St Mary's Court

We found the following examples of good practice.

The provider was transparent when sharing information with people and their relatives about how the home is managing the pandemic. At the time of the inspection there was a decision made to restrict visits. People had access to other means to communicate with their family. For example, video calls.

People and staff’s wellbeing was a priority for the provider. The provider had increased the resources for the activity team in the home. People had dedicated one to one time. For example, we observed people being involved in aromatherapy massage. Staff had access to an independent support phone number if they felt they needed to talk to someone.

An area of the home had been turned into a dedicated unit for people who may be admitted into the home and were unable to isolate in their rooms. In addition, the home had dedicated an area if people living in the home had a positive result and were able to move into that part of the home for the isolation period.

The provider ensured that there was always management present in the home which gave a sense of support for all staff. The service had a dedicated Infection Prevention and Control (IPC) lead so if staff needed any advice or support they were able to assist.

The service was clean and hygienic. Additional cleaning tasks and schedules had been implemented by

housekeeping staff. Systems were put in place to ensure that areas where people had tested positive, the provider had ensured deep cleans were completed.

The provider had developed policies, procedures and guidance for the service which had been implemented. Quality assurance audits were being completed during the pandemic to reflect best practice, and staff knew how to immediately instigate full infection control measures to care for a person with symptoms to avoid the virus spreading to other people and staff members

St Marys Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Marys Court accommodates people across three floors in four separate units. The service was purpose built, bright and airy and people had access to a range of outdoor spaces and gardens.

The needs of people using the service varied from residential, nursing and people living with dementia. A small number of people were receiving nursing care while they were waiting to return home following a hospital admission.

A registered manager was in place who had provided consistent leadership at the service for some years. 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.

At our last inspection of the service on 24 February 2016 we rated the service as good overall but outstanding in well led. At this inspection we found that they had maintained their rating. We again rated well led as outstanding because the quality of care that people received was continually assessed, reviewed and improved. The leadership of the service strived to create a service that offered outstanding care to people. We found elements of outstanding care in the other domains such as in staff training and in the activities provided. We identified some shortfalls which were largely in documentation but these were addressed by the registered manager during the course of the inspection.

The service had a robust recruitment process in place to ensure staff had the necessary skills and attributes to support people using the service. The service benefited from having an onsite trainer and all new members of staff completed an induction programme to develop their skills and knowledge. Ongoing training was provided which meant people received care from skilled staff who could meet their needs. Staff received supervision and annual appraisals to support them in their role and identify any learning needs and opportunities for professional development.

There were systems in place to ensure that risks associated with delivering care and with the environment were identified and managed. Incidents and accidents were logged and reviewed to identify learning. Medicines were well managed. Staff were clear about how to raise concerns and the safeguarding procedures.

People liked the food and the meals served looked nutritious and nicely presented. Staff had completed nutritional assessments for those people who were found to be at risk of malnutrition or a low fluid intake. This was clearly recorded in their care plans, and staff effectively monitored and recorded their food and fluid intake.

We saw that staff responded promptly to people’s changing health needs and referrals had been made to specialist healthcare professionals, including dieticians, optician and speech and language therapists, for additional advice and support.

Staff provided people with individualised care, which was centred on their needs and wishes. The care and support provided to people was based upon their preferences and were outlined in their care plan. People were supported to lead a full life and had access to a good range of activities.

People received care from staff who knew them and with whom they felt comfortable. Staff were thoughtful and patient when providing care and supported people to make choices about all aspects of their daily life. Staff were respectful and showed compassion and kindness when speaking to people.

People and their relatives knew how to raise concerns or make a complaint and were confident the registered manager would take prompt and appropriate action to address any issues raised.

The provider and registered manager had a clear vision for the service and systems were in place which enabled them to monitor and develop the service. Staff took pride in their work, felt valued and were clear about the values of the service.

St Marys Court is registered to provide accommodation, personal care and nursing for up to 90 people. At this inspection we found 75 people residing at the service. There is a passenger shaft lift to assist people to the upper and lower floor and the service is set in pleasant extensive grounds. The accommodation was purpose built, light and airy for people to enjoy. The outdoor spaces are developed with people at the service and made safe spaces with lawns, attractive raised beds, outdoors seating and wheelchair accessible. These add interest and provide a pleasant aspect.

The home had a registered manager in place. 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.

