The inspection took place on 4 and 5 September 2018 and was unannounced on the first day. At the last inspection on 1 and 2 August 2017, we rated the service Requires Improvement. We found breaches in regulations which related to information in care plans, consent, medicines management and overall governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led to at least good. Whilst we found some improvements in all areas at this inspection, there were concerns in the way risk was managed, care plans were recorded and maintaining accurate records. At this inspection, we have rated the service as Requires Improvement again.Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the second time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.
There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been employed and they were to start the registration process with CQC.
St Marys Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
St Marys Nursing Home is a single storey, purpose-built home, situated in its own grounds in a residential area of west Hull. The service can support up to 48 people who may have a range of physical health needs; some people may be living with dementia. There are 40 bedrooms, four of which are for shared occupancy. There is a large communal room which incorporates a dining area and seating areas for watching television or quiet time. There are plenty of bathrooms, shower rooms and toilets within easy reach of bedrooms. At the time of the inspection, there were 48 people using the service.
There were inconsistencies with people’s care plans. Some people had care plans, which contained good information and guidance for staff in how to meet their needs; these had improved since the last inspection. However, other people’s care plans lacked important information which meant there was the possibility of care being overlooked. Three people did not have care plans to manage their anxious behaviour, which could at times be challenging to themselves and other people.
Risk was not always managed safely. Most people had risk assessments for specific areas such as moving and handling and nutritional concerns. However, some areas of risk had not been identified and assessed properly, which could place people at harm of injury.
We found some areas of recording required improvement such as daily recording of the care given to people and monitoring charts when people were at risk regarding food and fluid intake.
The above three concerns were breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.
Overall governance had improved, shortfalls identified and action planned, however, the provider needed to follow through with these plans to make sure they were completed. We have given a recommendation about this. The new manager in post was aware of the shortfalls and was to be supported by a regional manager to implement the improvement plan. The quality monitoring system consisted of audits, meetings and questionnaires to gain people’s views about the service. There had been an issue with not following through action plans in a timely way.
Staff spoken with told us the new manager was supportive. However, there had been lots of changes in a short space of time and they also spoke of the need for team building and improvements in communication.
Staff were recruited safely and although there had been some concerns with staffing numbers, these had been addressed. The new manager used a tool to calculate staffing numbers and was to monitor this to ensure the levels remained safe. They told us they would continue to hold discussions with staff about their views regarding safe numbers. We will continue to monitor safe staffing numbers during our discussion with the provider.
Staff had received training in how to safeguard people from the risk of abuse. They knew what to do if they had concerns.
People received their medicines as prescribed.
Staff had access to training, support and development. Formal supervision meetings and appraisal had not been held with all staff but this had been identified and included in the improvement plan. We have made a recommendation that the provider follows through with the action plan to ensure all staff receive supervision and appraisal to aid their development.
People’s health and nutritional needs were met. Staff supported people to access health professionals when required and they could remain in the service for end of life care if this was their choice. People liked the meals provided to them, although some people said they could be hotter when served. The new manager told us they would address this with catering staff.
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
People who used the service and their relatives had positive comments about the staff team and their approach when supporting people. People’s privacy and dignity was respected.
There was a complaints procedure displayed in the service and people felt able to raise concerns and complaints.
The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.