Saint Lawrence Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 5 breaches of regulations. Risks associated with people’s care had not always been managed to keep them safe from otherwise avoidable harm. For example, people requiring pressure relief, did not always receive this consistently and information to guide staff was not always in place. Some areas of the home needed maintenance work to meet safety and hygiene standards. Some care records lacked detail to support people with nutritional intake and hydration. Where people required support to take their medicines they did not always receive them as prescribed. We found infection prevention and control (IPC) did not give people care and support in a safe, clean, well equipped, well-furnished and well maintained environment that met their sensory and physical needs. Processes in place to learn from accidents and incidents required improvement to help prevent re-occurrence. Systems to assure themselves people were protected from the risk of fire were not always completed. We saw staff delivered care which was respectful. We observed interactions with people were friendly. Feedback from people and their relatives was mixed in terms of the consistency. People and staff spoke positively about the management of the service.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us that if they raised any concerns with staff action would be taken. However, people told us they were unsure about being told what is happening with and in the service. Some people and relatives commented they had not been asked about their care or whether they were happy which meant the service could not learn how to improve people’s care.

Staff told us they sometimes get feedback after an incident or accident.

Records of accidents and incidents analysis were not always complete. Actions were not always formulated to evidence action taken to mitigate future risk.

People did not have any concerns regarding the systems and care pathways at Saint Lawrence Residential Care Home. People were supported to access healthcare, such as GP’s and district nurses.

People were supported from a range of professionals to meet their individual needs. Staff discussed how they shared concerns and the importance of maintaining good relationships to ensure external advice was discussed, recorded and implemented to help people maintain and improve their health and wellbeing. Staff told us families and people important to service users were involved in care plans and reviews, however, this was not always recorded on the online care planning system. Comments included, “We speak a lot to all involved in service users lives”.

We received mixed feedback from professionals involved with people’s care. Some feedback received was positive in reference to supporting people in a kind and caring manner. Whilst another professional said, “I would say the only issue is communication, sometimes things do not get communicated properly and there does not seem to be system in place to ensure that it does”.

Records reviewed showed referrals to other professionals were complete, such as dieticians, SALT, OT. There were mixed recordings of family involvement in reviewing of care plans. Some records evidenced involvement whilst others did not. Handover records were not used as intended. There was no evidence of how actions were followed up. There was a lack of activities for people. The manager had identified this and had implemented processes to support people’s engagement and meaningful activities.

People felt safe. People told us, “It’s lovely here, I cant fault it” and “Im safe”. A relative said, “They [relative] loves it here and feel settled and happy”.

Staff had a clear understanding of safeguarding. They were able to discuss personal values which were appropriate for their roles and responsibilities. Staff felt supported by the management team. The manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy.

Staff and the management team spoken with were all open and welcoming during the visit. People appeared to be comfortable living at the home, and in the company of staff supporting them. People confidently approached staff and where engaging and comfortable in their presence.

Safeguarding adults policy was in place and last reviewed October 2024. There were 10 staff out of 21 who had not received training in safeguarding people from abuse. Monthly accident and incident report had been completed but management had not identified areas of concerns and where improvements could be made. The audits had not been shared with staff or people living at Saint Lawrence Residential Care Home to ensure lessons were learnt. This meant people were not always protected from identified risks. Nine staff had not completed MCA training. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found DoLS applications had been made where required. Some records in relation to the MCA were not robust. For example, some people had comprehensive MCA’s in place where others did not have any in place. Also where restrictive practices were implements such as lowered beds, there were no supporting MCA or best interests in place to support. There were no MCA’s in place for administration of medicines.

People and relatives were happy with the care received. Comments included, " It's good here. I haven't anything I could complain about”, and “I am happy spending time in here and the staff check on me regularly, day and night”. People spoken with said they had not seen their care plans but believed they were supported in a manner that suited them and met their needs. People were unsure about how involved they were in decision making about changes in their care. While the people and relatives we spoke to said they were happy with the service and staff, our assessment found elements of care did not meet the expected standards.

