Saint Lawrence Residential Care Home is registered to provide care for up to 23 older people some of whom may be living with dementia. It is situated near the town centre and close to local amenities. It consists of a large residential house and provides care over two floors accessed by a passenger lift. There is a large communal lounge with a dining area, a conservatory and a secure garden area. There are 17 bedrooms in total; 11 are for single occupancy and the remaining six are for either single or shared use. Sixteen rooms have en-suites and the remaining one has a sink. Additionally, there are three bathrooms in the home with bath and shower facilities. The inspection took place on 14 and 20 December 2017 and was unannounced. At the time of our inspection, 12 people were using the service.
At the last inspection on 12 and 16 December 2016, the service was rated Requires Improvement due to issues raised at a previous inspection. We saw improvements had been made and sustained.
A condition of the provider’s registration was for the service to be managed by a registered manager. There was a manager who was responsible for the day-to-day running of the service and we saw they had submitted their paperwork for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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.
People told us they felt safe living at the service and we saw staff were trained in safeguarding and protecting vulnerable people. There were few accidents and incidents, and individual risk assessments were in place.
Staffing levels were sufficient for the number of people currently using the service and their dependency levels were assessed. This helped the provider ensure there were sufficient staff to meet people’s individual needs.
Staff were recruited safely and received an induction which was linked to the Care Certificate. Staff knowledge and training were good and they received regular supervisions, however these were not always fully documented. Competency assessments were completed to check staff used the skills they had learnt in practice.
The service was safe, clean and tidy and staff were trained in infection control. Personal, protective equipment (PPE) such as gloves and aprons was used and stored safely. Appropriate safety certificates were in place, however the fire extinguishers had exceeded their service requirement date. During our inspection, the manager arranged for this to be completed. Afterwards we received assurances these had been done and were sent a copy of an updated audit to ensure these would not be missed in future. Fire safety plans were sufficient although evacuations needed further recording. People had personal emergency evacuation plans (PEEPs) in place so staff were aware of their individual needs in an emergency situation.
The environment was being updated and we spoke with the manager about ensuring the decoration followed best practice guidance for being dementia friendly. People’s bedrooms were personalised and they were involved in colour choices in their rooms.
The manager and staff had good knowledge of mental capacity legislation and consulted and involved relevant parties when people lacked capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice.
People’s health and nutritional needs were met. People received their medicines as prescribed, and were referred to healthcare professionals in a timely manner. People could also access community services independently if they wished. The food was nutritious and healthy, and staff catered for people’s individual dietary needs.
People were supported by staff who were caring and kind, respected their privacy and dignity, and cared for their individual needs. People were encouraged to express their views and opinions, and regular questionnaires and meetings enabled them to do this. People told us they had a good relationship with staff, and staff listened to their needs and concerns. People could be as independent as they wished, and make choices regarding their care. Cultural, spiritual and other equality and diversity needs were catered for.
Care was person-centred and staff responded to people’s changing individual needs. Assessments were detailed and included people’s life history and preferences. End of life care enabled people to be supported to have a comfortable, dignified and pain-free death.
There were activities for people to participate in, and people could access the community, conservatory or secure garden areas independently. People were encouraged to maintain contact with their relatives, and also to access hobbies and interests in the community or the service.
Few complaints were received and people told us they would contact the manager if they wanted to discuss any concerns. The service provided information in accessible formats according to people’s needs.
The manager had submitted notifications to CQC as required which helped us to monitor how accidents and incidents were managed. There was an open management culture and people told us both the manager and provider were accessible and approachable.
Some policies and procedures were not up-to-date and did not reflect best practice. The manager informed us they were in the process of updating these, and would include current best practice. The manager had developed quality assurance and governance systems to highlight shortfalls and drive improvements within the service. Accidents and incidents were analysed for any patterns or trends so improvements could be made. Records were stored securely and computers were protected by passwords.