Archived: St Helens

Updated 21 December 2021

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 Care Act 2014.

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 first day on inspection was conducted by two inspectors. One inspector returned for the second day of inspection.

Service and service type

St Helens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission and we are dealing with this outside of the inspection process. A manager was in post, but they were not registered. We have referred to them as ‘the manager’ throughout this report.

Notice of inspection

This first day of inspection was unannounced. The second day was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and other professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with three people who used the service about their experience of the care provided. We spoke with five members of staff including the manager, provider, nurses and care staff. We also spent time observing staff interactions with people and conducted a tour of the service.

We reviewed a range of records. This included ten people’s care records in part and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, quality assurance records and policies.

Updated 21 December 2021

About the service

St Helens is a residential care home providing personal and nursing care for up to 28 older people, some of whom have mental health conditions or dementia. At the time of this inspection 18 people were using the service.

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

Robust quality assurance systems were not established or operated to monitor the quality and safety of the service provided. There was ineffective provider oversight and where concerns had been found, timely action had not been taken to address them.

The provider failed to follow their own improvement plan to ensure they were meeting regulations and providing safe care.

People were not always safe. The provider had not taken action to address maintenance, safety and infection prevention and control issues around the service. Risks to people were not always recognised or appropriately assessed. Medicines storage was inappropriate, and prescriber instructions had not always been followed.

Safe recruitment processes were not always operated. Staff had not received consistent support or had their competencies assessed to ensure they had the appropriate skills and knowledge to carry out their role.

Appropriate support had not always been provided to ensure people’s nutritional needs were being met. Monitoring documents had not been completed sufficiently.

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. Signed consent was not always in place. Where people lacked capacity appropriate capacity assessments had not been completed.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 November 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the safety of the building, risk assessing and nutrition management as well as the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety of the service and risk assessing, nutrition, consent, safe recruitment and governance systems at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to ensure a manager registered with the Care Quality Commission was in post. This was a breach of regulation and we are dealing with this outside of the inspection process.

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.