St Antony's Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Based on the findings of this assessment, the rating for this key question has changed from Good to Requires Improvement. This indicates that some aspects of the service were not consistently safe, increasing the risk of harm to people. The concerns centred on how the provider maintained and monitored the safety of the care home environment, particularly fire safety. There were also issues with the provider’s governance systems, including how they identified and addressed problems to improve safety. Some risk management plans were missing, lacked personalisation, or were insufficiently detailed, meaning staff did not always have the necessary information to mitigate risks. These failures led to breaches of 2 regulations: Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We discussed these issues with the registered manager, who acted promptly during and after our visit. They provided additional evidence showing how these concerns were either resolved or being addressed. More details can be found in the evidence section below. Care plans were based on thorough pre-assessments conducted by the provider and external health and social care professionals. Staff were knowledgeable about safeguarding, well-trained, and thoroughly vetted before working in the home. Infection control, including COVID-19 measures, followed current best practice guidelines.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us the provider learnt lessons when things went wrong and acknowledged when they could and should have done better.

Managers and staff told us any incidents and accidents, safeguarding concerns or complaints involving the people they supported were always logged and analysed to learn lessons and improve. For example, incidents were routinely reviewed to determine potential causes and to identify any actions they needed to take to reduce the likelihood of similar incidents reoccurring. Staff confirmed information about any lessons learnt were always shared with them during meetings with their line managers and fellow co-workers. The managers encouraged an open and transparent culture where people received a service, their representatives and staff could all raise concerns without fear. However, the registered manager acknowledged that some of the issues we identified as part of this assessment were areas, they should have picked up themselves as part of their regular monitoring checks of the premises and general health and safety. The registered manager was aware they needed to improve how they operated their established governance systems to help them identify and manage any environmental and health and safety maintenance issues, including fire safety, more effectively moving forward.

The provider's governance framework did not always ensure they continuously learnt and improved. Their approach was found to be a rather ‘tick-box’ exercise which was not always effective. The provider had established governance and monitoring systems in place, which included regular checks on the care homes environment, fire safety, medicines management, infection control, training and support staff received, accidents and incidents, and people's mealtime experiences. However, these governance systems were not always operated effectively because they had failed to pick up and/or take appropriate action to address a number of issues we identified at this inspection including, how the provider monitored and maintained the care home's physical environment and their fire safety arrangements. For example, we found half a dozen of the service's fire resistance doors did not always close properly into their frames when released or were propped open with a door wedge or chair, contrary to best fire safety practice and the provider's own fire safety procedures. The provider failed to identify these issues despite conducting regular health and safety checks of the premises. In addition, these audits had also failed to identify and/or take action to ensure all the care home radiators had been risk assessed and/or suitably covered to minimise the risk of people being harmed. Furthermore, the provider's environment audits did not specifically identify which bedrooms had been checked each month and their medicines audit did not identify which medicines records they looked at.

Managers and staff carried out pre-admission assessments and received information about people’s support needs when they received referrals for new placements. This meant they were able to identify if they could support people in the best way. The registered manager confirmed these initial assessments were used to help staff develop person-centred care plans for everyone they supported.

External providers confirmed they have a good working relationship with the provider and they were involved in initial assessments.

People told us the care home was a safe place to live. A person said, "Yes, I definitely feel very safe living here”, while an external health care professional added, “I have no concerns about the safety of my clients who live there.”

Managers supported staff to safeguard people from abuse. Staff understood how to recognise abuse and neglect, protect people from its different forms and to report any concerns to their line managers. The managers understood their legal responsibility to refer safeguarding incidents to all the relevant external agencies without delay, ensuring they were fully investigated and to take appropriate action to minimise the risk of similar incidents reoccurring.

We observed how people using the service interacted with staff and they looked at ease and comfortable in staff’s presence.

The provider's safeguarding policies and processes were in line with relevant legislation. The registered manager worked well with external agencies and acted in a timely way to make sure people were safeguarded and protected from further risk.

People told us staff looked out for them and knew how to keep them safe. An external health care professional said, “I have found the knowledge of staff about each individual resident is excellent.”

The service had an experienced staff team who were familiar with people’s daily routines, preferences, and identified situations where people may be at risk and acted to minimise those risks. For example, staff were aware of the signs to look out for and the action they needed to take to minimise the risk of people with mobility needs from falling. Staff told us they always followed people’s risk prevention and management plans to enable individuals to take reasonable and acceptable risks.

We observed staff supporting people in a safe way throughout this onsite visit. This included helping people with mobility needs to access the garden and other parts of the home. Staff were also vigilant in ensuring people had mobility aids near them and were using them appropriately.

We found records the provider is required to keep and appropriately maintain were not always person centred. For example, we saw 'we' written verbatim across multiple care records for different people using the service. This meant they were generic in tone and not always individual to the person they were written for. We also found that some risk assessments in relation to fire awareness were not fully completed. Where people had been assessed as not having a good understanding of fire procedures, there were no risk management in place to mitigate against this. The registered manager told us that all of the people using the service had a diagnosis of dementia and some did not understand the use of call bells. We looked at a falls management care plan for a person with mobility needs, this stated they had access to a call bell. However, the staff and registered manager told us they did not know how to use it. There was no risk assessment completed for this. These negative comments described above not withstanding we found most of the risks people might face had been assessed and management plans put in place to help staff prevent or minimise these identified risks. These plans covered most aspects of people’s lives including, mobility and risk of falls, skin integrity and nutrition. This meant staff had most of the up-to-date information about the action they should take to manage these risks and keep people safe. There were other areas of good practice, risk assessments had been updated following incidents that had occurred and the provider took steps to manage risks to people by ensuring body maps and incident reports were completed.

