St Anthony's - Care Home with Nursing Physical Disabilities

Updated 12 January 2024

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 Health and Social Care Act 2008.

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 team consisted of 3 inspectors 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 Anthony’s – Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Anthony’s – Care Home with Nursing Physical Disabilities is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, following the inspection, the provider informed us the registered manager was no longer in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 17 August 2023 and ended on 24 August 2023. We visited the location’s service on 17 August and 22 August 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 this information to plan our inspection.

During the inspection

During the site visit, we spoke with 8 people who lived at the home and 1 relative. We spoke with 9 staff in detail including team leaders, nurses, care staff, housekeeping and kitchen staff. We spoke with 2 other staff members but they had difficulty with understanding us due to their English language skills so we were unable to continue these discussions.

We also spoke with the registered manager, head of quality, operations manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Following the site visit, we also spoke with 2 additional relatives by telephone.

We looked at 8 people’s care records and 14 people’s medicine administration records (MARs). We also viewed 4 staff files and documentation related to the governance of the service.

The provider sent us further documentation we had requested following the site visit including audit documentation and evidence of staff feedback forms and relative meetings.

Updated 12 January 2024

About the service

St Anthony’s – Care Home with Nursing Physical Disabilities is a nursing home providing personal and nursing care to up to 34 people. At the time of the inspection, there were 26 people using the service. The service provides support to people with neurological and mental health conditions and people living with physical and learning disabilities in a purpose-built building.

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

Right Support: People told us they felt safe when having their care needs met by experienced staff but did not always feel safe when supported by newly recruited staff who they did not consider to be competent. For example, despite staff having completed moving and handling training, people told us new staff were not always competent in supporting them with hoisting. People’s medicines were not always stored and administered safely. We found examples of missed medicines and recording errors which meant people’s medicines were not always being administered as prescribed. Risks were not always managed safely. For example, staff told us they had undertaken a clinical task without training as they did not have time to wait for a nurse. Accidents and incidents were recorded but the provider could not be assured that action was always taken as forms weren’t always completed in full. Staff underwent stringent recruitment checks prior to employment but this did not always ensure they had adequate skills and competence to meet people’s needs safely. Staff understood how to report abuse and safeguarding referrals were made when required. The home was clean, and staff had been trained in Infection Prevention and Control (IPC). However, the provider could not be assured staff always understood the training as staff told us of instances where the IPC policy had not been complied with.

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.

Right Care: Care was not always person centred. People told us they did not always feel safe when their care was provided by newly recruited staff who were not sufficiently competent in the English language to understand and meet their needs. People told us experienced staff at the home made them feel safe and were able to meet their needs in a way they preferred.

Right Culture: The registered manager did not promote a person-centred culture throughout the home. Staff morale was low, and staff did not feel supported by the registered manager. People and relatives were aware of the low staff morale which did not support people to be empowered. People were not always asked for feedback regarding the care received and staff felt they weren’t involved or asked for feedback regarding the home. Systems in place to check the quality of care provided at the home were ineffective and failed to ensure concerns were identified and addressed. The provider had taken action following the inspection to address some of the concerns raised and improve the culture at the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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 28 July 2021).

Why we inspected

We received concerns in relation to medicines administration, the management of risk and governance. As a result, 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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 Anthony’s - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.