St Annes Residential Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question required improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

At our previous assessment we found significant shortfalls in service leadership. The registered manager did not promote a culture which facilitated good outcomes for people. They did not understand their responsibilities to raise concerns and record safety incidents. The registered manager had not followed their responsibilities under the legislation and had not ensured that all significant events were notified to CQC. The provider sought assurances from the registered manager that effective systems and processes were in place to assess, monitor and improve the quality and safety of the service. However, systems were not in place to demonstrate that the service operated effectively to ensure compliance with the regulations. The registered manager did not have systems in place to receive or review feedback about the service and had not used informal feedback to improve the quality of care provided.

After the last assessment, we received assurances from the registered manager in the form of an action plan. However, these assurances contradicted the findings of this assessment. The registered manager had not followed their action plan, and the provider had relied on verbal assurances this had been completed.

At this assessment little had changed, and we found repeated breaches of the legal regulations relating to good governance.

At our last assessment the provider had failed to display a rating for the service on the website. This breach has now been met.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were unable to tell us the goals of the service. While staff understood the importance of kindness in caring for people, they did not know the goals of the service. Staff members did not feel there was a good culture at the service. A staff member said “A lot of staff do not get on together, so much that we would not work with certain staff because it is too stressful. I think it’s because people do not understand the way each of us works. Some [staff] work harder than others.”

Another staff member said, “I have never been asked my opinion on how the home is run, and no one says anything about what is going on in the service, and at St Anne’s, and if they do it is not in person and from afar. We never see the manager; it would be nice for her to see what is really going on.”

Systems in place to ensure that the culture of the service was positive were not effective. Care records and feedback from staff demonstrated that care people received was task driven. For example, there was a bath list with people having allocated bath or shower days.

Leaders at the service were not always visible to staff and some staff thought the managers did not lead the service well. One staff member told us, “I think the manager should have trained [senior staff] better to help them in their role. The management are not leaders.” The registered manager did not complete some basic management requirements, for example they had not completed the provider information return (PIR) when requested. The registered manager told us they, “had no recollection of the request,” and “did not receive it.” This was discussed with the provider following the assessment, who told us they were “surprised as the registered manager had told them they had asked for an extension on the PIR to have time to complete it.”

The local authority contracts team raised some concerns about the service, specifically about a lack of oversight and a lack of quality control at the service. During the assessment, we found the registered manager had gaps in their knowledge and did not always provide accurate information when requested. The registered manager did not demonstrate an appropriate knowledge legislation including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), relevant best practice and guidance. They did not understand the consequences of failing to take action on requirements.

The registered manager had failed to operate an effective complaints system. When we discussed this, they said, “To be honest, we don’t get a lot [of complaints].” They said they were, “not able to evidence this,” and “had no oversight.” The registered manager also told us there was, “no audit of complaints,” and “no log of complaints.”

Staff told us they had raised concerns with the registered manager and had also discussed their concerns with a senior staff member. They told us no action had been taken. They said the registered manager was not interested and did not take any action.

Following the assessment, we received anonymous information from staff that there were, ‘Management threats to care staff over whistle blowing and they [staff] will lose their jobs or be demoted for doing so.’

There were policies in place at the service covering complaints and staff whistleblowing. A staff member told us “Yes, I know about whistle blowing policy, and no I would not feel comfortable using it.” The registered manager had not followed these policies when concerns were raised with her. After the assessment we spoke to the provider who immediately took action to ensure correct investigations about complaints took place.

Staff were positive about inclusivity at the service. A staff member told us, “I think people are inclusive here.” Another said, “I have experienced some bigotry previously, but it has been dealt by management team [here] very well.” The workforce was diverse, and the majority of staff had completed equality training.

Staff had equality training.

At our previous assessment we found that the registered manager had not completed checks on the quality performance at the service. Following the previous assessment the registered manager submitted an action plan. In their action plan, the registered manager stated that they would be compliant with regulations by March 2024. When we spoke to the registered manager, they told us their action plan was not completed, and the service remained non-compliant with the regulations.

This was discussed with the provider following our assessment. They told us, they had put their trust in the registered manager. They said they would, “speak to the trustees and compile an action plan.”

A staff member told us, “A lot could be better, the manager does try, but I don’t feel the home is currently her main priority.”

Audits had not been completed, and the registered manager did not have oversight of the service. We saw records were not fully completed. For example, there were gaps in the recording of falls. Concerns and complaints were not documented. Some peoples care records were incomplete or contained conflicting information. There were no clear guidelines for staff to manage or reduce the risks to people.

At our previous assessment we found that the provider had not followed their responsibilities under the legislation and had not ensured that all significant events were notified to the Care Quality Commission. They had failed to notify CQC of serious injuries. At this assessment very little had changed. Whilst the registered manager had notified CQC of some significant events, CQC had not been informed of all events required by legislation.

People were not supported to stay in touch with their community. Staff told us, “The care home does not really support community contacts due to not enough staffing and cost.” One person told us they asked to go out into the community, but were told there were no staff available and they were taken into the garden instead. Communication with external healthcare professionals was not always effective. For example, a person refusing their medication had not been discussed with their GP or the pharmacist, and referrals to the speech and language therapists were delayed.

The registered manager could not show evidence that staff and leaders engaged with communities and partners to share learning. This meant there was no evidence of improvements to the service. The registered manager did not use networks to identify new or innovative ideas. When we discussed ideas with a senior staff member, they were receptive to change, however the management of the service was reactive rather than proactive to change.

We had not received any comments about the service engagement with communities, from other health care agencies or professionals. However, the local authority quality monitoring team was working with the registered manager to improve care and monitoring at the service.

Communication between the service and the GP, and pharmacist was not always effective. For example, one person ran out of their medicines. There were no formal medicines reviews scheduled with the pharmacist. There were no processes in place to ensure people were able to stay connected to their community.

A staff member told us they were responsible for some audits, but they said they did not always have time to complete them. The staff member also told us they were responsible for updating care plans, however, they said there was no formal plan in place to ensure all plans were updated regularly. The registered manager had no oversight of the audits or care plan updates. A new electronic care plan system was in use although staff had not received adequate training on it, a staff member said, “We all use the app now and I still don’t know much about it, I’m still learning as I go. We did not really get trained on it, although the registered manager did try to show me.” When staff suggested improvement ideas they were not always followed up. A staff member told us, “We don’t really have time to read the care plan. Information is passed over in the hand over between shifts, so things can get missed. I again did make a suggestion to the registered manager they should have some sort of team meeting with the seniors to tell us.”

At our previous assessment we found that governance systems had not identified areas for improvement to enable actions to be taken. Effective systems and processes were not in place to assess, monitor and improve the quality and safety of the service. In addition, systems were not in place to demonstrate the service operated effectively to ensure compliance with the regulations. There had been no audits carried out and people were not asked about their care.

At this assessment we found that little had changed. There were no processes in place to monitor accidents and incidents affecting people’s safety. No action had been taken to ensure lessons were learnt and the registered manager was unable to evidence changes to staff practices to keep people safe. There were no processes in place to confirm the safe running of the service. The provider told us they had put their trust in the registered manager. They said they would, “speak to the trustees and compile an action plan.”