St Mary's Nursing Home Margaret Street Stone

St Mary's Nursing Home Margaret Street Stone is a care home providing personal and nursing care to older people. The service can support up to 59 people in one building over 3 floors. At the time of the inspection, the service was supporting 50 people.

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

Environmental risks to people had not always been mitigated enough to make sure people would always be protected. This included hot radiators and pipes and windows without appropriate restrictors on. There were some omissions in the information about ‘when required’ medicines and some gaps in recording, however no one had come to harm as a result of this. Quality assurance systems in place had failed to fully recognise and address risks to some people. Following feedback, all concerns were swiftly rectified by the registered manager and management team. Overall, medicines were managed safely, and people received these as prescribed.

People and relatives consistently felt safe living in the home and felt positive about the care they received. Staff knew people well. Staff understood their safeguarding responsibilities and how to recognise potential abuse. Staff were safely recruited to ensure they were appropriate to support those using the service. There were enough staff to keep people safe. The home was clean and tidy and without malodours. People and relatives confirmed this was consistently the case. There were no restrictions on visiting. Lessons were learned when things had gone wrong, with reviews taking place and an analysis of incidents to determine if there were any trends or further action needed.

People, relatives, and staff were consistently complimentary about the service, the registered manager and management team. The culture of the home was open and inclusive. People felt well cared for and all felt they could raise concerns if they needed to and felt confident these would be addressed. People were supported to practise their faith if they wished to do so. Staff felt equally well supported and there were extra support mechanisms in place. Learning was encouraged and shared, with staff empowered to be champions of areas they were passionate about. The registered manager was proactive and involved in many external organisations and schemes in order to continuously improve. Professionals confirmed the home worked in partnership. The registered manager was fully aware of their duty of candour.

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.

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 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident was subject to further investigation by the CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of moving and handling. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we found some environmental concerns. Please see the safe section of this full report.

Following the inspection, the CQC determined they would take no further action taken in response to the incident.

Enforcement

We have identified a breach in relation to quality assurance systems in place failing to identify and address environmental risks to people.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St Mary’s Nursing Home Margaret Street Stone is a residential care home providing personal and nursing care to people aged 65 and over. The service can support up to 59 people in one adapted building. At the time of the inspection, the service was supporting 46 people.

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

The service was particularly skilled at helping people and their families to explore and record their wishes about care at the end of their life. People told us end of life care was exceptional, they told us they received kindness, time together and spiritual support towards the end of life.

The service took innovative steps to meet people’s information and communication needs. People were supported to communicate in a manner to suit their preferences and abilities.

The service found innovative ways of supporting people to maintain relationships with family and friends, particularly throughout the pandemic, when visits were not always possible.

Visiting professionals told us how the service focused on providing person-centred care and support, and achieved exceptional results.

People told us how staff had outstanding skills, and had excellent understanding of their individual needs relating to their protected equality characteristics and their values and beliefs. People told us they were listened to by staff and were confident to voice their opinions.

People felt actively involved in decision-making and empowered to make choices in daily life; they were also encouraged to remain independent where possible.

Arrangements for social activities were innovative and followed best practice guidance ensuring people could live as full a life as possible.

People were encouraged to maintain hobbies and interests; there were opportunities throughout the day for people to engage in fun and interesting activities. People told us they were happy and enjoyed living in the home.

The registered manager was visible, approachable and acted as a role model for staff. There was a positive culture of inclusiveness within the service, which ensured people were part of their individualised care. Staff and visiting professionals told us the registered manager was a passionate leader, focused on promoting people's wellbeing.

Feedback was welcomed to drive improvements in people's support, which had made a positive difference to people's quality of life. The registered manager continually looked for ways to improve and learn through involvement in projects and leading meetings with other professionals within Health and Social Care settings.

People received their medicines safely and we observed safe medicine administration practices.

People told us they felt safe and well supported. The staff described how they could recognise unsafe care practices and the action they would take to report poor practice. Lessons were learned when things had gone wrong.

There were enough trained and competent staff, people did not have to wait long for support. Staff were recruited safely. People were protected from the risk of cross infection and the home followed government guidance in relation to the COVID-19 pandemic.

Care plans were robust and detailed people’s preferences, risks and health requirements. These were regularly reviewed by management. People and relatives told us they felt included in the care planning process. People were supported to access other health professionals when needed, and advice was followed.

People and relatives were positive about the food and drinks available and people had choices over menus and where they wanted to eat. The home was adapted to meet the needs of those living there and people could personalise their own rooms to feel more at home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in line with 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 and update

The last rating for this service was good (report published 09 September 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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 to show how the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has not changed, it remains Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Mary’s Nursing 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. Mary’s Nursing Home is a care home providing personal and nursing care to 56 people aged 65 and over at the time of the inspection. The service accommodates up to 58 people in one adapted building.

