Archived: St Paul's Convent

St Pauls convent is a residential care home providing personal and nursing care and accommodation for up to 26 sisters. At the time of our inspection there were 18 sisters using the service. St Pauls is a unique service as it is for women who are referred to as sisters who are

from a religious order of St Paul, the apostle. The sisters have spent their lives as nuns serving others and are part of the catholic religious community. The home is purpose built and based within the convent.

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

The provider needed to improve their understanding of their regulatory responsibilities to ensure incidents were reported to CQC without delay. Action was taken to address this when raised with the provider.

Improvements were required to ensure care records completed for sisters fully reflected the support sisters received from staff to maintain their health and wellbeing and to reflect any changes in need.

Sisters were supported by staff that understood their individual needs and had been trained and understood how to protect sisters from abuse. Sisters received their medicines when they needed them and had access to healthcare professionals where required. Systems were in place to reduce the risk of infection, and to review any incident and accidents to see if there were any lessons to learn from these.

Sisters 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. Sisters enjoyed the food provided which met their preferences. Sisters were supported to fulfil their religious obligations and to access meaningful activities which they enjoyed. Sisters were supported to access the extensive grounds of the convent.

Sisters made positive comments about the staff that supported them. Staff were described as friendly, caring, and respectful. Sisters were treated with respect and dignity and their independence was promoted. Sisters were involved in the development of their care plans which reflected their needs and preferences. Sisters knew how to raise concerns and felt confident any issues would be addressed.

Sisters were supported to provide feedback about the way the service was managed. Systems were in place to monitor the delivery of the service and drive improvement.

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 10 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, poor staff practices, staffing, poor care, and poor management. 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.

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, which will help inform when we next inspect.

• St Paul’s Convent is a care home that provides nursing and personal care for up to 26 ‘sisters’, some of whom require nursing care. People living at this service are referred to as 'Sister's' as they have all previously lived at the convent and are part of a community of Catholic religious women who endeavour to live the Gospel way of life.

There were 14 Sister's living at the home at the time of the inspection, as the registered provider was refurbishing some parts of the home, and had reduced the number of Sister's it would care for.

People’s experience of using this service:

• The sisters continued to receive safe care and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support the sisters safely. The sisters received their medicines as it was prescribed. Staff followed infection control guidance and had access to personal protective equipment. Staff noted accidents and incidents and monitored trends to reduce the amount of accidents.

• The effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent as the provider had not always followed the principles of the Mental Capacity Act (2005). The sisters’ nutritional needs were met and they accessed health care when needed. Staff were supported and had the skills and knowledge to meet the sister’s needs.

• The sisters continued to receive care from staff who were kind and caring. Staff supported and encouraged them to be involved in how decisions were made about their support. Staff were caring, compassionate and kind. Staff respected the sister’s privacy, dignity and independence.

• The sisters continued to receive responsive care. Their support needs were assessed and planned with their involvement to ensure they received the support they needed. The sisters support was individualised and reviewed. The sisters were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaints process which the sisters were aware of to share any concerns.

• The service continued to be well managed. The environment was welcoming, warm, comfortable and clean. There were some areas with temporary restricted access due to on-going refurbishment of the service. The registered manager was known and made themselves available. Spot checks and audits were taking place to ensure the quality of the service was maintained.

Rating at last inspection:

• Rated Good (Report published July 2016).

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service has a registered manager who was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

The Sister's told us they felt safe living at the service. Staff were aware of how to recognise possible signs of abuse and the need to report any concerns. We saw there were enough staff available to meet individual requests for support in a timely manner.

Medicines were given safely and there were systems in place to monitor medication administration.

Staff had a good understanding of the Mental Capacity Act (2005) and could explain how they put this into practice when supporting the Sister's. Staff received sufficient training to provide care based on people’s individual needs.

The Sister's had their healthcare needs met and received support to maintain their nutritional and hydration needs. The Sister's were treated with dignity and respect and their independence was promoted.

The Sister's told us they were happy with the care provided and that staff were kind and caring and knew people well. The Sister's were involved in planning their own care, and we received feedback that the care provided met people's individual preferences. Staff that we spoke with were enthusiastic about their role and could describe how each Sister preferred to be supported.

There was opportunity for people to join in activities. The service had resources for activities at the home and also engaged with the wider community to provide external activities for people. The Sister's had opportunity each day to express their faith, both individually and corporately.

The Sister's were aware of how to raise concerns and were confident that any concerns raised would be dealt with in a timely manner.

The Sister's, health professionals and staff were happy with how the service was managed. The registered manager had ensured that the quality of the service was monitored and sought feedback. Staff felt supported in their role and felt able to make suggestions for improvements to the service.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and staff. There were risk management plans in place for people and health and safety. The premises were well maintained and repairs made where necessary so that they remained safe for use. We found that staffing numbers ensured people received appropriate care when they wanted it. Staff had received training for their respective roles to promote their competency for delivering safe care and treatments for people who used the service.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. We found that one application had been submitted to a registered assessor through the appropriate channel. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people and or their relatives or an advocate being involved with the development of care plans. We found regular nutritional assessments of people had been carried out. Appropriate systems were in place to ensure people were supported in having a balanced diet that met their needs. A process for monitoring people who failed to eat or drink enough was in place. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff encouraged and supported people in leading interesting and enriched lifestyles. The people we spoke with all said they received the standard of care that matched their needs.

Is the service caring?

The people we spoke with were positive about the way they were cared for and supported. A person told us: "Staff know what I need and they assist me automatically." Another person said: 'They (staff) are really helpful and do exactly what you want.' People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. We observed staff making arrangements to assist people with their preferred activities when they had made a decision about what they wanted to do. The home was supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

Staff respected people's confidentiality and asked for permission before sharing personal information with other organisations. When people who lived in the home made suggestions for changes these were actioned as far as practically possible. We found evidence that people were able to make choices about their care, activities and day trips. One person said: 'They (staff) don't put pressure on us to do things.' Records' confirmed people's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes. We found evidence that staff sought professional advice when they had identified concerns about people's health and safety. Staff followed the guidance provided by healthcare professionals to ensure that people received appropriate care and support.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. There were clear processes in place for dealing with complaints. Regular audits had been carried out that enabled staff to make changes that could be of benefit for the people who used the service. Staff told us they were clear about their roles and responsibilities, the ethos of the service and the quality assurance processes. A nurse told us: 'We work well, I have a great team here.' There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something.

We found that people had all been supported to undertake personal care to a very high standard, including people being cared for in bed. We found that people had been involved in writing their care plans and when required were supported to access health care facilities at local clinics or hospitals.

People told us they were very satisfied with the food provided. We observed staff provide patient, sensitive support to people when they needed help to eat. We were concerned that records did not show people being cared for in bed were always getting enough to drink.

The provider had systems in place to ensure that people were protected from the risk of abuse. We found this was a subject raised with people and staff on a regular basis to ensure people felt confident and had opportunity to speak out if necessary. We found some improvements were required to the record keeping of people's personal monies.

People had opportunity to administer their own medicines or to receive staff support. People were getting the correct medicine at the correct time.

We found that the systems in place to manage and audit the home were not as effective as is required. This was not ensuring the home was always a safe place to live or work.