St Bridgets Care Centre

St Bridgets Care Centre is a residential care home registered to provide personal care and support for up to 12 people. The service provides support to older people. There were eight people using the service at the time of inspection.

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

Improvements were needed to the governance systems within the service. The systems for monitoring and checking the home operates in a safe way were not effective. The service did not actively seek feedback from others in order to drive improvements within the service. Policies and procedures were either not in place or up to date to support the systems and processes within the service. The provider did not carry out any formal checks of the service.

People had risk assessments in place for their care and support needs. However, assessments were not always detailed and the use of different formats meant it could be confusing for staff. The registered manager told us they were working to ensure assessments were clear.

Accidents and incidents were recorded and the appropriate actions taken. Events within the home were analysed to identify patterns. However, this information was not routinely used to learn lessons from events within the home. The registered manager told us they would begin using the information and share within the team.

People received their medicines safely, by trained staff. However, guidance was not in place for medicines people received occasionally. This meant there was a risk the medicines would not be administered consistently. The registered manager told us they would put the guidance in place.

There was a recruitment process in place and staff had received the necessary checks before commencing employment at the home. However, records were disorganised and not always kept in one place, the registered manager told us they would work to improve the system.

There was a lack of stimulation for people and social activities within the home. There were some bookings for external entertainers and parties within the home. We have made a recommendation about social stimulation and activities.

People had care plans in place for their care and support needs. However, these were not always updated as planned. People knew who to contact if they had a concern or wanted to make a complaint, the registered manager told us they knew how to address concerns raised. The provider had a complaints policy in place, however, it contained incorrect information about the management of formal complaints.

Safeguarding concerns were managed within the home and people felt safe living at St Bridgets Care Centre. People were supported to have maximum choice and control of their lives and staff supported the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had enough to eat and drink and received access to medical and healthcare as required. Infection control procedures within the home were robust and the environment was clean, and free from clutter. Records were stored confidentially. People told us staff were kind and caring and they treated them with dignity and respect.

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 17 May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the management oversight of the home at this inspection. We have made a recommendation about social stimulation within the home.

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.

People’s experience of using this service:

People gave positive feedback about the home and had no concerns about safety. The staff knew people well and knew how they preferred their care and support to be given.

Staff were knowledgeable about the systems and processes in place to safeguard people from potential abuse and knew what action to take if they suspected people were at risk of abuse.

Staff treated people with kindness, respect and dignity, whilst at the same time promoting people’s independence. People received personalised care and, which was planned and delivered to meet their needs.

The home was in good decorative order and people had access to well-maintained gardens.

People were happy with the standards of meals provided.

Staff were supported with regular supervision, annual appraisals and relevant training courses.

The service worked closely with health care professionals to ensure people received the support they needed to manage their health needs.

People were provided with access to activities and to access the community with outings to places of interest.

People’s medicines were being managed safely, stored securely and administered by trained staff.

People and their relatives were involved in assessing and planning the care and support they received.

People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

There was a system of audits and spot checks in place to ensure the service received ongoing monitoring to review the quality of the service provided.

People had confidence in the management team and felt the service provided clear leadership.

Rating at last inspection:

The last inspection report was published on 26 October 2016, when the service was rated as good.

Why we inspected:

This was a planned scheduled comprehensive inspection.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

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

St Bridgets Care Centre is registered to provide accommodation, care and support for up to 12 people. At the time of the inspection there were nine people living at the home. There was a registered manager employed at 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.’

Our previous inspection of the home, completed in April 2015, identified two breaches of the regulations. These related to; failing to assess, monitor and mitigate the risks relating to the health, safety and welfare of people and a breach relating to people’s privacy in regard to their records.

We told the provider that they must make improvements to protect people from these risks and asked them to send us an action plan stating what improvements they would make. The provider sent us the completed action plan as requested.

At this inspection we found the provider had made the required improvements to meet the regulations that had been breached in the previous inspection. This inspection found the provider was compliant with the regulations.

People were being well cared for and told us they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. People told us they felt there were enough staff available on each shift to care for them well. Staff felt well supported by the management team and received regular supervision sessions and appraisals.

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

Medicines were managed safely, handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people’s prescribed medicine had been given. Medicines were stored securely and at the correct temperatures. There was a system of checks in place to ensure any medicine errors were quickly identified.

People were referred to health care professionals as required. Equipment such as hoists, pressure relieving mattresses and cushions were readily available, well maintained and used safely by staff in accordance with people’s risk assessments.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work. Records showed appropriate mental capacity assessments had been carried out. Where some people were unable to consent to living in a care home, appropriate applications for a Deprivation of Liberty Safeguard (DoLs) had been made. Staff were able to explain to us how they provided people with choices and how they encouraged people to make their own decisions.

Staff ensured people’s privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed atmosphere which resulted in a calm and happy culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought feedback from people and changes were made if required.

People told us they felt the service was well led, with a clear management structure in place. Relatives told us they were always made to feel welcome at any time.

There were systems in place to drive the improvement of the safety and quality of the service.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service caring?

People were treated with consideration and respect. We spoke with three people and one person's relative. One person told us, 'The staff are very good. The way we are treated is very good.' Another person said, 'If you don't look very happy they question it.' One person's relative commented, 'The staff have always been very friendly.' We saw that people were treated sensitively. For example, we saw staff kneeling down to a person's eye level and provide reassurance regarding their medicines. The provider may find it useful to note that we observed staff assisting people to eat while wearing disposable gloves. The registered manager told us that this practice was carried out to reduce the risk of infection. However, no specific risks of infection had been identified with helping these people to eat and this practice did not respect the people's dignity.