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

People were supported by safely recruited staff, who had the skills and knowledge to provide effective support. Staffing levels were regularly reviewed to ensure there were enough staff available to meet people’s needs. People’s medicines were managed, and staff followed infection control procedures.

Effective care planning and risk management was in place, which guided staff to provide support that met people’s needs and in line with their preferences. 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 were supported to access healthcare professionals and advice received was followed by staff. There were systems in place to ensure people received consistent care and support.

People were supported by caring staff who promoted choices in a way that people understood, this meant people had control and choice over their lives. Staff provided dignified care and respected people’s privacy. People’s independence was promoted by staff.

People were involved in the planning and review of their care. Staff followed care plans to ensure they provided support in line with people’s wishes and diverse needs. People’s communication needs were met, and information was provided in a way that promoted people’s understanding. There was a complaints system in place which people understood. People were supported to have a comfortable and pain free death.

Systems were in place to monitor the service, which ensured people’s risks were mitigated and lessons were learnt when things went wrong. People and staff could approach the registered manager who acted on concerns raised to make improvements to the delivery of care. Staff and management were committed to providing a good standard of care.

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 Requires Improvement (report published 21 August 2018).

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 regulations.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection.

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

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. Mary’s 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. Mary’s Nursing Home accommodates up to 58 people in one adapted building. There was a specific unit that provided care to people at the end of their life. At the time of the inspection there were 50 people using the service.

The service did not have a registered manager. The last manager de-registered with us on 9 April 2018. The provider had appointed a new manager in May 2018 who planned to register with us. 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.

We found that medicines were not always managed safely to protect people from potential harm.

Improvements were needed to ensure people received the least restrictive care and treatment to keep them safe in line with the Mental Capacity Act 2005.

Improvements were needed to ensure the systems in place to monitor the service people received were imbedded and sustained.

Risks to people’s health and wellbeing were managed and followed by staff who knew people well, which ensured people were supported safely.

There were enough suitability recruited and skilled staff to provide support to people. Staff had received training to ensure they had sufficient knowledge to carry out their role effectively.

People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

The environment had been adapted in a way that promoted people’s safety.

People enjoyed the food provided and were supported with their nutritional needs. Action was taken to ensure people at high risk of malnutrition were supported effectively.

Advice was sought from health and social care professionals when people were unwell, which was followed by staff.

There were systems in place to ensure people received consistent care from staff within the service and also from staff from external agencies.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to privacy upheld.

People were supported with their communication needs and information was provided in a format people understood which meant that people were supported to make informed choices.

People received care that met their preferences. People’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs. People had opportunities to participate in social activities, interests and hobbies.

People were supported to have a comfortable, pain free death in line with their preferences because their wishes had been considered and planned.

People and their relatives knew how to complain. Complaints received had been investigated and responded to in line with the provider’s policy.

People, relatives and staff felt able to approach the registered manager and feedback had been gained from people about their care.

The provider had recognised that improvements were needed and action had been taken to plan and implement changes to ensure people received a good standard of care. People, relatives and staff stated that some improvements had been made at the service by the new manager. The provider understood their responsibilities of their registration and worked in partnership with other agencies.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At this inspection we found improvements had been made in all areas of the service, none of the five key questions were rated as inadequate. Therefore the service will no longer be in special measures.

St Mary's Nursing Home provides support and care for up to 58 people. At the time of this inspection 54 people used the service.

The service does not have a registered manager. Recruitment for a registered manager was on-going; in the meantime an interim recovery manager was managing and leading the service. 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.

People medicines were not always managed administered stored or recorded safely. Improvements were needed to ensure a safe system of medication management was in place and was effective.

People were supported by some staff who were caring and compassionate. However, not all staff were as thoughtful or respectful as they should be when engaging with people.

Sufficient staff were available to keep people safe and meet people's care needs in a timely manner. Staff received induction, training and supervision they needed to ensure they felt able to provide care and support to people. Recruitment and vetting procedures were in place that ensured appropriate people were employed.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to.

People were supported with their care and support needs in a safe and consistent way through the effective use of risk assessments and care plans.

The principles of the MCA 2005 were followed to ensure that people consented to or were supported to consent to their care, support and treatment.

People were supported with their daily nutritional requirements. Improvement had been made to the dining experience and people were offered and provided with the level of support they required.

People were supported with a range of healthcare services. When people became unwell and needed additional support with their health staff responded and sought the appropriate guidance and assistance.

People, their relatives and representatives were involved in the planning and review of their care. People were given the opportunity to feedback on the quality of their care and actions were in place to make improvements. A complaints policy was available and people knew how to complain and who they needed to complain to.

Social and recreational activities were arranged each day, people chose whether they wished to participate or not.

People who used the service, visitors, relatives and staff told us the interim recovery manager was approachable, supportive and had implemented the changes that were needed. Staff felt well supported with their in their role.

