St Anne's - Saltash

We found the following examples of good practice.

The service had sufficient supplies of Personal Protection Equipment (PPE) and was available throughout the service. This included a two week emergency pack of supplies if the supply was not able to be delivered as normal. Signage was in place throughout the home regarding the requirement for wearing PPE. Additional signage identified the PPE to be worn when a person was assessed at higher risk of infection.

The home was clean, hygienic and uncluttered in appearance. There were procedures to ensure that infection control risks were reduced. For example, increased cleaning of communal areas and weekly audits to ensure cleaning procedure where followed thoroughly. All high contact areas were cleaned regularly throughout the day and night staff also had a cleaning rota.

Procedures were in place regarding self-isolation for people and staff if they showed symptoms of COVID-19, or who were admitted to the home from the community or other health care provision. The admission procedure had been reviewed and developed to reduce the risk of infection from COVID-19.

Due to the current national lock-down, visiting was currently restricted. Friends and families were provided with information on the current restrictions. Where visiting was permitted inside the home for compassionate reasons. For example for people receiving end of life care, suitable infection control procedures were in place. Visitors were accompanied around the building by staff, and only able to be spend time in their relative’s bedroom. Visitors were screened for COVID-19 prior to entering the home. Visitors were required to wear masks and PPE.

The service had a summer house set up in the grounds to enable visitors to meet people safely with a clear screen installed to minimise the risks of infection. This enabled social distancing to be maintained. People were supported to speak with their friends and family using IT and the telephone as necessary.

Appropriate testing procedures for COVID-19 had been implemented for all staff and people who used the service following national guidance regarding the frequency and type of testing. Arrangements had been made to enable people and staff to access the vaccine.

Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19. Staff were provided with verbal and emailed information when best practice recommendations were updated. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.

The registered manager had completed risk assessments regarding the environment and risks to staff and people who used the service. The registered manager was aware of staff members who were at increased risk from COVID-19 and a plan had been agreed with staff should there be an outbreak in the home.

The provider had a detailed contingency plan to manage any outbreak of COVID-19.

St Anne’s provides accommodation with personal care for up 33 people. There were 33 predominantly older people using the service at the time of our inspection.

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

St Anne's provided outstanding dementia care and support in an extremely dementia friendly environment. Bathrooms were warm, cosy and decorated making it look more like a domestic bathroom. A great deal of co-production had taken place between staff and people, working together to enhance the environment. Each corridor was themed. The registered manager told us, “I want the corridors to have some use, I don’t want them just to be corridors.”

The entrance of the service was designed as a village square, complete with sweet shop, post office, bank and book shop. All were accessible for people to visit and purchase items or receive help with their finances and queries.

The registered manager had focused on further improving people’s dining experience. A tea service delivered on a tray to each person had been added since the last inspection. At lunch time one staff member told us, “We make sure there is space between the tables. Everything is laid up, so they have what they need, we set it in the same way, so it's familiar, even make sure we put the table cloth the right way or it could cause confusion. One man didn't like green, so we waited to see where he wanted to sit and then put a cream table cloth on.”

Staff provided a visual choice of meal as well. ‘Show plates’ of each meal option were bought to people to help them choose what they would like to eat.

To further increase their knowledge staff had recently received training on the International Dysphagia Diet Standardisation Initiative (IDDSI) Dysphagia is a term used to describe swallowing difficulties. IDDSI is a global standard with terminology and definitions to describe the texture of food and thickness of liquids provided to people with dysphagia.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. The registered manager encouraged new people to join the staff team by becoming apprentices. The apprentice role meant people without care worker experience could work for 30 hours a week alongside and in addition to existing care staff, providing personalised activities and meal support.

People living at the service helped the registered manager with the interview process. Prospective staff were shown around the service and spent time with people. Later the registered manager would seek the views of the people who had met the candidate.

People told us they felt safe being supported by staff. Staff understood risks to people and how to help reduce them. Systems were in place to safeguard people. People received their medicines on time from staff who had received training in medicines administration.

