St Agnes Retirement Home

St Agnes Retirement Home is a residential care home providing personal care for up to 26 older people. At the time of our inspection there were 18 people living at the home. The service is across two floors. On the ground floor there is a lounge, additional quiet lounge and a dining room with level access to the garden. Bedrooms are situated on the ground and first floors

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

The service had made improvements to ensure people had meaningful activities to engage in. Staff supported people to access the local community and maintain relationships with friends and family.

We made a recommendation about governance systems as further developments were needed. This was to ensure all areas were identified where actions were required and incorporated into the service’s improvement plan. For example, in the accuracy and wording of care plans, how feedback information was gathered and in the personalisation of end of life care plans.

The home was clean and tidy. People enjoyed their individual rooms and the outdoor space at the home. There was a good atmosphere where people were listened to and respected.

People were supported well with their nutrition, hydration and healthcare needs. People and relatives felt comfortable in raising any concerns or complaints and actions were taken. Staff were well trained and skilled in their role. Staff knew people well and had developed positive relationships with people.

There were good systems of communications within the staff team and with relatives. People’s opinions and feedback was sought. The management team were open, honest and approachable.

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 and update

The provider had completed an action plan after a comprehensive inspection (published 19 November 2019) to show what they would do and by when to improve in relation to the breaches of regulation found. The last rating for this service was requires improvement (published 11 February 2021) where improvements had been demonstrated.

At this inspection we found further improvements had been made and the provider was no longer in breach of Regulation 9 (Person-Centred Care).

At our last comprehensive inspection (published 19 November 2019) we recommended that the provider reviewed published guidance about best practice in relation to exploring and recording people's end of life care preferences. At this inspection we found improvements had been made but further development was still required to ensure they were personalised.

Why we inspected

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

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.

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 requires improvement to good based on the findings of this inspection.

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

Follow up

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

St Agnes Retirement Home is a 'care home'. The service specialises in care for older people and can accommodate up to 26 people. 19 people were living at the service at the time of the inspection. The home is made-up of two former domestic properties and laid out across two floors. To the ground floor there is a lounge, additional quiet lounge and dining room with level access to the garden. Bedrooms are situated on the ground and first floors.

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

The service had made improvements to ensure peoples safety. Risk relating to hot surfaces and water had been addressed as had requirements relating to fire regulations. Medicines were stored and managed safely. We have made a recommendation in relation to written guidance in administering medicines.

New staff were recruited safely. Changes had been made to ensure people were supported in the least restrictive ways. Deprivation of Liberty Safeguards were monitored and reviewed. Notifications were submitted as required.

Governance systems were in place. However, further development of audits and relating action plans were required to ensure the service continued to identify and action areas for improvement, including refurbishments.

People were happy and enjoyed living at St Agnes Retirement Home. There was a friendly and welcoming atmosphere. Staff were valued by the provider and worked well as a team. We received positive feedback about the management and staff.

There was good communication. Relatives said the service was open and responsive.

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 inadequate (published 19 November 2019). Where six breaches of regulations were identified. We issued a warning notice in relation to Regulation 12 (Safe care and treatment) and Regulation 19 (Fit and proper persons employed). We followed up this warning notice in a targeted inspection (published 03 February 2020). The provider had made improvements and met the Regulation 19 breach (Fit and Proper Persons Employed) and the majority of Regulation 12. However, there were still some outstanding areas.

At this inspection we only reviewed the safe and well led key questions. This is because of our current methodology and risks related to COVID-19 meant we were not reviewing the breaches of regulations in the responsive key question.

At this inspection we found improvements had been made and the provider was no longer in breach of Regulations 12, 13 and 17 (HSCA 2008 (Regulated Activities) Regulations 2014) and Regulation 18 (Registration Regulations 2009).

This service has been in Special Measures since 19 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the service was meeting legal requirements relating to Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse) and Regulation 18 (Registration Regulations 2009) (Notification of incidents). This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. Our report is based on the findings in those areas at this inspection.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Agnes Retirement 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 Agnes Retirement Home is a ‘care home’. The service specialises in care for older people and can accommodate up to 26 people. The home is made-up of two former domestic properties and laid out across two floors. To the ground floor there is a lounge, additional quiet lounge and dining room with level access to the garden. Bedrooms are situated on the ground and first floors, there is chair lift access to the first floor. The registered managers office is located adjacent to the quiet lounge on the ground floor.

