Archived: St Martins Care Home For The Elderly Limited

This inspection took place on 22 December 2016 and was unannounced.

A registered manager was in post 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 the last inspection on 28 April 2016, we asked the provider to take action to make improvements to reduce the risks people rights to liberty were not met, and this action has been completed. At this inspection we found people are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us they felt safe because of the way staff cared for them. Staff took action to care for people in ways which promoted their safety and people's care plans gave clear guidance for staff to follow in order to promote people’s well-being. Staff knew what action to take to protect people from the risk of potential abuse. There were enough staff employed to care for people and where people wanted assistance to take their medicines this was given by staff who knew how to do this safely.

People benefited from receiving support from staff with the knowledge and skills to care for them. Further training was planned for staff so they would be able to continue to meet people’s care needs. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

Caring relationships had been built between people and their relatives and staff. People and their relatives were positive about the staff who supported them and felt valued by the staff. Staff took time to chat to people and offered them reassurance in the ways they preferred when they were anxious. People’s right to privacy was taken into account in the way staff cared for them. People were encouraged to make their own day to day decisions about their care. Where people needed support to do this this was given by staff.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. People’s care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

Positive comments were received about the way the home was managed. Staff understood how they were expected to care for people, so people enjoyed living at the home. The registered manager checked the quality of the care provided and people and their relatives were encouraged to give feedback on the care provided. The registered manager introduced changes to develop people’s care further. After the inspection the registered manager had put plans in place so staff would receive additional training and some items of equipment would be replaced.

After our inspection on 21 September 2015 we received concerns in relation to how people were supported to maintain their safety.

We undertook a focused inspection on 28 April 2016 to look into these concerns and also to see if they had followed their plan and now met legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Martins Care Home For The Elderly Limited on our website at www.cqc.org.uk

The provider is registered to provide accommodation and care for up to 15 older people who may have support needs owing to physical disabilities and sensory impairment. There were 15 people living at the home at the time of our inspection.

A registered manager was in post 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 focused inspection we found the provider had followed their plan and they now met the legal requirement in relation to Need for Consent.

We found there was potential risk people’s rights to liberty would not be protected as the staff did not understand the processes they needed to follow to make sure people’s rights were promoted. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and improper treatment, 13, (2), (5) and 7(b).

We found people’s safety needs were considered by the staff, who understood what actions to take in order to promote people’s safety. Staff worked with other organisations, such as the local authority, so plans were put in place to keep people safe. We saw the registered manager had made checks before new staff started to care for people so they could be assured new staff were suitable to care for people. We found we had not consistently received information about incidents which affected people’s safety. We discussed this with the registered manager, who then sent the information to us without delay.

You can see the actions we have asked the provider to take at the end of this report. We will follow up on the action we have told the provider to take at our next comprehensive inspection to make sure improvements are made.

The manager of St Martins Care Home had submitted an application for registered manager status to the Care Quality Commission (CQC) and they had a date for an interview shortly after this inspection in order to assess whether registration would be approved. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We observed the care and support that people received to meet their different needs over the course of the day. We also looked at a sample of care plans for three people who lived at the home and various management records. These records were used to review, monitor and record the improvements made to the quality of care and support that people received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

People who lived at the home and their relatives told us that they felt safe and staff responded to their needs with minimum delays. One person told us, 'If I need them (the staff) they are there. I am happy and safe here.' Another person said, 'They (the staff) are always there when I need them.'

There was a focus on people's safety and we saw that staff assessed, identified and had taken action to reduce risks so that people were protected as much as possible from harm. For example, we saw that a sensor mat had been sought for one person so that staff were alerted to the person's movements. This meant that the risks to the person from falls had been reduced without their independence being restricted.

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This supported people's health needs to be effectively met.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection no applications had needed to be made. However, there were proper policies and procedures in place and staff and the manager were aware when levels of intervention or supervision may represent a deprivation of a person's liberty.

We saw that equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People's health and care needs were assessed and people had been involved in planning the care they received. Care plans had been reviewed regularly and matched the care people required. The plans supported staff to deliver care and support that effectively met people's needs.

People were involved in how their care was delivered. Staff asked people for their consent before any care or treatment was provided. People's mobility and other needs were taken into account in relation to their environment. This enabled people to move around freely and safely and with the level of support that met their needs.

