St Petroc's Care Home

St Petrocs Care Home is a residential care home providing personal care to up to 30 people. The service provides residential care to older people who may have a physical disability. At the time of our inspection there were 24 people using the service.

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

Risks were identified, assessed and recorded. Care plans were completed for each person and contained details of the person's needs and preferences.

There were sufficient staff to support people. The service was fully staffed with no vacancies. The service was not using any agency staff at the time of this inspection. Recruitment procedures were robust.

People told us they felt safe with staff. There were systems to help protect people from abuse and to investigate any allegations, incidents or accidents.

People were supported by staff who had been appropriately trained to carry out their role. Staff told us they felt well supported.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet, where this was part of their plan of care.

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 understood the importance of respecting people's diverse needs and promoting independence.

Mental capacity assessments had been carried out where it was indicated. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. The registered manager did not have effective recorded oversight of the two authorisations in place at the time of this inspection. However, we were assured immediate action would be taken to address this and were provided with evidence of this the day after the inspection visit.

There were robust auditing or monitoring processes in place at the time of this inspection. The provider had implemented effective quality assurance systems to monitor the quality and safety of the care provided.

Staff were able to access the management team whenever they needed any assistance or guidance. Staff comments included, “I feel happy and well supported here, we get regular supervision and the manager is always around if we need anything,” “Morale is good, we all get along, it is better now we have more staff” and “I have just arrived from India, I have done all my training and am very happy here.”

People told us they liked living at St Petroc's and that the staff were caring and responded when they called. Comments included, “Just had a wash and clean up, they have made me very comfortable,” “They (Staff) always look after me well” and “I have no concerns.”

Visiting healthcare professionals told us, “We come here regularly, there are always staff around to speak with. They report any concerns to us quickly. I have been asked to check on someone today as the carer has noticed something. We have no concerns” and “They are responsive and good at letting us know if someone is unwell.”

People were regularly asked for their views by the management team at meetings and through surveys. People were provided with information on how to raise any concerns they may have.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 2 March 2020).

Why we inspected

We received concerns in relation to medicines management, communication, slow staff response to people’s changing needs and staff moving and handling practices. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well led sections of this full report.

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 not changed following this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Petroc's 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.

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 had successfully used zoning, to stop an outbreak of COVID-19 spreading to other residents.

A separate entrance had been created for staff, where they changed into their uniforms and don PPE, (personal protective equipment, such as gloves and masks). This had reduced the risk of cross infection.

High touch points in the service such as light switches, were labelled to highlight that they needed cleaning regularly.

The provider had invested in extra equipment so that each floor had its own equipment which did not need to be moved between floors. This helped reduce the risk of cross infection.

People confirmed that the service had followed appropriate guidance regarding infection control and visiting throughout the pandemic.

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

Following our previous inspection the provider had made improvements to the safety of the premises. Security measures were in place and remedial action had been taken to improve fire safety.

Shared areas of the home were pleasant and well maintained. Improvements were being made to add a treatment room and reconfigure an existing bathroom to make it more accessible for people with mobility problems. People’s bedrooms were personalised. Areas around people’s sinks lacked storage with most people only having shelves to store spare toilet rolls and toiletries. This was impersonal and did not protect people’s privacy. Some shared bathrooms were being used to store mobility and cleaning equipment and were cluttered. We have made a recommendation about this in the report.

Relatives were positive about the service and staff. They told us they were welcomed and the atmosphere was pleasant and friendly. Staff kept relatives informed of any changes in their family members needs. Staff and relatives told us the registered manager was approachable and listened to any concerns.

Medicines were well manged and kept securely. Staff administering medicines were trained and had their competency assessed. The home was clean and staff had access to aprons and gloves to use when delivering personal care.

An activity co-ordinator had been employed and they organised daily pastimes which were in line with people’s interests. Community links were being developed and the service took part in community and national events.

Care plans were informative and covered all aspects of people’s care. There were plans to reduce the use of paper records in the near future. The service was able to provide end of life care and people’s preferences at this time of their lives were sought and recorded.

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 25 January 2019) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

We identified several safety risks identified in relation to the environment. People were at increased risk of scalds because hot water temperatures in wash hand basins in bathroom, shower and numerous bedroom areas were too hot. One fire exit was poorly maintained and another wasn’t properly sealed which meant it would not prevent the spread of a fire. Other safety risks included uncovered electric portable radiators, which were hot to touch, and a pressure relieving mattress which wasn’t working properly. An unmarked change of floor level was a slip, trip, fall hazard for people.

We brought these risks to the attention of the registered manager. Since the inspection, they have contacted us to confirm work undertaken to further reduce the risks.

Other parts of the environment and equipment were well maintained. People had detailed personalised risks assessments which showed ways staff reduced individual risks for people, such as falls risks.

People said they felt safe living at the home, and further work was underway to improve security. There were enough staff to keep people safe and meet their needs. People were protected because staff knew about signs of abuse and felt confident to report concerns. People received their medicines safely and on time. People were protected from cross infection by good hygiene measures.