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

Since our last inspection, the provider, registered manager and manager had worked to develop the service and improve safety for people living in the home. However, improvements were still needed to make sure that people were not at risk of harm. This meant that not all the requirements of the warning notice had been met.

Although improvements had been made to lower the potential risk of scalds and burns to people, further improvements were needed to remove the risks completely. This meant the Warning Notice for Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was not met.

We found the service had made sufficient improvements to recruitment processes and the management of medicines and topical creams. This meant the Warning Notice for regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was met.

Rating at last inspection and update

The last rating for this service was inadequate (published November 2019) when we identified six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulations 12 (Safe care and treatment) and 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 01 November 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider following our last inspection. CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a warning notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Agnes Retirement Home is a residential care home and was providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 26 people.

St Agnes Retirement Home is located in Weston Super Mare and is made up of two converted former domestic properties laid out over two floors. The ground floor consists of bedrooms, a communal shower room and toilet. There is a lounge-dining area with access to the garden through a small room that provides seating for approximately five people overlooking the garden. An additional ‘quiet lounge’ is located close to the manager’s office. To the first floor there are bedrooms, a communal toilet and separate bathroom and a reading room.

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

People were not protected from the potential risk of avoidable harm. For example, risks from asbestos were identified in 2010 however no action had been taken to remove asbestos or make areas containing asbestos safe. Further environmental hazards included those from fire doors that did not conform to current safety standards and risks of scalds from hot surfaces and water. Although staff spoke confidently about actions they would take if abuse was suspected, contact was not always made with the local safeguarding team when potential safeguarding concerns were identified. Staff were not consistently recruited safely because gaps in employment were not always explored. Medicines were not always managed safely.

The service was not well-led because there was a lack provider oversight. Governance systems were not always used effectively to identify concerns and omissions we identified during our inspection. This meant people were at risk of avoidable harm. Notifications were not always submitted to the commission as required by the legislation. People provided mixed feedback about how involved they felt with the running of the home. People and staff spoke positively about the management team and the atmosphere within the home.

People were not always supported to have maximum choice and control of their lives and staff did not always 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. The home security system was not used in a way that encouraged people to retain their independence and access the community as they wished. DoLS had not been applied for appropriately because the management team was unaware that DoLS authorisations needed to be reapplied for. Capacity assessments did not always correspond with actions taken by the service and one person was being deprived of their liberty unlawfully. The environment required maintenance in areas throughout the home, further information is contained in the detailed findings below.

People were not always supported to access meaningful activities regularly, we received mixed feedback from people about the activities being provided. People’s End of Life care preferences were not always explored and recorded. There were positive examples of how the provider supported people through care planning. The provider offered people additional support to access information important and relevant to them. The provider had not received any complaints since our last inspection.

People told us they were supported by kind and caring staff who treated them with dignity and respect. We observed many kind and caring interactions between staff and people during our inspection.

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 (Published October 2018)

At this inspection sufficient improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Well-Led, Responsive and Effective sections of this full report.

We have identified breaches in relation to the provision of safe care and treatment, failure to submit statutory notifications, ineffective governance systems and a further failure to ensure robust processes were in place to ensure people were protected from potential harm and abuse. People were not consistently supported to access meaningful activities.

Enforcement: We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 6 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 the 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.

The inspection took place on 1 August 2018 and was unannounced. There was a registered manager in post. The registered manager was also the provider. 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 registered manager had appointed a deputy manager for the day to day running of the service. Care plans provided information about how people wished to be supported and staff were aware of people's individual care needs and preferences.

People told us they were involved in their care planning. The electronic care planning system had up to date information relating to people who were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and there were policies and documents to ensure this.

The service had systems to ensure medicines were administered and stored correctly and securely. Medicines records had information relating to people's preferences. However there was no protocols for ‘as required’ medicines to guide staff about administration and creams did not have a date of when they had ben first opened to ensure they were still suitable for use.

There were no hand washing facility at the point of care delivery to prevent cross infection. Recruitment procedures did not always check staff employment history and there were no risk assessments where convictions had been disclosed.

People and their relatives were happy with support arrangements provided. People told us they felt safe and were treated with respect. Systems were in place to protect people from harm and abuse and staff knew how to follow them.

Staff interactions with people were positive and caring. Staff received training to understand their role to ensure the care and support provided to people was safe. All training was up to date.