People at this service were keen to tell us of their positive experiences. People felt involved in the development of their care and support and were consulted on matters that affected them. Staff knew people well, but had up t date person centred care plans to guide them with risks mitigated where possible. People and their families told us that staff were caring, compassionate and acted with kindness. We observed a staff group that worked well with people and ensured peoples comfort with all their interactions. Staff were mindful of privacy and dignity and diversity of people and therefore treated people as individuals and respectfully.

The staff group truly understood and practiced the values of this organisation of Kindness, Comfort and Respect. The leadership was visible and led by example. Staff felt valued in their contribution. There were robust systems in place to recruit, induct, train and support staff to ensure there was a staff group who were effectively prepared to meet the needs of individuals in their care.

People were able to have a varied and interesting life that was supported by sufficient staff for them to access the community and a host of social activities that were widely advertised. People experienced the pleasure of good food that suited their needs, with people who needed a soft diet having food that was presented using moulds so that different foods were separate and looked like real food was intended to. People were supported to maintain good health and if their needs changed they were promptly referred and seen by medical practitioners. Qualified nurses had the skills to meet the nursing needs of people at this service. Medicines were managed so people got medicine as intended by the prescriber, but where possible people were supported to be independent and manage their own medicines.

The was a strong quality assurance system throughout the service that truly enabled a ‘floor to board’ approach with the provider seeking out new ways to understand the experience of people using the service and listening to what it was like to use the service. Managers were listening and were flexible in their thinking to take on suggestions made by staff, other professionals and people at the service. Managers and the provider responded to people if they made suggestions or made complaint to show how they had acted responsibly.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people had complex needs which meant they were not all able to tell us about their experiences. However, we observed the care being provided and spoke with twenty people who lived at the home and relatives that were visiting. We also talked with staff including three nurses, the Registered Manager of the home, the Clinical Director, the Training Manager and the Matron.

We looked at staff training and recruitment records, the provider's audits and action plans and people's care records.

The home was divided into different areas Oak, Cedar, Ash and Beech. Overall we found that the home was meeting people's needs but that improvements were needed on Oak.

Is the service safe?

People told us that they felt safe and that they could talk to a member of the staff if they had any concerns.

Discussion with staff and the records confirmed that they had attended training in safeguarding vulnerable people and were aware of the procedures to follow if they thought anyone had been harmed.

We found that each person had a care plan and associated risk assessments in place. However, we found that on Oak the care being provided did not always reflect the information in the care plans. This meant that people were at risk of not receiving the care and support they needed.

Staff and people living at the home told us and observations of care confirmed that in the majority of the home the staffing levels were sufficient to meet people's needs. However on Oak the staffing levels in the afternoon were reduced which meant that staff were rushed and the care became very task based. We discussed this with the Clinical Director and they responded by increasing the number of staff the day after the inspection.

Is the service effective?

Staff received appropriate training and support for their role, including attendance at one to one and group meetings. Information supplied by the Registered Manager showed that staff had received training in relevant topics so that they were aware of best practice.

We observed breakfast and lunchtime in all of the four areas in the home. We found that in three areas people were offered choices, had the individual support they needed and were not rushed. However on Oak we found that there was not enough staff in the dining room to give people the individual care and support when they needed it. Although people were given a choice they did not always understand the choice as it was explained and alternative methods were not used to show them the options. We also found that some people's needs were not being appropriately assessed and professional healthcare guidance was not sought which could have placed them at risk.

Is the service caring?

People told us that they were happy living in the home. One person said, 'I am very happy here. I moved from the other place as they thought I needed more care. The staff are lovely, very caring. I can have a shower if I want but I prefer a wash in bed. The food is very nice and well presented. I have no concerns'. Another person told us, 'I feel at home here, the staff are extremely nice and I am very happy here. One person commented, 'They are nice carers and we feel respected and we respect them'. The relative of one person living in the home told us, '(Name) has been coming here for four years now to give me a break and the staff they are very caring and very efficient. I do look at (their) care plan and if I ever ask for something they do their best to accommodate.'

We observed staff working with people and saw that they treated them with kindness, dignity and respect. Staff obviously knew people well and people responded positively to them.

Is the service responsive?

Where people had capacity to make decisions for themselves, we found that staff consulted them before providing their care. Records showed that some people had been involved in writing their care plans.

The care plans that we looked at were detailed and contained information about how people should be supported and their preferences. Care plans were being regularly reviewed although we found that the reviews had not always picked up areas that needed updating or further investigation.

Activities were regularly organised in the communal areas and the daily activities staff also spent time on a one to one basis with people who did not wish to participate with group activities.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that staff had received training in the MCA and the DoLS, and there were procedures in place to ensure that people who could not make decisions for themselves were protected. Capacity assessments had been completed and DoLS applications were in the process of being considered for anyone that needed it.

