St Annes Care Home

Updated 5 January 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 Act.

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 1 inspector 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 Anne’s is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with 6 people, 7 relatives over the telephone, and 4 staff, including the registered manager, care staff, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted 4 external professionals via email and all remaining care staff via email. We spoke with 3 more staff via telephone.

We observed interactions between staff and people. We reviewed a range of records. This included 4 people's care records and medicines records. We reviewed a variety of records relating to the management of the service, including policies and procedures, training records and meeting minutes.

Updated 5 January 2023

About the service

St Anne’s Care Home is registered to provide accommodation and personal care to a maximum of 40 older people, including people who live with dementia. At the time of the inspection there were 30 people living at the home.

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

People felt safe and supported by staff. They told us they didn’t have to wait for support as staff were patient with them.

People’s care plans were up to date but needed more person-centred detail to improve them. The provider had recognised this and had plans in place to improve records.

Systems and processes for identifying patterns and trends were in place. The provider planned to improve the means by which they analysed falls to help reduce risks.

The provider needed to try more innovative and creative work to try and reduce the risk of falls. We have made a recommendation about this.

Medicines administration was safe. Records were clear and auditing had been improved recently following advice from external professionals.

There were sufficient staff to keep people safe. The provider had reduced reliance on agency staff significantly, meaning people had started to received a greater continuity and consistency of care.

People were kept safe from the risk of abuse. Relevant policies were up to date. When incidents occurred the provider acted promptly.

Staff were recruited safely. Supervisions and team meetings reminded staff of areas of good practice to keep people safe. Staff felt well supported and able to speak up if they had concerns.

The registered manager had made some positive changes and had more planned. These included reinstating relatives and residents’ meetings, an introductory coffee morning, and a range of staff champions to improve understanding and application of best practice.

The provider had a conflict of interest policy in place but had not always had regard to it. We have made a recommendation about this.

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.

The registered manager demonstrated a strong understanding of the service and people who used it.

The environment was clean. There was a range of refurbishment work underway. Where completed, it had a positive impact on people’s day to day quality of life. There was ongoing work to the dining and communal areas. The provider was trying to reduce the impact of this on people and had on-site maintenance support in place.

The provider worked well with external professionals to ensure people received the help they needed.

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

Rating at last inspection

The last rating for this service was good (published 3 April 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.