Infection control measures were in place to prevent cross infection. A member of staff, who was the appointed link person to the project, had been acknowledged in a Plymouth university hygiene study paper having supported the research into how the robotic pets, used at the service, could be kept hygienically clean and not pose an infection risk.

St Anne’s continued to support an intergenerational dementia awareness initiative, The Archie Project. The aim of this project was to engage children at a young age, dispel any fear of dementia, and develop caring attitudes towards others. Staff told us, “Some people don't have younger children in their family anymore and they really enjoy the contact. [Person’s name] is 100 years old and his face was a picture listening to the children read. You can see on their faces, the impact it has on them.”

The service continued to receive exceptional feedback. Relatives told us, "It’s a wonderful place. I cannot imagine it’s a care home it’s more like a hotel. So friendly and kind, Mum has really settled well and look at her with the children she is very sociable, so this is perfect for her." "This place is outstanding, we have seen others and they don’t even come close."

There were activities provided for people in the morning and the afternoons, seven days a week. Five staff ‘Champions’ had been given additional training and responsibility for providing arts, crafts, activities and exercise and supported the whole staff team in delivering the planned programme.

The service continued to be a certificated member of the National Activity Providers Association, upholding the values of the uniqueness of everyone and providing person centred and meaningful activities.

The provider was keen on the use of technology to bring new experiences to people. They funded Virtual Reality (VR) headsets which had enabled people to have experiences that they would not usually be able to have in reality.

St Anne’s had been chosen as the first research site for a trial of the use of robotic pets’, by Plymouth university. Feedback from the university was that St Anne’s, ‘really are the best home I have worked with, totally pro-research with a really engaged team’.

St Anne’s were also involved in the ‘Smart Speakers Scheme’. A research project which provides devices to care homes. These can be tailored to meet individual’s needs. For example, hearing the latest games scores for the keen sports fan and cooking along with the device which works at the user’s pace. People could also be supported to use the device to contact relatives, often abroad.

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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

The registered manager continued to be passionate about, ‘bringing the outside in’. The Macular Degeneration Society continued to hold their local meetings at the service once a month. The local library visited to bring large print books, talking books and advertise their events and resources to people living at the service. Volunteers were welcomed. St Anne’s supported the recent ‘My Saltash’ weekend, opening their doors to the public when over 40 people visited, chatted with people and staff over tea.

The registered manager involved people living at the service and their families with the local ‘Dementia Voice PL12’. Through involvement with this organisation people at the service had access to ‘singing for the brain’ sessions at the local church, a dementia café in Saltash held each Tuesday, walking groups and a Veterans group.

The registered manager sat on the monthly End of Life care forum linked to the Daffodil standards, at the local GP practice. The Daffodil Standards help spot areas for improvement and build on the good care already provided to people.

Staff had completed the ‘Six Steps to Success’ in end of life care. Covering discussions with people as end of life approaches, assessment, care planning and review, co-ordination of high-quality care in the last days of life and after death.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service. Records were stored appropriately and were accessible and up to date.

Many compliments had been received from people, relatives and healthcare professionals. Comments included, “I cannot praise the care my mother has had at St Anne’s enough. I have over 40 years of nursing experience and the care and emotional support I have seen since my mother was admitted here is exemplary. Simply superb,” “You also looked after us, anything we needed was your concern. I don’t think there are many people who could say that as they lose a loved one,” “I can only say that I think people are extremely lucky to live there. The environment really is wonderful” and “The surroundings are really very good indeed. So much to look at and occupy people,” “It is a very special home” and “We are all very proud of the home. We have a wonderful boss.”

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

Rating at last inspection

At the last inspection the service was rated as outstanding (report published 24 August 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

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.

St Anne’s is a care home which offers care and support for up to 33 predominantly older people. At the time of the inspection there were 32 people living at the service. Some of these people were living with dementia. The service uses a detached building over two floors. There is a passenger lift and a stair lift to assist people to move around the service.