People told us that staff responded when they called for assistance and we saw most people had call bells within easy reach.

Is the service well led?

There was a Registered Manager in post, a Matron and a Clinical Director who was responsible for line managing both of the homes on the same site.

We found during this inspection that the area that needed improving was Oak. This also reflected the finding of our previous inspection. The Registered Manager stated that they were aware that work needed to be done to improve the outcomes for people living on Oak and that the home had recently signed up to a dementia pledge which they thought would enhance the quality of life for people living with dementia within the home. However there was no specific action plan to highlight what action was going to be taken to improve the care and support.

Although the Registered Manager responded to our feedback and took appropriate action about the staffing levels in the afternoon and at mealtimes the care staff told us that they had raised these issues before but no action had been taken.

The Registered Manager told us and staff confirmed that any issues could be discussed and that staff had been made aware of the whistle blowing procedures if they didn't want to raise concerns internally.

We found that although audits were in place these were not always used to ensure that improvements were made. For example although safeguarding reports had been seen by the Registered Manager these had not been fully analysed or evaluated to establish cause; identify any trends or themes and continually review practice. Whilst in some cases investigations were being, or had been, undertaken in relation to the conduct of some staff, there was no system in place to develop solutions and risk reduction actions to protect people and ensure future lapses were minimised.

This is a summary of what we found;

Is the service safe?

When we arrived at the service the registered manager greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Equipment within the service was maintained to ensure safety. This included hoists and shaft lifts. We saw servicing records which showed that health and safety matters in the service was regularly checked. This included regular fire safety checks, gas, electrical, water quality and temperatures. This meant that people were protected because the facilities were well maintained.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. Four staff spoken with said there were sufficient numbers of staff on duty and that they were aware of how the dependency levels of people at the service was used to determine staff levels.

We examined an application made under the Mental Capacity Act (MCA) 2005 in relation to a Deprivation of Liberty Safeguards (DoLS). The application had been granted. This demonstrated that staff at the service were aware of the legislation and how to protect people and uphold their rights by appropriately using this legislation.

Is the service effective?

Care at St Mary's Court was effective because we did not see higher than expected pressure sores or falls. Systems in place to audit medication and care plans made for effective organisation in the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. We particularly found that staff on Ash were understanding of people's needs and this was supported by the individualised care plans that related specifically to peoples support in relation to living with dementia. People told us that they liked the amount and types of activities on offer.

People using the service, their relatives and other professionals involved with St Mary's Court completed satisfaction questionnaires. Where shortfalls or concerns were raised we did not see how that information was then used to improve the service.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. This included regular trips out each week on the minibus.

The service had an effective complaints procedure in place. We examined records and saw that where people had raised concerns appropriate action had been taken to address concerns and where possible to the satisfaction of the complainant.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to regularly review care plans. This included seeking support and guidance from health care professionals, including a doctor and district nurse. However not all people were aware of the content of their care plan and there was not a system or evidence in place to ask people their view on their care plan. The provider may like to note that there was no pain monitoring tool in place to ask people or for staff to observe pain type, levels and duration. Therefore staff currently could not respond efficiently to pain management where needed.

Is the service well-led?

The service worked well with other agencies and services such as health and social care professionals to make sure people received their care in a joined up way.

The service had quality assurance systems, audits and records seen by us that showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People told us that they were generally happy with the care that they received and they felt safe but they also told us that they thought there were not enough staff to support their needs at all times. We observed that staff provided care to people who used the service in a caring manner. We found that the number of staff on duty to meet people's needs and the skill mix of staff was not always suitable or sufficient.

We found that whilst people said that they felt safe, their care records did not always support that they received safe or effective care that met their individual needs. We found that care plans were not always reflective of people's needs. We also found that records relating to people's care were not always accurate or fit for purpose. For example we saw two different examples of skin integrity risk assessments in people's records. So it was not clear which one was to be referred to and followed.

We saw that the service had a management structure in place and that staff felt like they could approach senior management. Staff told us they were not always confident action would be taken on concerns raised.

We found that significant progress had been made with regards to safeguarding, medication and staffing levels at the service. The service provided enough qualified, skilled and experienced staff to meet people's needs.

The manager had introduced a falls prevention strategy that had reduced the number of falls experienced by people who used this service. This demonstrated that the manager was effectively managing this risk to people's health and safety and had taken reasonable steps to prevent a reoccurrence.