a recommendation about the recruitment of staff.

Aside from the concerns we noted and shared on inspection, risks to people were now assessed and managed safely and monitored routinely.

People were protected from the risk of abuse, and the provider had systems and processes in place to safeguard people. People and relatives told us they felt safe and were positive about the staff who supported them.

People, relatives, staff and professionals spoke positively about the leadership of the service and told us they had seen significant improvement.

People were supported to have maximum choice and control of their lives and staff 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 (15 November 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 Regulation 12 of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014 or Regulation 18 (Notifications) of the Care Quality Commission (Registration) Regulations 2009.

At this inspection we found the provider remained in breach of regulation 17. Although we found substantial progress had been made, more time was needed for some actions to be completed and embedded before we could judge that the provider's actions had been effective in making and sustaining improvement.

When we inspected 5 July 2022, we recommended the provider consider current guidance related to legionella risk management and take action to update their practice accordingly. In our subsequent inspections risks relating to the management of legionella had not improved. However, at this inspection we found improvements had been made to legionella risk management and practice.

When we inspected 5 July 2022, we also recommended that the provider strengthen the systems in place to gather and communicate how feedback has led to improvements. In our subsequent inspections we found the provider had not made the necessary improvements. However, at this inspection we found improvements had been made to strengthen their system in relation to feedback.

Why we inspected

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. 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.

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 Paul’s Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to good governance 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.