Staff had the most up to date information about people's needs. This included daily handovers that supported staff to deliver effective and consistent care and treatment to people.

Is the service caring?

People who lived at the home told us that they thought staff were very caring and they had no concerns about how staff treated them. During the day we saw staff treated people in a kind and caring way. One person told us, 'They (the staff) are all kind.' Another person said, 'They are all good to me which is a blessing.'

People received personalised care in an attentive and patient manner to meet their different needs. During our inspection we observed staff supporting some people with their lunchtime meals using comforting gestures and words to make people feel at ease.

Is the service responsive?

Staff worked in partnership with other professionals that supported people to receive appropriate care, treatment and support to meet their different health and social care needs.

Consideration of the Mental Capacity Act was evidenced in care plans where people gave their consent to their care and treatment. We found that people's mental capacity was assessed and included in their care plans. This meant that staff had access to information about people's ability to make daily decisions. When people lacked capacity to give their consent verbally the manager and staff would use their knowledge of the people or speak with people's family members in deciding what was in the best interests of people. We saw staff demonstrated their understanding of people's behaviour when they patiently explained options to a person and gained their understanding and consent.

During our inspection we saw that there was evidence of unplanned engagements with people and staff chatting to each other. We also saw people had the opportunities to do some painting. The manager was reviewing the planned activities for people to ensure that these continued to be improved upon.

People told us that staff listened to their views and supported them to keep in touch with people who were important to them by way of visits.

Is the service well led?

The manager sought the views of the people who lived at the home and their family members. The manager told us that they used people's views to make on-going improvements at the home.

The manager was developing a quality assurance system and identified actions had led to improvements in the service that people received. The manager showed us that they have carried out audits and checks to make sure the quality of the service was maintained.

Where investigations had been required, for example in response to accidents, incidents or safeguarding concerns, the manager had completed a detailed investigation. This included information such as the actions that had been taken to resolve them.

We spoke with the manager, the provider and two care workers. We spoke with four people who used the service a visitor and a healthcare professional.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. This was confirmed by people who were using the service. From our observations we saw that people were provided care that met their individual care needs. People were complimentary about the care they received. Comments included: 'Looking after me very well. I am more than happy here' and: If you need a doctor they get you one'.

We found that appropriate arrangements were in place to ensure the safe use and management of medicines.

We found that records we asked for were available although some we not completed fully or totally up to date. The manager was aware of the shortfalls however staff were knowledgeable about people's care needs.

In this report the names of the registered manager who appear were not in post and were not managing the regulatory activities at this location. The names appear because they were still a Registered Manager on our register at the time.

We spoke with people who used the service and two relatives. We also spoke with the provider, the manager (not yet registered with the Care Quality Commission) and members of staff. The staff included care workers who were on duty during the night before our visit and during the day time.

The people we spoke with told us they were happy with the care provided. One person commented on the staff and told us: 'You can see how well they work, they do very well'. Another person said: 'They look after me well'. A relative spoke with us and said: It's really worked out for her here at this home'.

We found that changes had taken place in the management of medication. We identified that further improvements were needed to make sure that people using the service always had medication available to them.

The manager was aware of shortfalls in staff training and assured us that these would be addressed to ensure that people were not at risk of receiving inappropriate care.

During the inspection we requested certain documents and records. We found that these were not always available as staff were unable to locate them.

In this report the names of the registered manager who appear were not in post and were not managing the regulatory activities at this location. The names appear because they were still a Registered Manager on our register at the time.

We saw that care plans, risk assessments and other records were in place to give staff guidance and direction about the level of care required to meet individual needs. There were other care needs identified during our inspection for which a care plan was not in place. Professional advice about the use of specialist pressure relieving equipment had not been obtained.

We saw that improvements had taken place in the management of medication to make sure that people received their medicines as prescribed. Improvement had taken place to make sure that recruitment procedures were safe. We saw certificates to show that pieces of equipment used to lift people had been serviced.

Since our last inspection the registered manager had introduced effective systems to assess the quality of service provided for people.

In this report the name of one registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. The name appears because they were still a Registered Manager on our register at the time.