St Luke's Care Home

St Lukes Care Home is a residential care home providing regulated activities of personal and nursing care to up to 32 people. At the time of our inspection there were 22 people using the service.

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

The manager had been in post approximately 2 months, during this time they had worked with the provider to improve the standard of care for people. There had been significant improvements in people’s care. However, we would need to see these improvements seen at this inspection, sustained over a longer period of time to be assured good outcomes for people would be maintained.

The majority of personal risks to people’s safety were well managed. We highlighted an area in one person’s care plan which needed further information to support the person.

The management of medicines had improved but there were still further improvements required, such as ensuring medicines were dated when opened. Some as required medicines lacked a reason for their administration on their medicines administration record (MAR).

The manager was receptive to our feedback on these issues and addressed the concerns straight away.

Quality monitoring processes at the service had improved but aspects of these processes needed further refining. This included the issues we found with medicines and monitoring of personal care. The provider and manager was receptive to our feedback and assured us they had plans to further improve their auditing processes.

Assessments of people’s needs had been undertaken using nationally recognised assessment tools, and measures to reduce risks had been put in place using these risk assessments.

People told us they felt safe at the service. The management team worked with the provider to ensure all safeguarding concerns were dealt with appropriately. There were processes in place to enable learning from events. People were supported by adequate numbers of staff who had been recruited safely and received appropriate training for their roles.

People lived in a clean environment and although there were areas which needed to be refurbished the provider was aware of this and had a plan in place to prioritise the works required.

People’s nutritional needs were well managed, they enjoyed the food served to them. They were given choice and supported with their meals by a staff group who showed good knowledge of their nutritional needs.

Peoples’ health needs were well managed and there were good working relationships with external health professionals to provide good outcomes for people.

People were supported by a staff group who treated them with respect and maintained their dignity. They were supported to be involved with their care, which was provided in a person-centred way. Staff had good knowledge of people’s needs and used their care records to ensure people’s current needs were met.

People were supported to maintain relationships with their families and there were various leisure and event opportunities planned to reduce people’s feelings of boredom or isolation.

The service had systems to manage complaints and concerns from people or their relatives and people told us they felt listened to.

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 last rating for this service was inadequate (published 25 May 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 May 2023. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

Follow up

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

St Luke’s Care Home is a residential care home providing the regulated activities of accommodation and personal care for up to 32 people. At the time of our inspection there were 25 people using the service.

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

The risks to people’s safety were not always well managed. Identified measures to reduce the risk of falls, fire safety and skin damage were not always in place for people. People’s medicines were not well managed, staff did not follow best practice when administering and recording people’s medicines. Incidents were not always investigated or reported to both the local safeguarding teams or CQC.

Staff supporting people did not always have the necessary training for their roles. People were supported by large numbers of agency staff, some of whom only stayed at the service for one to two weeks. People did not receive consistent person-centred care.

Staff recruitment processes were not robust. Management of agency staff employed was poor. There was a lack of records to show the provider had assured themselves these staff had the necessary employment checks and training to ensure they were safe to support the people in their care.

There was a lack of robust and consistent quality monitoring systems to maintain good standards of care for people. There was a lack of effective provider oversight of the service. This had resulted in a deterioration of people’s care.

Staff were not always supported by the management team and people and their relatives were not asked for their opinions about the quality of the service.

Infection prevention and control practices were safe, and people were able to see their families and friends when they wished.

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 last rating for this service was requires improvement (published 10 August 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they met their warning notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 Inadequate. This is based on the findings at this inspection.

We carried out an unannounced comprehensive inspection of this service on 14 and 16 June 2022. Breaches of legal requirements were found. We issued a warning notice to the provider.

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.

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

Enforcement

We have identified breaches in relation to regulations 12, 17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to manage the risks to people’s safety in relation to their medicines, personal safety, falls and skin damage. There was a lack of consistent training for staff employed at the service. The provider had failed to have recruitment processes established to ensure fit and proper persons were employed and failed to provide effective governance of the service.

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.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 time-frame, 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 the provider’s 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.

St Luke’s Care Home is a residential care home providing regulated activities of accommodation and personal care for up to 32 people. At the time of our inspection there were 24 people using the service.

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

Risks to people’s safety were not always identified and mitigated putting people at risk of harm. These risks included both environmental and personal risks to people. The processes in place to reduce the risks of the spread of infection were not effective. Staff did not always wear personal protective equipment in line with government guidance, and standards of environmental cleanliness at the service required improvement. There was a lack of learning from events and staff did not always work together to provide the safe care.

The registered manager did not have effective oversight of the service. They were not aware of all the concerns we found prior to this inspection. There was a lack of effective quality monitoring processes at the service which affected the quality of the environment, care plans and risk assessments, and the analysis of incidents and accidents.

Staffing levels did not always reflect people’s needs. There was a lack of support staff in place to allow care staff to fully focus on their roles. Staff attempted to provide regular social activities for people to engage in; however, this area required some improvement. A lack of housekeeping staff impacted on the cleanliness of the service. There were several areas of the home which were not always well maintained, and some areas needed refurbishment.

The service used several agency staff to support their permanent staff. There was a lack of profile records for some of these agency staff, to assure the provider they were safe to work with the people at the service.

Staff practices around the administration of medicines were not always safe and people were not always supported effectively with their nutritional needs

People were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not always demonstrate people were supported in the least restrictive way and in their best interests. Where decisions had been made for people who lacked capacity to make specific decisions, there was a lack of documented consultation with relevant family members, social workers or advocates.

Nationally recognised assessment tools were used to assess people’s needs, however these were not used effectively. There was contradictory information in the assessment tools and some information in people’s care plans did not reflect their needs

The provider did not always ensure they met their responsibilities to inform us of significant events at the service as they are required by law to report to us. We are looking into this and will follow our own processes to decide on any necessary action against the provider.

People were supported by kind and caring staff who maintained their privacy and dignity when providing care. They were supported to manage their health needs. The manager and their staff team worked to ensure relationships with external health professionals affected positive outcomes for the people in their care.

There was engagement with people during our inspection, however, there was little evidence of how people were involved in any decisions made about the service.

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 requires improvement (published 24 April 2021).

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of people’s safety and the governance of the service. This inspection examined those risks.

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, Responsive and Well Led sections of this full report.

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

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 Regulation 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always protected from risks to their safety and there were not always enough staff. Quality monitoring processes in place did not highlight issues of concern found 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.

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.

St Luke’s Care Home is a residential care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

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

Risks associated with people’s care were not always recorded consistently. Care plans were not always effectively audited. People received their prescribed medicines. However, there were some improvements required around the management of people’s medicines. There were areas of the environment which required work. However, there was a plan in place to resolve this.

Staff received safeguarding training. Safe recruitment practices were being followed. There were enough staff to meet people’s needs. Measures were in place to reduce the risk of infection to both people and staff. Accidents and incidents were monitored and reviewed by the provider.

The management team were complimented on how they managed the service. Staff felt supported in their role and could raise concerns where required. The provider was responsive, open and honest. The service worked in partnership with others to promote better outcomes for people.

Rating at last inspection

The last rating for this service was good (published 18 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about previous leadership and safeguarding concerns. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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.

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.