St Annes Residential Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

People told us they were not routinely involved in the planning of their care. We saw that people’s care records contained contradictory information. The registered manager had nothing in place to ensure they kept up to date with current best practice guidelines. The registered manager had not ensured that people at risk of choking had been adequately assessed by a speech and language therapist (SaLT). People’s clinical needs were not always catered for appropriately. People did not see a dentist unless they arranged it themselves.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 25 (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 they were not routinely involved in the planning of their care.

People did not always have their wellbeing assessed or documented. We spoke to a person who told us they wanted to listen to more audio books but this had not been addressed by the registered manager. When CQC raised this with a senior staff member they said they would see what they could do.

We saw that people’s care records contained contradictory information regarding their mobility and risk of falls. For example, one person’s records included various mobility issue and it was not clear which was current. This meant people could be provided with inappropriate care for their needs.

The registered manager said, people were, “not involved as much as they should be. Their needs and wishes were respected but they were not routinely involved in care planning.” The registered manager was not able to provide any evidence to demonstrate that people’s needs and wishes were respected .

Care plans on the electronic system were not complete. The system allowed for a detailed plan of care including risk, health, well-being, food charts, weight etc. However, in most cases these were not completed. A staff member told us “We are moving everything over to the [electronic] system but it’s taking time .” The registered manager had no oversight of people’s care plans. People’s care plans were not accurate and up to date. We looked at the care records for all 19 people living at St Annes. The records showed that 12 of the 19 care records were overdue for review. This placed service users at potential risk of them not receiving the care they needed. People had no clear goals or reason for being at St Annes. There was a lack of person-centred care. This meant people were managed in a task driven way. While some staff stopped to talk to people, we found most people happy to talk to us as they lacked frequent interaction. People were unaware of their care plans.

People at the service were accepting of the care and facilities offered. People were not routinely included in the planning of their care, and were not informed of developments in care and treatments.

The registered manager had not ensured that people at risk of choking had been adequately assessed by a speech and language therapist (SaLT). One person’s care plan stated, “SaLT referral to be made and NHS dental referral.” We discussed the care of this person with the registered manager who told us, “I think there was a SaLT assessment in hospital, but I’ve not seen it. I got a referral form about two weeks ago but have not completed it because [person] is going to another home.”

The registered manager had nothing in place to ensure they kept up to date with current best practice guidelines and standards. Staff had mandatory training but there was no evidence of ongoing learning beyond the standard set of training subjects. People were not involved in the care planning nor were they aware of any changes to best practice guidelines.

People and their relatives felt the manager worked well with other agencies and health care professionals. A relative told us, “[my relative] is only three minutes from my home so I am able to drop in to take them to appointments if need be but the doctor visits the home and the management team arranged for the opticians to visit the home which was a great help to me.” While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards.

The registered manager had not acted in response to concerns about some staff behaviour raised by staff members. The registered manager had not reported these concerns to the local authority. A staff member told us, “The manager sometimes doesn't listen to the staff.”

Staff did not always work in partnership with GP's and other health and social care professionals to ensure people had access to health care support when they needed it. For example, we saw that one person had been refusing their prescribed medicine for three and a half weeks. This had not been addressed, their GP had not been informed and it had not been discussed with the pharmacist .

There was no process for conducting pre-admission assessments for people being re-admitted following a stay in hospital .

People’s clinical needs were not always catered for appropriately. People did not see a dentist unless they arranged it themselves. However, people did have access to activities they enjoyed that improved their mental wellbeing. We saw people engage with the activities and a staff member said , “Our activity coordinator is amazing. She works so well with all residents. She makes sure the activities are suited for all residents. She takes time to go into residents’ rooms and chat with them. All the residents love her.”

At our previous assessment we found that people were expected to arrange and manage their own dentist registration and appointments. At this assessment we found little had changed. The registered manager told us there was no visiting dentist as they had been, “too busy to organise it.” They said that staff still needed oral healthcare training. People remained at risk of pain, poor oral health and subsequent poor nutrition.

Despite concerns raised at the previous assessment, details of people's dental healthcare were still not recorded on their care plans, there were also no records to show if people had accessed dental services .

People were accepting of the care at the service, however we did not see evidence of people’s health improving. A lack of audits meant the registered manager was unable to monitor care and outcomes. However, some relatives said they had seen some improvements in their loved ones, one relative said “Since moving there, [my relative] has improved well, their eyesight is much better and their memory has improved - I'd like to say their mobility has improved, but it hasn't.”

Staff failed to seek guidance from professionals to guide them, for example, people did not have access to dental services. Where people had swallowing difficulties, advice from the appropriate professionals was not sought in a timely manner leaving people at risk .

Records showed that staff communication and referrals to health and social care professionals were not always made in a timely manner.

Referrals to additional support services such as speech and language teams were not completed , and care records were not always updated when required to reflect people’s needs.

Mental capacity was seen by staff as a blanket term, so people who were assessed as lacking capacity were unable to make any decisions about their care. One person who had been assessed as lacking capacity told us they disliked the service and wanted to leave. People were not supported to make their own decisions.

At our previous assessment we found that the awareness of mental capacity and when to apply for a DoLS was an area that required improvement.

At this assessment we found that there was still a lack of understanding by staff and leaders in relation to mental capacity and DoLS.

Care records showed that a person living at St Annes lacked the capacity to leave the service alone. The registered manager told us the person had been assessed by the DoLS team and confirmed their lack of capacity to leave. However, the service was not secure.