A culture of safety was embedded within the staff team, and staff were vigilant in spotting potential risks and addressing them. Staff responded quickly to any changes in people’s needs. People's safety and well-being was promoted because staff developed positive and meaningful relationships with people and spent time with them. The atmosphere in the service was calm and organised.

Any accidents or incidents that took place were recorded by staff. The reports were audited by the registered manager to identify any patterns or trends. Action was taken to address specific concerns and the service worked closely with external healthcare professionals to help reduce the risk of re-occurrence.

People who lived at the service were consulted about recruitment decisions. People were given the opportunity to meet prospective new staff at the time they were interviewed. It was important to the staff and manager that people living at the service met potential new staff to ask them if they felt they would ‘fit in’. The service had developed a ‘care apprentice’ role to help encourage young people 17 – 21 years old to join the care industry and address the recruitment challenge in the care industry.

People received their medicines safely and on time. Staff who administered medicines were trained and assessed to make sure they had the required skills and spoke knowledgeably about people's medicines. People were given the opportunity to self administer their own medicines.

Healthcare professionals told us the service was exceptionally effective in supporting people’s needs. Comments included, “I rate them very highly indeed, they are the best service in the area easily. We place people there to avoid them being admitted to hospital. They liaise well with the GP, are very proactive and effective in the care they provide. People recover well and return home” and “They are striving for excellence in end of life care. They are keen that people regard St Anne’s as their home and will do their upmost to allow them to be cared for. They are one of the best homes I work with and all seem to genuinely care and strive for the best care.”

Staff worked in partnership with people, other professionals and continually developed their knowledge and skills. Staff were encouraged to have additional skills and knowledge to support their ‘champion’ roles in areas such as infection control, safeguarding, moving and handling, nutrition, falls, health and safety and medicines. The ‘six steps’ end of life care accreditation was being sought for St Anne’s and two care staff were attending a course at the local hospice. This would bring valuable skills to the service to support people’s care at the end of their lives.

The service was well maintained. People and staff had collaborated to re-design the corridors from a plain clinical look to a more attractive environment. Each section of the corridors had been themed involving people living at the service. For example, a Cornish theme had examples of ships, fishing, knots and the Cornish flag. Another section displayed film stars of the 40’s and 50’s with people being involved in choosing which film stars picture was hung outside their particular flat. This meant people were supported to remain as independent as possible when moving around their home. There were no malodours anywhere in the service. People had self contained flats comprising of an ensuite bathroom and open plan kitchenette with microwave and a fridge. Many people living at the service were living with dementia. Their needs were considered in the re-design of corridors with clear pictorial signage throughout the service. This made it easier for people to maintain their independence when using the bathrooms, toilets and their own flats.

The registered manager had recognised that the war years were not the most memorable to many people now living at St Anne’s. The 50’s were their era. An upstairs lounge had been carefully themed to resemble a typical sitting room in a house in the 50’s. The registered manager told us how they were always thinking of ways they could “Bring the outside in” to St Anne’s. It has been arranged that various community groups held their regular meetings at the service. The local dementia alliance group had worked with St Anne’s to make the local area more friendly for people living with dementia. Together they approached all local shops and businesses to ask them to nominate an employee as a ‘Dementia Friend’. St Anne’s had arranged for a member of their staff to attend a specific course to enable them to become a trainer for the ‘Dementia Friends’ course hosted at the service. Many businesses have benefited from the collaboration of St Anne’s and the local dementia alliance to improve things for people locally living with dementia.

Food was cooked fresh on the premises. People gave us exceptionally positive feedback about the quality of the food at the service. Comments included, “We get the menu bought to us so that we can choose what we want, if we don’t want anything on there we can have something else. No one here looses weight!” and “I really enjoy my meals here.” One relative was particularly positive about the food and told us, “Mum doesn’t have many pleasures left in life but she enjoys her food so it is particularly good that the food here is so very good. Some people needed additional support in choosing their meals and drinks. Staff took time to help people to make choices by placing drinks and meals in front of them to give them visual cues rather than just the words on the menu. We observed staff offering people to taste a meal before choosing, to further assist them in making a choice.

