St Leonards Care Home

Updated 31 May 2023

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 was carried out by 1 inspector on both days of the inspection. An Expert by Experience was on site on day 2 of the inspection and a second Expert by Experience carried out calls to relatives after the inspection.

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 Leonards 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 Leonards is a care home without 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 inspect.

During the inspection

We spoke with 8 people who used the service about their experience of the care provided. We spoke with 4 staff which included the registered manager, deputy manager, a team leader and the training administrator. We observed lunch and used the Short Observational Framework for inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We walked around the service and reviewed the environment. We reviewed a range of records relating to people's care which included, multiple medicine records and 7 care plans. We reviewed 5 staff recruitment files and a variety of records relating to the management of the service, including fire, health and safety, accident/incidents, safeguarding, and audits were reviewed, and other records were requested.

Following the visit to the service we sought feedback from relatives, staff and continued to seek clarification and records from the registered manager. We received written feedback from 6 relatives and spoke with a further 12 relatives. We received written feedback from 3 staff, and spoke remotely with the assistant manager, a team leader, a senior carer, the cook and an administrator.

Updated 31 May 2023

About the service

St Leonards Care Home is a residential care home providing the regulated activity accommodation and personal care to up to 45 people. The service provides support to older people, including people with dementia. At the time of our inspection there were 44 people using the service.

St Leonards care home accommodates people across 2 units. 1 of the units specialises in providing care to people living with dementia. Each unit has a communal sitting and dining room facilities, with people having access to an enclosed outside space.

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

Risks to people were not consistently identified, mitigated, and reviewed.

Staff were not suitably recruited and did not have their competencies assessed for the tasks they were involved in, including administration of medicine. However, medicines were given as prescribed and the service took action to complete staff competencies.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Auditing was taking place and shortfalls in the service were identified. However, timely action was not taken to address the outcome of the audits to mitigate risks to people. Records were not consistently managed, with some records not updated in response to changes in people's needs and other records were contradictory.

People were supported by a consistent staff team. Whilst records and feedback from people and staff indicated staffing levels were suitable, some staff felt staffing levels were not sufficient to enable them to provide the high-quality care they aspired to, because of the volume of administration tasks. This was fed back to the provider to explore further with staff.

Systems were in place to safeguard people and actions were taken to prevent reoccurrence of incidents which impacted on people’s safety.

People were assessed prior to moving into the service and their health and nutritional needs were met. The service had established community links and people had access to regular, varied, and engaging activities.

Whilst we found some areas for improvement within the service, people and their relatives told us they were happy with their care. They felt they got safe care and that their needs were met in a service that was well managed. People commented, “All I can say is that I feel privileged I am so well looked after. Staff who help me are kind, they do their job with pride,” and “The carers here are like my family. Whatever I need, I get. If I need to talk, staff are there to sit and ask if I need anything, they are there for me.”

The registered manager was actively involved in the running of the service. They were passionate in providing person centred care and had positive relationships with people, relatives, and staff. They acknowledged the shortfalls we found and was committed to make those improvements.

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 14 November 2017).

Why we inspected

We received concerns in relation to the care people received and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. 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.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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.

The registered manager took immediate actions to make the improvements and ensure these are embedded and sustained.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Leonards care home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, recruitment and training of staff, consent to care, and good governance.

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.