People told us the care home was a comfortable and pleasant place to live. One person said, “It’s genuinely nice here. Its homely, which I like.”

Managers and staff told us they had developed an action plan to totally refurbish the care home and improve its interior decoration and general maintenance. The registered manager said, “We have recently completed totally refurbishing the ground floor ‘Parker’ bathroom and toilet, and a few peoples’ bedrooms, as well as plastering the damaged ceiling in the dining room. We still have a long way to go to complete all the refurbishment work we’ve got planned, but we’re slowly getting the place up to scratch and looking how we want it.”

People lived in a care home environment which was homely and people were comfortable in their surroundings. However, half a dozen fire-resistant doors we tested at random did not close properly into their frames when released and several other doors had been propped open with door wedges or chairs. This meant these doors would not automatically close when the fire alarm was activated, contrary to fire safety regulations and the providers own fire safety policies and procedures. In addition, while we found many of the care homes radiators had been suitably covered, many were not, and a number had either covers that were damaged and/or were only partially covered. The risks associated with older people living with dementia being harmed by radiators that were not properly covered had also not been accurately assessed and action taken in response to mitigate any identified risks. We also found several trip hazards in doorways leading from the kitchen and dining room to the rear garden which people with mobility needs and/or living with dementia were at risk of falling over. These uneven surfaces posed an immediate risk to people with mobility needs and/or living with dementia.

The aforementioned health and safety issues described above notwithstanding other checks were routinely completed by managers and staff. This included regular health and safety checks on the care homes gas and water systems. The provider also had an up to date fire risk assessments in place for the building and personal emergency evacuation plans [PEEPs] in place for everyone who lived at the care home.

People told us there were always enough, competent staff available in the care home to support them. A person said, “Staff always come quickly whenever I call them. When I press my call bell they [staff] come within 2 minutes to see what I might need help with. They also do a quick check on me at night to see if I’m ok.”

Managers and staff told us there were enough people employed to meet people’s needs. Staffing levels were consistent across the whole week, including weekends. There were 3 staff on shift every day and 2 staff during the night, of which one was sleeping-in. The registered manager also said they regularly reviewed staffing levels at the care home to ensure there were always enough suitably experienced and trained staff on duty to meet people’s needs and keep them safe. Staff received relevant training to support them in their roles. They were well supported by managers to learn and continuously improve their working practices. Staff told us about the training they had as part of their job roles and were knowledgeable about the topics they were trained in, such as supporting older people living with dementia. Staff told us they felt supported by the managers and were able to discuss their job roles in their regular supervision, appraisal and team meetings they attended with their line managers and fellow co-workers. A member of staff said, “I enjoy working here and we’re supported by the managers.” Another added, “Anytime I need anything, the managers are around to help us.”

We observed staff were visibly present throughout our onsite inspection. For example, we saw people did not have to wait long for support from staff when they requested it. Staff were vigilant when people were moving around the care home or undertaking activities to ensure people remained safe. We saw additional one-to-one staff assistance was being provided during the day for one person who was at risk of falling and like to wander around the care homes communal areas and the rear garden.

Staffing levels in the care home matched the staff duty rota for the day we visited, and we saw they were available in sufficient numbers to meet people's needs and keep them safe. Managers used dependency tools to make sure there were always enough staff to meet people’s needs safely. Managers conducted checks on staff that applied to work at the service to make sure they were suitable to support people. This included checks with the Disclosure and Barring Service (DBS) who provided information including details about convictions and cautions held on the Police National Computer. The information helped employers make safer recruitment decisions. Training records showed that staff received ongoing training that was appropriate for their role. This included the Care Certificate. The Care Certificate is an agreed set of standards that defined the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It’s made up of the 15 minimum standards that should be covered if you are ‘new to care’ and should form part of a robust induction programme. Other relevant training staff received included dementia awareness which everyone residing at the care home was living with. All the training staff were provided were refreshed at regular intervals, so staff continuously stayed up to date with current best practice. Supervision and appraisal records showed staff had regular supervision meetings and an annual appraisal of their overall work performance with their line managers to support them in their role and to identify any further training or learning they might need. There were systems in place for the provider to identify and monitor staff training and supervision requirements and ensure it remained relevant and up to date.

Managers and staff told us they had received up to date infection control and food hygiene training.

The care home was clean and tidy. The provider had cleaning schedules in place to guide staff on maintaining the cleanliness of the care home. They followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. We saw staff used personal protective equipment [PPE] effectively and safely. People told us staff kept the care home clean and odour free. A person living at the care home said, “The staff do a good job keeping the place clean”, while an external health care professional added, “The home is always clean when I am there.”

People told us they received their medicines as they were prescribed. A person living at the care home said, “Yes, the staff are particularly good at making sure I always get my medicines on time. This has never been a problem.” An external health care professional added, “The management of medicines is well done, and the provider is quick to raise any concerns about people’s medicines and when required.”

Staff were clear about their roles and responsibilities in relation to the safe management of medicines. Staff received medicines training and their competency to continue managing medicines safely was routinely assessed by their line managers.

Medicines systems were well-organised and staff appropriately maintained medicines records. We found no recording errors or omissions on any of the medicines records we looked at during this inspection. Medicines were safely stored in locked cabinets in the office. People’s care plans included detailed guidance for staff about their prescribed medicines and how they needed and preferred them to be administered. This included protocols for people prescribed ‘as required’ medicines however, protocols for the use of ‘as required’ behavioural modification medicines were not always sufficiently detailed. This meant staff might not have access to all the information they needed to know when and how to safely administer this type of medicines. We discussed this issue with the registered manager at the time of our inspection and they agreed to improve guidance for staff in relation to when and how they administer a person's prescribed ‘as required’ behavioural modification medicine. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.