Systems in place to monitor the quality of the service had continued to improve. The provider must now ensure the continuity of the consistent approach with monitoring the safety and quality of the service systems to ensure people are reliably provided with a safe, responsive and well led service.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At this inspection we found some improvements had been made in relation to safeguarding people from abuse and the governance arrangements. However there were continuing breaches of the Regulations in relation to staffing and providing people with safe care and treatment. The service will continue to be in special measures and will be kept under review.

St Mary’s Nursing Home provides support and care for up to 58 people. At the time of this inspection 56 people used the service.

The service had a registered manager. 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.

Staffing levels were insufficient to ensure people’s care and support needs were met in a timely and effective way.

People’s risks had been assessed, but improvements were needed to ensure these were monitored and managed to protect people from the risk of harm.

People's medicines were not always managed or administered in line with the prescribing instructions.

Mealtime choices were limited and did not always meet people’s personal preferences.

Staff were supported through training opportunities to require the knowledge and skills necessary to meet people’s individual care and support needs. Further training in specific topics were needed to ensure staff provided support in a consistent and reliable way.

The provider operated recruitment and vetting procedures that ensured appropriate people were employed. Regular checks were made to ensure staff continued to be of good character and able to work within their defined role.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported by staff who were caring and compassionate. Choices on how people wanted their care and support provided were promoted, listened to and acted on.

People and their relatives were involved in the planning and review of their care. The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

People were given the opportunity to feedback on the quality of their care and actions were in place to make improvements.

People and staff told us the registered manager was approachable and staff felt supported in their role.

Systems in place to monitor the quality of the service had improved; further development of these systems would ensure people were consistently provided with a safe and responsive service.

St Mary’s Nursing Home provides support and care for up to 58 people. At the time of this inspection 57 people used the service.

The service had a registered manager. 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.

There was insufficient staff available to meet people's individual needs. People experienced delays when staff were needed to provide them with the care and support they required.

The provider did not have effective systems in place to assess, monitor and improve the quality of care.

The principles of the MCA were not consistently followed. People were at risk of unlawful deprivation as referrals for a DoLS assessment had not been made for some people who lacked capacity to consent to their care and treatment within the service.

Risks to people's health and wellbeing were identified and assessed but not always reviewed to ensure the action needed to mitigate the risks was recorded.

Staff did not always receive the training they needed to be able to support people in a safe way. This meant some people's specialist needs were not met safely or effectively.

People generally told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Not all records for the purpose of monitoring people's fluid intake had been fully completed to ensure people's needs were fully met.

People had access to a range of health care professionals but follow up consultations were not always arranged.

Staff were kind and caring, however low staffing levels had a detrimental effect on meeting the care and support needs of all people.

There was a range of daily activities arranged for people to enjoy.

Staff were aware of the safeguarding procedures and knew where and to whom they could raise concerns.

The provider had a complaints procedure and people knew how and who to complain to.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to 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.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection 58 people were living in the home. We spoke with staff, visitors and people who used the service that were able to tell us about their experiences.

One person who used the service told us: "I moved here after a stay in hospital. I can't go home so I am planning to stay and so far it has been excellent. I am trying to get my room sorted so that I can have some things brought in from my home. The staff are all very good and friendly. The food is good and I can join in the activities when I wish to. I have no concerns".

Another person said: "St Mary's is home from home".

A visitor told us of their satisfaction with the care and support provided to their relative. They went on to say how much their relative had improved since they moved in.

Some people were unable to speak with us either because of frailty or personal preference. We spoke with staff about the care and support they provided. They gave a detailed account of the specific individual needs of people. We saw that staff treated people compassionately; offering discreet assistance to those who required it.

We saw that systems were in place to ensure that medication was administered in a safe way. Some improvements were needed for storing medication that required a cool environment.

We saw systems were in place for recruitment of staff and for effective record keeping.

The manager has provided us with a written report which records the actions they have taken to ensure improvements have been made. Staff have received additional updates in the care planning process and have been allocated time to check and update care plans. People who used the service will now have a comprehensive plan of their care which is reviewed at regular intervals to ensure their individual care needs are fully met.

We spoke with staff about the care and support they provided each day, they offered an explanation of people's individual needs. We looked at a selection of care records to check the care being given to people. We saw some inconsistencies in the recording of people's care needs.

Some staff we spoke with told us about their understanding of safeguarding vulnerable adults and what they would do if they had any suspicions of wrong doings. Other staff were not too sure of the actions they would take. People told us they would speak with staff or a family member if they had any concerns about the care they received.

People who used the service told us the staff were very good and looked after them very well. We saw some staff supported people in a caring, compassionate way. Staff told us they were always very busy and additional staff would be beneficial.

We saw the service had a system for monitoring the quality of the service, some improvements would be beneficial.