Staff told us they felt well supported by their team leaders, the deputy manager and the registered manager and were easily able to ask for additional support if they needed it. Staff received regular supervision and appraisals. The registered manager maintained a comprehensive training matrix which showed all the training completed by staff and when updates were due. This was monitored at provider level and was currently shown as having reached over 95% of staff having completed necessary training. There were sufficient numbers of staff to meet people’s needs. Some people living at St Anne’s liked to get up early in the morning. The service had responded and recently introduced an additional shift from 6 am to 1.15 pm to support the night staff with people who wished to get up early. This meant the service was flexible to meet people’s changing needs and wishes.

People's legal rights were protected because staff understood the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS), which were embedded in day to day practice. Appropriate applications had been made and the conditions of one authorisation in place at the time of this inspection were being supported.

People living at St Anne’s received good dementia care because staff had been trained well and had a deep understand of their care needs. Staff knew how people wished to be cared for and spoke about people respectfully and fondly. One man was dressed in smart trousers, shirt and tie. Staff told us, “(the person’s name) will never be seen without their tie, it is part of who they are. Track suit bottoms would not be at all appropriate for (the person’s name).” This showed staff used what they knew about people’s backgrounds when caring for them.

A ‘Dignity Tree’ had been created and displayed in a corridor. Children from the local primary school had spent time at the service learning about the importance of dignity and respect. They drew around their hands, cut them out, wrote on the ‘hand’ what they felt dignity and respect meant to them, then hung it on the tree.The children's presence was greatly enjoyed by the people living at St Anne’s.

People and relatives consistently gave us very positive feedback about how the service met people’s needs. Comments included, “The staff don’t simply just look after (the person) they seem to genuinely care,” “I would not hesitate in placing my mum here” and “They (the person) have had a number of health setbacks but each time they have slowly recovered as a direct result of the close observation and care they have received. I regard St Anne’s highly and the staff in particular.”

The service was a certificated member of the National Activity Providers Association. This meant staff at the service were upholding the values of the uniqueness of everyone, providing person centred and meaningful activities in a fun and creative way provided by skilled staff. People were provided with planned and advertised activities seven days a week, both in the morning and afternoon. This included trips out in the service’s minibus. People told us, “We go all over the place, it is great.”

We received very positive responses from the people living at the service, staff, relatives and healthcare professionals about the registered manager and the way the service runs under their leadership.

Care and treatment was provided in accordance with people's needs. A holistic approach was evident in the care records which considered people's physical, mental health and social needs. Evidence of health and social care professionals' involvement was apparent. Risks were assessed and updated if people's needs changed. People were able to participate in community activities as they wished.

One person told us 'the staff are very kind'. Another said, 'I like it here' and the staff are as good as gold.'

We saw that the home was clean and well maintained which reduced the risk of infection.

There was a system in place to manage complaints and the people living at St Anne's care home and the staff were confident complaints would be taken seriously and investigated.

The people we spoke with were positive about how staff supported them. One person said 'staff are very friendly and caring'. Another said "they [the staff] knock on my door, I feel my privacy is respected".

During our inspection, we spoke with two people who lived at St Anne's - Saltash, who said that they enjoyed the food they received. People told us they were given a choice of meals every day.

We were shown that there was a robust system in place to obtain medicines from the pharmacy for people who lived in the home. This meant that people received the correct medication at the correct time.

We checked if St Anne's - Saltash operated an effective recruitment procedure. This was to make sure the people Anchor Trust (the organisation that owns St Anne's) employed were of good character, suitably qualified, skilled and experienced.

The care records seen were maintained and updated daily. This meant they were accurate and directed staff in how to provide care and support for people who sued the service.