We observed caring interactions between people and staff around the home. However, on the first day of the inspection, people had a very poor dining experience. They waited a long time for their meal and people who needed assistance were not appropriately supported. We fed back our observations of people’s lunchtime experience to the registered manager, who spoke with staff and made sure people’s dining experience the next day was improved. Since the inspection, the registered manager has promoted improved staff practice through regular mealtime observation.

The service was an old Victorian building. Some adaptations in bathroom/toilet areas had been made to meet people’s needs but further improvements in disabled access were needed. For example, some toilets areas were not easily accessible. The registered manager explained refurbishment was currently on hold as the provider was looking at the feasibility of a major extension to create additional rooms. Some improvements in the environment and equipment had been made. The lounge had recently been redecorated. Electric profile beds had been purchased which were easier for people to get in and out of, and minimised moving and handling risks for staff.

Most people said staff treated them with dignity and respect and people looked well cared for. Families could visit anytime and were made welcome. Several people participated in their local community. People and relatives said staff consulted them in decision making, although their involvement was not always well documented.

People said they didn’t always do enough to occupy them and we identified meaningful activities as an area for improvement. People’s care records included personalised details about their life history, preferences and communication needs. Most people's care plans were detailed about their individual needs and preferences, with one exception, which we made the registered manager aware of.

People were supported to have a comfortable, dignified and pain-free death. Where people had expressed any advanced decisions about resuscitation, this was recorded in their care plan. However, records of people’s wishes for their end of life care and any preferred funeral arrangements needed improvement.

People knew how to raise concerns and complaints and any concerns were positively responded to with improvements made in response. However, the complaint log had limited detail about the nature of more minor complaints which meant it was difficult to identify any themes or trends.

The service had quality monitoring systems in place. However, these needed to be improved, as they were not fully effective in identifying and addressing health and safety, dignity and other care issues for people. People’s feedback about leadership at the service was mostly positive. Local health and social care professionals said staff worked in partnership with them.

People were asked for their consent before they received any care and treatment and staff acted in accordance with their wishes. Since the last inspection improvements in recording best interest decisions had been made for people who lacked capacity.

People received care from staff who received training and support to enable them to meet people’s care and treatment needs. People’s individual health needs were assessed. Care records showed staff followed evidence based practice. Health professionals said staff contacted them appropriately and followed their advice.

Rating at last inspection: Good. (last report published 15 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. Some areas of the service had deteriorated and it the service was rated Requires Improvement overall. We have made requirements about two breaches of regulations found at the service.

Follow up: We will revisit the service in the future to check if improvements have been made. We will continue to monitor intelligence we receive about the service until we return to visit. If any concerning information is received we may inspect sooner.

St Petroc’s Care Home is a residential care home which provides care and support to older people, some of whom have dementia. Accommodation is set over two floors, with spacious shared lounges and a dining room. There are also well maintained gardens which people can easily use. The home can accommodate up to a maximum of 30 people. At the time of our visit there were 26 people living at the service.

The service 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.

We observed positive and caring interactions between people and staff. Staff took the time to stop and chat with people and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection.

People’s rights were not always protected under the Mental Capacity Act 2005 (MCA). Although staff had undergone training and some were knowledgeable about the principles of the Act and how it applied to their role, some records were inaccurate. For example, some people’s records showed they had the capacity to make decisions for themselves, but then went on to describe best interest decisions staff were making on their behalf. Some people’s relatives had been asked to sign to agree to elements of a person’s care plan without the correct legal authority to do so.

People’s care records did not always reflect changes in their health needs. Some records were kept but these often lacked detail and were not always used to update people’s care plans or risk assessments so staff knew how best to support them.

People enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people told us they had their medicines as prescribed and on time. People were supported to see a range of healthcare professionals including district nurses, chiropodists, doctors and social workers.

People were kept cognitively and socially engaged through a range of activities, both inside the service and in the local community. The service employed an activities coordinator and there was an activity on offer each day. People were involved in suggesting activities.

People were kept safe by suitable staffing levels. People told us there were enough staff on duty and that their needs were met in a timely manner. Interactions between people and staff were unhurried. Staff recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had sufficient training to carry out their roles effectively. Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported by an induction and there was an ongoing programme of staff supervision and appraisals.

There was a safeguarding adults policy in place at the service and staff had undergone training on this subject. Staff confidently described how they would recognise and report any signs of abuse. There were also policies in place around the duty of candour and whistleblowing. This encouraged an ethos of openness and honesty.

People, staff and relatives were encouraged to give feedback through a variety of forums including team meetings, residents’ meetings and questionnaires. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. People and relatives said they felt confident that if they raised concerns these would be dealt with appropriately. There was an effective quality assurance system in place which included a range of audits including medicines, care records and staff and resident satisfaction.

We saw people's privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

We obsevered staff had positive interactions with people. People told us staff answered their call bells promptly. One person told us the staff were 'polite and friendly'. Another person said, 'I am very happy here, no complaints'. People told us the food was good and they were offered choices. We were told visitors were welcome. One person said 'I can go to bed when I want, if I wanted to go out someone would take me'. Another person told us they were involved in the planning of their care.

We heard care staff ask people what they would like to do and they shared ideas if people could not make a choice.