St Peter's House

St Peter's House is a residential care home providing the regulated activity of accommodation for person's who require nursing or personal care for up to 66 people. The service does not provide nursing care. The service provides support to older people some of whom lived with dementia. At the time of our inspection there were 45 people using the service.

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

We were not assured the systems, processes, and leadership currently in place to oversee the quality assurance of the service were robust and effective and regulatory requirements were not always being met. We received mixed feedback from people and their relatives about the standards of care and support provided.

People were not consistently protected against harm because all risks to their safety had not been identified and managed.

Medicines were not always safely managed and audits in place to monitor the safety of medicines were not effective in keeping people safe.

There was a lack of consistent and effective leadership at the service and quality assurance systems were not effective in identifying and addressing issues.

The provider took responsibility for the issues we found and responded immediately after the inspection to make improvements that were required.

Staff had been trained to safeguard people from abuse and understood when and how to report safeguarding concerns to the appropriate authority. Recruitment and criminal records checks were undertaken on staff to make sure they were suitable to support people.

Staff had access to personal protective equipment (PPE) and there were effective infection prevention control measures in place.

People were mainly supported to have maximum choice and control of their lives and staff mainly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported 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 24 May 2022)

Why we inspected

We received concerns in relation to the quality of people’s personal care and the high number of falls people were having. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this 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 changed from good to requires improvement based on the findings of 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 House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of risk and medicines as well as the staffing levels and the providers governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We will request an action plan from the provider and will also 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.

St Peter’s House is a residential care home providing the regulated activity of accommodation for person’s who require nursing or personal care for up to 66 people. The service does not provide nursing care. The service provides support to older people some of whom lived with dementia and people with mental health support needs. At the time of our inspection there were 45 people using the service.

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

Staff understood what safeguarding meant to people and how to support them to keep them safe. People received their medicines as prescribed; medicines were safely managed, and staff ensured they followed infection prevention guidance and good practise. Enough skilled and suitable staff had been safely recruited. The service and the staff team took on board learning when things went wrong and managed risks safely.

Staff who had the necessary skills supported people who felt comfortable with them. Staff knew peoples assessed and current needs well, and care plans were amended as soon as changes occurred. Staff had received the training appropriate to their roles and had ongoing support to help them maintain and improve their skills to fulfil their responsibilities. People said staff had the skills necessary to care for them well.

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 home environment was suitable for people’s needs. Work was in progress to make further improvements.

People said staff were caring and knew their needs and preferences well. Staff gave people privacy, treated them with dignity and respect, and helped promote people's independence.

People said they were involved when reviewing their care and felt staff were responsive to their changing needs. People received dignified and compassionate end of life care and their choices were respected. The provider adhered to its complaints process, provided apologies when needed, and ensured concerns were acted on.

Monitoring and oversight of the service was effective in identifying and driving improvements. The registered manager led by example and had fostered an open and honest staff team culture. They understood their responsibilities to report incidents to the CQC. People came first and foremost, and they had a say in how the service was provided. The provider worked well with other organisations, to provide people with joined up care.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.”

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.

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 the service under the previous provider was Outstanding, published on 26 September 2017. The current provider registered the service with us on 21 December 2020 and this is their first inspection.

Why we inspected.

This inspection was prompted in part due to concerns received about staffing, safety of the premises, staff care practices, management of the service, and infection prevention and control. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, caring and well-led sections of this full report.

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.