St Catherines Care Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We saw examples of staff caring for people and positive interactions. We saw people were not always responded to in a timely manner when they became distressed. Staff were very task orientated, and care plans had demonstrated nursing needs as the main priority as opposed to reflecting individuals’ social history and interests. People who preferred not to join in activities programmes did not receive individual sessions to prevent social isolation. Some relatives considered their loved ones to be well looked after yet others commented on their relations had looked unclean, unkempt and in need of their continence aids being changed.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We observed people being treated by staff with kindness, compassion and dignity in their day-to-day care and support for some of the time. People's privacy was maintained, and staff recognised the significance of ensuring people's wishes were listened to. One person told us "The staff here are lovely." Three relatives said staff had shown kindness to their loved one. However, our observations revealed this was not always the case. We found residents were left unattended. People were being left without any meaningful interaction for unacceptable periods of time and call bells were left unattended with staff walking past without any intervention.

 One relative told us "St Catherines is good but it isn't perfect. Some of the staff are gems." People did not always believe staff will respond to their needs quickly and efficiently. One person told us there are not enough staff to support everyone at dinner time "the staff are mostly good, but they need to be more efficient." One person told us "They tell me they will be with me in a second, but it never happens. It is more like 30 minutes." One relative told us about their concerns around staffing levels at night. "Staff are excellent, but current staffing levels are unsafe." One relative told us there are too few staff working at the weekend. "Staff are not consistent." One person told us “The food isn't very nice."

Some of the staff we spoke with told us they are often short staffed which is having an adverse impact on the care they provide to people. One staff member said, "we cannot give them the care they deserve because we are too short staffed." One staff member told us people are not being offered a drink for extended periods of time.

Staff members told us people are not given personal care in a timely manner. One member of staff said, "residents are not offered or provided with assistance to have a bath or wash, sometimes for weeks at a time."

Partners had expressed concerns that staff were stretched and that there was not enough staff to attend to the needs of everyone. Their recent visit to the service had witnessed call bells being activated with lengthy response times. Again, staff had approached them about the lack of staffing.

We found that call bells were not being answered within a satisfactory timeframe.



Care plans we looked at evidenced that people were not being offered a drink for long periods of time.

Some people expressed they were happy with the care provided and commented on how courteous staff were to them. People were able to receive visitors and stay connected with significant others. This view was reflected in some relatives' comments although this was not a view held by everyone. Some said there was little interaction between staff and their relations and “[name] was at risk of becoming isolated” and “Sometimes he gets forgotten about as he likes to stay in his room.”

Staff told us providing basic care for people was challenging and ensuring the personal and cultural needs of people were not a priority given the staffing challenges they faced. People were not always treated with dignity. One person gave us an example, "[Name} who is at the end of their life was found in a soaking wet bed. [Name] had not had a drink or mouth care recorded in his records for over 13 hrs. Staff stated they were short-staffed, which is having an impact on people's care. Another member of staff said, "residents are not offered or provided with assistance to have a bath or wash, sometimes for weeks at a time."

Support for people did not meet all their needs or preferences. We saw people not receiving meaningful staff interaction for long periods of time which put them at risk of social isolation. At lunchtime we observed one person struggling to eat their main meal without support for 20 minutes. Support was given and then the same person was left unsupported to eat their dessert. The preferences of people were not respected by staff. Again, at lunchtime, background music was agreed upon only to be changed some time later by staff with no consultation.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff were rushed and did not have time to engage with people. One staff member sat in the lounge and did not engage with people unless they were asked a question.

Care plans included the nursing needs of people yet there a limited reference to the interests, hobbies, or social history of people. For those people who had had a particular interest in the past, we could see no evidence that these interests had been pursued or suggested by the staff team. The communication needs of people were included in care plans, however, there were few documents that provide accessible information to people in line with their care plans. Care notes included symbols to represent events in the day, for example, meals or person care, yet these care notes were not available to people.

