St Peter's Care Home

St Peter's Care Home is a residential care home providing personal care to 18 older people and people living with dementia. The service accommodates people over four floors in one adapted building with a lift. The service can support up to 43 people.

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

The quality of service people received had improved since our last inspection. People told us that they felt safe and they received the care and support that they needed.

Management of the service had improved significantly. Since the last inspection a new manager had been appointed and had since registered with Care Quality Commission (CQC). The registered manager had oversight and scrutiny of the service and was receiving support from the provider and an external consultancy agency. People, their relatives and staff spoke highly of the registered manager. They were described as ‘getting everything sorted out’ and ‘approachable’. The registered manager told us they had worked hard to address the breaches and shortfalls identified at the last inspection. They had worked through a comprehensive action plan.

People were protected from the risk of avoidable harm. When concerns were identified about people's safety, information was shared with appropriate stakeholders so investigations could be conducted.

Risk to people health and safety where identified. The registered manager had ensured all risks associated with people and the service had been assessed. However, some guidance on what action to take if the risk occurred was not consistently recorded. Staff did know what action to take. People were supported with their health needs. The registered manager had oversight of incidents and accidents and lessons had been learnt when things went wrong.

There was a clear vision and open culture. A governance framework was in place which covered all aspects of the service and the care delivered. Numerous quality assurance audits had been completed. When shortfalls had been identified, plans were in place to continue with the improvements. We will check that improvements have continued and sustained at the next inspection. People, relatives and staff were engaged in the service. Their views were listened to and acted on.

The management of medicines had improved. Medicines were stored safely and people received their prescribed medicines when they needed them. The service worked in partnership with other professionals, and the community when able to do so.

The registered manager and staff promoted and encouraged person centred care to ensure people were treated as individuals. Staff knew how people preferred to receive their care and support. There were enough staff available to make sure people received the personal care and support that they needed. People's needs had been assessed and assessments had been used to plan staffing level.

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 were recruited safely. Safety checks had been completed before staff started working with people. People were safeguarded from the risk of abuse and received person-centred care that promoted their dignity and independence. When there were any incidents and accidents these were recorded, and steps were taken to prevent any re-occurrence. Staff understood how to prevent infection and wore protective equipment when necessary.

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 Inadequate (published 24 June 2021). The service was rated Inadequate in the domains safe and well led and was placed in special measures. We took enforcement action and placed a restriction on the provider's registration so that they could not admit any people to the service without prior written consent from the CQC. We also required the provider to tell us how they had mitigated risks to people. 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 the regulations.

This service has been in Special Measures since 24 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 13 May 2021. Breaches of legal requirements were found. We undertook this focused inspection to check the provider had taken action 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Peter’s Care Home on our website at www.cqc.org.uk.

Follow up

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 Peter's Care Home is a residential care home providing personal care to 22 older people and people living with dementia. The service accommodates people over four floors in one adapted building with a lift. The service can support up to 43 people.

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

People were not protected from the risk of avoidable harm. When concerns were identified about people’s safety, information was not shared with appropriate stakeholders so investigations could be conducted. Risks were not well managed. The provider had not ensured all risks associated with people and the service had been assessed. People were not supported with their health needs. The providers oversight of incidents and accidents was poor, lessons had not been learnt when things went wrong.

Medicines were not always managed or stored safely. We were not assured that the provider was protecting people from the risk of infection. High touch points had not been included on cleaning schedules and not all staff wore the appropriate Personal Protective Equipment (PPE) to reduce the risk of infection transmission. Although there were enough staff to meet people’s needs staff had not been given the training to support people well. Staff were not always recruited safely.

There was a lack of leadership, oversight and direction resulting in poor outcomes for people. The culture was poor. Staff did not understand their responsibilities and were not consulted or engaged so improvements could be made. There was no evidence of continuous learning and the provider had little knowledge of their service. The provider had not identified any of the concerns identified during our inspection. People were not engaged or consulted about their care or service in a formal way so improvement could continually be made.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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

The last rating for this service was Good (Published 08 January 2020).

Why we inspected

We received concerns in relation to leadership of the services, failure to notify outside agencies of incidents and management of health risks. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

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 have found evidence that the provider needs to make improvements. Please see the Safe and Well led sections of this full report.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Peter’s Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, risk, staffing, recruitment and management and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St Peter’s Care Home is a residential care home providing personal care to 38 older people and people living with dementia. The care home accommodates people over four floors in one adapted building with a lift. The service can support up to 43 people.

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

People were supported by kind and caring staff who treated people as individuals and with dignity and respect. The provider had robust recruitment systems to ensure staff were safely recruited. Staff spoke knowledgeably about the systems in place to safeguard people from abuse.

People were supported by staff who were inducted, trained and supervised. People’s accidents and incidents were recorded however the provider did not record lessons learnt. We have made a recommendation in relation to lessons learnt.

People, relatives and staff told us staffing levels were not always sufficient. We have made a recommendation in relation to the deployment of staff.

People told us they felt safe. Risks to them were identified and managed. Where required people were safely supported with their medicines needs. Infection control measures were in place to prevent cross infection. The support required by people with health and nutritional needs was identified and provided.

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.

People’s privacy and independence were promoted. Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to.

People had person centred support plans in place. People and their relatives were actively involved in their care and contributed to the development of care plans and reviews. People’s communication needs were identified, and their end of life care wishes were explored and recorded. People and relatives told us activities were offered.

People, relatives and staff told us the registered manager was approachable and supportive. Staff told us they felt well supported by the service. The service had quality assurance processes in place. The service worked well with other organisations to improve people’s experiences.

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 23 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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 Peter's Care Home is a large four storey building located on Herne Bay seafront. Accommodation includes 43 single rooms, all with en-suite facilities. Communal areas include lounge areas on each floor, two dining areas, an activity room, a library, a hairdressing room and a large garden. The service provides personal care and accommodation for up to 43 older people some of whom may also be living with dementia.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

People told us they felt safe living at St Peter’s Care Home. Risks to people were assessed, managed and reviewed and action taken by staff to keep people as safe as possible. People were protected from the risks of abuse and staff were confident to raise any concerns with the registered manager.

The registered manager followed safe recruitment processes to make sure staff employed were of good character. There were sufficient staff on each shift and this was regularly reviewed. People received effective care from staff who had the knowledge and skills to carry out their roles.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet and food they liked.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff knew the importance of giving people choices and gaining people’s consent.

Staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called DoLS.

People were treated with kindness, compassion, dignity and respect by staff who knew them and their relatives well. People and their relatives were involved in planning their care and support. People received care and support that was individual to them and their needs and preferences.

People had enough to do during the day were supported to follow their interests and take part in meaningful social activities. Staff supported people to maintain relationships with their families and friends.

Complaints were investigated and action taken to address any concerns when needed. People and their relatives told us they had no complaints.

People, their relatives and staff felt the service was well-led. The management team encouraged an open and transparent culture. Regular and effective audits were completed. Action was taken when shortfalls were identified. Notifications had been submitted to CQC in line with guidance.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support the people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said "Staff are very good. I have no concerns". Another person said 'Food is great, lovely choices and plenty of it'. Another person said "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".

The provider may wish to note comments were made with regard to ensuring that sufficient audits and checks were carried out to further strengthen the quality assurance systems within the service.