People's privacy was respected. One person told us, 'The staff will knock on the door before coming in. They always close the curtains when they are helping me.' Another person said, 'The staff knock on the door before they come in. We have enough privacy.' We saw that people were supported with their personal care needs behind closed doors and staff knocked on people's doors before entering their rooms. The provider may find it useful to note that a list of people and the day they had a shower was publically displayed in the home. This did not respect people's privacy.

Is the service responsive?

People could access the services of healthcare professionals as necessary. One person told us, 'The staff phone the doctor if we need them. The district nurses have also been in before.' Another person said, 'They are on the ball here with the doctor. The doctor comes here we never have to go to the surgery. If I ask to see the doctor they get one for me.' A person's relative commented, 'The manager will call the doctor if she needs to. Mum is taken to outpatients appointments by the home.' We found that contacts with healthcare professionals were documented in people's care records, for example, visits by the chiropodist and GP.

Is the service safe?

We looked at four people's care records and found that their needs were not always accurately assessed. For example, people's risk of malnutrition was assessed using a nationally recognised tool. This tool requires the assessor to consider weight loss in comparison to the person's usual weight over a period of three to six months to calculate the degree of risk. None of the assessments we looked at had considered any weight loss over this period and there was no recording of the person's usual or pre illness weight. One person had lost a significant amount of weight in the previous month, however, the assessment concluded that they were at a medium risk of malnutrition rather than a high risk as the assessment had not been accurately completed. This meant that there was a risk that people at risk of malnutrition were not identified.

People's moving and handling needs were not adequately assessed. We looked at people's care records in relation to moving and handling. These records did not demonstrate a sufficient assessment, such as consideration of the type and size of equipment required to assist the person to move safely. The registered manager told us that the hoist slings allocated to people did not have any identifying markings on them as staff could visually recognise each person's equipment. We found that the hoist sling in one person's bedroom was marked with a name of a person who did not occupy the room. Another person had a large sized hoist sling which the registered manager said was due to their epilepsy rather than their size. However, there was no assessment which detailed that this was recommended by a healthcare professional.

People told us that there were sufficient staff to meet their needs. We spoke with three people and one person's relative. One person told us, 'Normally they are very quick when I press the bell.' Another person said, 'I think there are enough staff. They have got short now and again, but they just get on and do extra.' A person's relative commented, 'I've never noticed there being a shortage of staff. As far as I know, when mum presses her buzzer there is no unnecessary delay.'

People's care records did not always contain sufficient information to protect people from the risks of unsafe or inappropriate care.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had made a number of applications under these safeguards.

Is the service effective?

People's risk of skin damage was assessed and care was planned to reduce this risk. We found that an assessment of people's risk of skin damage had been carried out. We found that where people were assessed as being at risk of skin damage a plan was in place to reduce this risk. For example, one person had a pressure-relieving mattress which was set at a level which was consistent with their weight and was regularly checked.

People told us that care was delivered to meet their needs. We spoke with three people and one person's relative. One person told us, 'They always look after me. The staff are brilliant.' Another person said, 'The staff are very nice and very good. They are there to help us and they do help us. You will have to go a long way to beat this place.' A person's relative commented, 'They are meeting mum's needs.' We spoke with three staff who were aware of people's needs.

Is the service well led?

People's views of the service were sought. We spoke with three people and one person's relative. One person told us, 'The manager is very attentive. I see her quite a bit. She is always there if I want her.' Another person said, 'We asked for our supper later, so they now bring it at 9pm rather than 8pm.' We looked at the minutes of two recent 'residents meetings'. We found that people's views were sought during these meetings on a range of topics such as activities and the menu. The registered manager told us that they were preparing a survey for people to complete.

The provider did not have an effective system to monitor the quality and accuracy of people's care records. The registered manager told us that they monitored the quality of people's care records by completing monthly evaluations. However, this monitoring had not identified issues such as the lack of adequate assessment of people's moving and handling needs or the absence of detail in people's repositioning charts.

Audits of practice were not always effective. For example, we looked at records relating to a health and safety audit. The audit looked at moving and handling, among other health and safety topics. The audit stated that the correct size of hoist slings were used and detailed in people's care records. However, we found that this was not the case in all of the people's care records we looked at.

Trends in accidents and incidents were considered on a three monthly basis. We found that the provider had a system to review all accidents and incidents on a three monthly basis in order to identify any trends. We looked at records for the previous six months. No trends had been identified during this period.

At the time of our inspection there were nine people living at St Bridget's Care Centre. We spoke with four of them in order to obtain their views about the service the home provided.

We also spoke with five visiting relatives and five members of staff in order to obtain their views about the home.

People we spoke with who lived at the home all expressed satisfaction with the support they received. They told us their needs were met, food provided for them was good and the home was kept clean They said the home's manager asked them for their opinions about the service they received.

Nationally recognised assessment methods or tools were not always used to identify risks to people's health and welfare and care plans had not always been put in place to ensure people's needs were met.

There were appropriate arrangements in place for people who lacked capacity to make decisions for themselves. Arrangements were also in place that ensured people's nutrition and hydration needs were met; they were protected from the risk of infections; medication prescribed for them was managed safely; individuals recruited to work in the home were suitable; and the quality of the service was monitored.

The senior care coordinator told us that some people living at the home had been assessed as not having capacity to make choices and decisions which affected their lives.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so.

We spoke to staff and reviewed records which showed us that people were protected from abuse and that their care was planned and delivered in a respectful and safe way. One individual told us they were 'quite satisfied with there care'.

People told us the food was good and people could choose what they wanted to eat, when they went to bed and time they got up in the morning.

People told us they felt safe and knew who to speak to if they had any complaints. They told us there were organised activities once a week they could join in with if they wanted.

We found evidence of unsafe arrangements that were in place in relation to the recording and administration of medicine.