St Luke's Hospital - Oxford

All visitors entering St Luke’s Hospital are screened for symptoms of acute respiratory infection before being allowed to enter the site. The area of the home which had been designated for COVID-19 positive people was physically separate from the rest of the service, with its own external entrance. On the approach to the area there was prominent signage and instructions explaining what people should do to ensure safety. The service had acquired computers and tablets to support people to maintain social contact with friends and relatives whilst they were isolating in the COVID-19 area of the service.

Staff wore fluid repellent surgical masks, gloves and apron when delivering personal care to all people. People have single occupancy rooms. Adaptions to the building and measures are in place to support staff to social distance during their planned breaks.

The use of PPE was in accordance with current government guidelines. The provider had ensured there were sperate areas for staff to change their PPE, one for the main service and another for the area of the service designated to care for people with COVID-19. There were ample supplies of hand sanitiser and PPE in both areas of the service.

The provider was putting in place appropriate signage to mark out separate areas of the COVID-19 positive area to ensure staff and people could reside there safely, which is in line with other practices within the service. The provider had put plans in placed to ensure that laundry from people with COVID-19 would be washed and laundered by an external agency to reduce the risk of cross contamination in the service’s own laundry facilities.

Staff had received training from the external health professionals in the correct use of PPE. The provider had assessed the impact on staff and how working in the COVID positive area of the home may cause fear and anxiety.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

St Luke's Hospital is a care home. It is registered to provide personal and nursing care

for up to 63 people across three separate wings, each of which has separate adapted facilities. At the time of our inspection 37 people were living at the service.

People’s experience of using this service and what we found

People living at St Luke’s Hospital received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines safely and as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home.

The home was well-led by a registered manager who was committed to improving people’s quality of life. The service had a clear management and staffing structure in place and staff worked well as a team. The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Staff worked well with external social and health care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was requires improvement (published 3 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: We carried out an unannounced comprehensive inspection of this service on 4 July 2019. Three breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent as well as good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Luke’s Hospital-Oxford on our website at www.cqc.org.uk.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Luke’s Hospital is a care home. It is registered to provide personal and nursing care

for up to 51 people across three separate wings, each of which has separate adapted facilities. At the time of our inspection 41 people living at the service.

People’s experience of using this service and what we found

Peoples care plans did not always contain accurate up to date information in relation to their medicines. Medicines management was not based on current best practice.

Risks to people were not always managed safely. The systems in place to monitor the quality of service were not always effective. Not everyone who was receiving a service had a care plan in place, care plans did not always contain up to date person centred information.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The service met the accessible information standards. The Accessible Information Standard (AIS) was introduced by the government in 2016 to make sure that people with a disability or sensory loss are given information in a way they can understand. It is now the law for the NHS and adult social care services to comply with AIS.

The systems in place to monitor the quality of service were not always effective. The provider, managers and staff were enthusiastic and committed to further improving the service delivered for the benefits of people using it. People spoke positively about the leadership team at St Luke’s Hospital.

Without exception people told us they felt cared for by a staff team that were kind and considerate. People's dignity, confidentiality and privacy were respected, and their independence was promoted. Enough staff were available to meet people's needs and people told us when they needed assistance, staff responded promptly. The premises were clean, and staff followed infection control and prevention procedures.

People's needs were assessed, and care was delivered by staff who were knowledgeable about people's care and support needs. People were encouraged to maintain good diet and access health services when required. People had access to a wide range of activities and were supported to avoid social isolation.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

Good, report published 29 December 2016.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We identified three breaches of regulations. These were in relation to safe care and treatment, mental capacity, and good governance.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Luke’s Hospital is registered to provide accommodation for up to 51 older people who require nursing care. At the time of the inspection there were 45 people living at the service.

The service had a registered manager. 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 told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

There were sufficient staff to meet people’s needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People received their medicines as prescribed. Staff administering medicines checked each person’s identity and explained what was happening before giving people their medicine. Nurses were supported to maintain their registrations with the nursing and midwifery council (NMC).

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

People told us they enjoyed the food provided by the home. Where people required special diets these were provided by a chef who clearly understood the dietary needs of the people they were catering for.

People received person centred care. People were cared for by a service that understood the importance of getting to know the people they supported. There was a clear focus on the importance of knowing people’s histories.

The service employed three recreational therapists and supported 15 volunteers to provide people with meaningful activities as well as supporting people to attend exercise classes and physiotherapy appointments.

People were confident they would be listened to and action would be taken if they raised a concern. People told us the service was responsive and well managed. The service sought people’s views and opinions and acted upon them.

The service had systems to assess the quality of the service provided. Learning from audits took place which promoted people’s safety and quality of life.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery.

People we spoke with felt respected and involved in their care. One person told us, 'I have a choice to be involved in activities being run, but I prefer to read, or watch TV in my room. Someone does come to check whether I want to be involved in activities that are taking place'. One person's relative told us they felt involved in decisions relating to the care and support of their relative and their views are listened to.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care files we reviewed all contained preadmission assessments which informed care and treatment plans and these were regularly reviewed. Where needed risk assessments were completed and regularly updated.

We saw that the provider had procedures in place to respond appropriately when they suspected that abuse had occurred or was at risk of occurring. We saw that there was an up to date safeguarding policy and procedure in place.

We saw that the provider carried out monthly satisfaction surveys for people in the short stay department and annual surveys for long term patients. We saw the results of a patient satisfaction survey for the short stay beds which showed the majority of people were 'Very Satisfied' with their care and would recommend St Luke's to friends and family.

We talked to people who were living at the service for a number of years on a long term basis and those who came for respite or short term rehabilitation. One person said "I think it's great, the food is lovely". Another person said "its the best place I've ever been, I can't imagine how they could improve on it".

People who use the service told us that they felt safe with the staff who supported them. They said they had no concerns or complaints about their care but would speak with their relatives, matron or nurse if they needed to.

Assessment and care plans were in place that people using the service were involved in developing and reviewing.This demonstrated that people experienced care, treatment and support that met their needs and protected their rights.