New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported. People were complimentary of the food provided.

There were systems in place to receive feedback from people who use the service and their relatives. People and relatives were aware of how to raise concerns and they were confident if they raised concerns these would be responded to.

The registered manager and provider had systems in place to monitor the quality of the service. The service had an action plan in place that identified shortfalls in the service and the required improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a recommendation about advanced care plans. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 11 May 2016 and was unannounced.

There was a registered manager in post. The registered manager was also the provider. 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 registered manager had appointed a manager for the day to day running of the service.

Care plans provided information about how people wished to be supported and staff were aware of people’s individual care needs and preferences. People told us they were involved in their care planning. The electronic care planning system did not always direct us to the most up to date information relating to the person.

The service had systems to ensure medicines were administered and stored correctly and securely. Some medicines records lacked information relating to people’s preferences.

People and their relatives were happy with support arrangements provided. People told us they felt safe and were treated with respect. Systems were in place to protect people from harm and abuse and staff knew how to follow them. Staff interactions with people were positive and caring.

Staff received training to understand their role to ensure the care and support provided to people was safe. There were some gaps in staff training and the registered manager had plans in place to address this. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

People were complimentary of the food provided. There were systems in place to receive feedback from people who use the service and their relatives. People and relatives were aware of how to raise concerns and they were confident if they raised concerns these would be responded to.

The registered manager and provider had systems in place to monitor the quality of the service. The service had an action plan in place that identified shortfalls in the service and the required improvements.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and what the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People are treated with respect and dignity by staff. People told us they feel safe and are happy with the care, treatment and support provided. One person told us "I chose to come here after visiting four care homes. I have not regretted it at all".

Systems were in place to make sure that managers and staff learnt from accidents and incidents as well as comments received from professionals and relatives of people who used the service.

The service was safe, clean and hygienic. Regular checks were seen to be undertaken on equipment, electrical items and fire safety matters.

Recruitment was seen to be thorough and staff who recently joined the service told us they had a good induction. There were sufficient staff with the right skills and experience to meet the needs of the people using the service.

Is the service effective?

People's health and care needs were assessed comprehensively and they were involved in writing their own care plans. Specialist dietary and mobility needs had been identified in care plans where required.

Is the service caring?

People were supported by staff who took time to listen to the people who used the service. One person told us "the staff are very kind and look after me well". Another person told us "the staff do anything I ask, I am very glad of the help I get".

Is the service responsive?

People told us that they found the manager and staff very approachable. We saw that people had been involved in planning outings for the summer months. We saw care plans which showed us that the care, treatment and support was reviewed in the line with people's changing needs.

Is the service well-led?

The service has a good quality monitoring system which ensures that the manager is aware of any changes in the service and is able to respond proactively.

Good relationships between staff and management were observed on the day of the visit.

Other agencies had written positive comments about the way that the service provides good information and works in a way that improves people's health and well-being.

All of the people we spoke with gave positive feedback about the home. People we spoke with told us they were happy and safe at St Agnes. One person told us, "It is good here; they look after me very well'. Another person said "they go out of their way to help me'. They said the manager was good and they were confident about talking to them if there were any issues.

All; eight people spoken with told us they found the staff friendly and helpful. They said staff were very knowledgeable and worked well as a team. The staff we spoke with had a clear understanding of the care needs of people who lived in the home. One staff member told us 'I love working here'.

People we spoke with said they could choose how to spend their day. We saw there was information for people in the reception area of the home. This included suggestion and complaint forms.

We observed the atmosphere and general ambiance of the home to be friendly, calm and relaxed. We saw staff treated people with respect and dignity.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the manager and provider. They told us there were always enough staff on duty and there was a duty manager on call if needed.

People who lived in the home were positive about the service and said they were treated with respect. Each person commented that they were happy living at St Agnes. One person said "It's very good here."

People told us that staff treated them as individuals and made the changes to their daily routines when they requested it. One person said 'the staff are helpful, caring and considerate.'

People told us they had good relationships with the staff and said "on the whole it's all very pleasant" about the home and people told us they were able to talk to staff if they had any worries or concerns.

We were told people were involved in the decision making in the home by talking to the manager or one of the owners who was regularly in the home. We saw that people's views were surveyed through regular questionnaires and information was shared through regularly produced newsletters which people shared with their families and friends. Newsletters could also be found near to the main entrance and were available for anyone to read and keep up with what was going on in the home.