People have access to their friends and family. One person told us that their family have said "the place feels homely and is welcoming."

Some people had access to activities. One person told us, “There are lots of activities going on for us." Some relatives were concerned that while their relations’ choice to stay in their room was respected, there was little or no interaction with them. There was a concern that this person, and others may be at risk of social isolation.

Activity staff identified the range of activities that were being done for each week with reference to key annual events. A Halloween party had been arranged, and preparations were in place for that.

There was a range of different activities available to residents to participate in. The activities staff worked hard to provide a variety of activities for those who wishes to join in. On the first day of our visit, the Quality Director was seen encouraging people to join in with main activities and reinforced to staff to ask all individuals if they wished to join in. The Quality Director had come to work at the service to ensure that standards of care were improved and maintained. On the second day of our visit, the Quality Director was not present having been deployed elsewhere in the organisation. We did not witness any encouragement to people previously made.



Apart from those participating in activities, many people were in their rooms or lounge areas. During our visits, we found that people were being left without any meaningful interaction for unacceptable periods of time.



Once activities were over, we observed the activity staff was on their own trying to support people to eat. Some relatives had told us that this was usual practice. Care staff eventually came in to support them. One person said, “Poor [Name] is usually on their own at mealtimes and it is too much for them to try and help all of us by themselves

Care plans outlined the nursing needs of people yet there was little reference to their social history or interests. For those who preferred to stay in their rooms, activity records evidenced that there had been little, or no activities/stimulation offered to them on a one-to-one basis. Some recorded activities had included “smoking” and “watching television” which were passive and did not require staff intervention.

One person told us about call alarms being activated regularly and that these were not attended to for some time. They said that there were delays in attending to the alarm and they seemed to go on a long time.

Many relatives provided examples of occasions when their relation had not been attended to in a timely manner. They told us that they had found their relatives unkempt, in need of continence support or not dressed. They said that on one visit, “[Name’s] face was dirty with food in their beard, nails have dirt underneath” and “There are some staff that work on [Name’s] “side” that are amazing, and they bend over backwards to help [Name] when they can.

Staff commented that the high dependency levels of people meant that there were insufficient staff to ensure that all people’s needs were attended to immediately. Staff cited examples of people not having baths of people being incontinent because staff were stretched attending to the needs of other people.

We observed there were not enough staff to attend to people’s needs or comfort. We observed one member of staff not interacting with one person who was distressed. The staff member was standing over them updating records on a handheld device. We saw staff responses to people who were expressing discomfort or anxiety were not immediate and interventions were prompted by the presence of an Inspector.

We witnessed two call alarms exceeding or close to the 5-minute mark before being answered. We saw that staff on duty were not particularly busy and could have responded with more immediacy. On one occasion, an alarm was activated yet a member of staff who could have responded did not.

Some staff told us that morale was very low, and that staff did not feel valued for the role they did. Other comments were more positive. All staff mentioned low staffing levels, were fearful of any further cuts to staffing levels and how they felt exhausted. They felt that there was little managerial presence on “the floor” to witness the challenges they faced. They said, “Some days morale is good, other days its low as were too busy and we can't the residents the care they deserve because we are too short staffed”

Staff told us, “We used to have to chance to read risk assessments, but I've not read them for a while as we've been so busy.”

Evaluations of key records noted that events were attributed to the need for more vigilance from staff (in the case of unwitnessed falls) and better encouragement of taking fluids. When medicines were not administered these medicines, this was attributed to better performance needed by nurses in ordering medicines. These had identified staff performance as a factor rather than exploring other causes.

Processes did not ensure that people received safe, effective, and person-centred care. Staff numbers meant that staff did not always receive regular breaks. Supervision for some staff had not taken place for over 12 months and therefore not all staff had regular opportunities to provide feedback, raise concerns and identify improvements. People who lived there, as a result, were potentially impacted receiving care from an inconsistently supported staff team.