Staff knew people well and supported them in a way which minimised any risks. However, risk assessments to guide staff were lacking details and had not been regularly reviewed. Staff told us they did not have time to read risk assessments and relied on people to tell them. Staff also told us they felt they did not have enough training in relation to risk assessments. The manager told us how they supported people with additional communication needs and adaptations required to anticipate that persons needs.

We observed staff supporting people in line with their needs during our visit to the home.

Risks to people were not always assessed or managed safely. Care plans and risk assessments did not always demonstrate people were involved in managing risks. Risks to people were not always clearly documented in their care plans to ensure people's needs and risks were mitigated or managed safely. For example, 1 person’s care plan had conflicting information regarding their skin integrity, support, and treatment. Another person's care plan stated they had diabetes. However, there were limited person-centred guidance in place for staff to follow to support this person safely. Records did not always evidence important information about people using the service. For example, repositioning charts did not always evidence requirements as identified in care files. Staff were not always aware of risks posed to people due to lack of direction and guidance within care plans. For example, 1 person had a diagnosis of chronic kidney disease which should avoid high potassium and phosphorus in their diet. This person was at stage 4 (includes signs of severe kidney disease and kidney failure) for which the amount of fluid they consumed may need to be limited to preserve kidney function, there was no guidance for staff to support this. There was little evidence people, or their families had been engaged with when planning their care or managing risk.

Feedback from people was generally positive about their personal room environment and equipment. People felt the equipment was available to support them as needed.

Staff told us they are not involved in time simulated evacuations. Staff said, ‘we are not involved in evacuations”. The manager told us, this was an area for improvement and would implement.

We found areas of the home that required urgent maintenance and updating. We did find that a COSHH cupboard was unlocked during our visit and other areas were chemicals were accessible to people using the service. We also observed accessible stairwells for people using the service who were deemed as being high risk of falls. Action was taken on the day of assessment to reduce the risk of falls on the stairs. We observed staff using various equipment during our visit to support people to move safely.

We could not be assured that processes to assess the home environment and maintain people’s environmental safety had always been completed. Required checks and maintenance to the buildings and equipment were not always completed or current. For example, window restrictor checks, water temperature checks and bed rail checks were not completed. Time simulated evacuations had not taken place to assure themselves, safe and timely evacuation could be achieved. We could not be assured evacuation of a compartment was in line with guidance. There was nothing recorded within the fire risk assessment to suggest additional measures were needed when the time could not be achieved. A recent fire risk assessment had identified actions as high priority to be completed immediately. There was no evidence to support these actions had been completed.

We received mixed feedback in relation to staffing. Some people were not sure if there were enough staff but said they [staff] are very busy. People said the time staff took to answer the buzzers varied but they didn’t wait too long. However, 1 person said they waited too long.

We received mixed feedback about staffing. Some staff felt there were enough staff on each shift, whilst other staff felt the numbers did not reflect people’s needs. Some staff told us, staffing on a night was a concern. Staff told us they did not receive regular supervision or appraisals. Staff told us supervisions were seen as a negative experience because they were generally completed when something had gone wrong. The manager told us they were reviewing people’s assessed needs in order to review safe staffing levels.

During our visit to the service, we saw that staff were busy, though not always rushed, at times some staff appeared task orientated to meet people’s needs. We observed calm and relaxed support during the visits. Staff were patient and attentive to people, and interactions were friendly.

Staff were not receiving regular 1:1 supervision or appraisals. There had been some infrequent supervisions around specific topics. Staff training was not always up to date. Whilst rota's reviewed mostly reflected staffing levels highlighted within people’s records, we could not be sure this was an accurate reflection of people's current needs. There was limited staff available during night hours which had led to 1 person leaving the building without support. The provider had a checklist for audit purposes; this was not always completed. There were systems in place to enable the provider to identifying staff’s equality, diversity or inclusion needs

People and relatives we spoke with did not raise concerns with the cleanliness of the home.

Staff said they had received appropriate training in infection prevention and control and were aware of safe hygiene practices. However, training records did not show full compliance. Staff told us they were not always clear on policy and procedural requirements or where these documents were and they raised their concerns that there were insufficient staff to maintain the home to the standards required. We received mixed feedback on how to escalate an isolation plan on each unit.

We observed people’s rooms were not always clean and some had noticeable unpleasant odours. Service rooms, including the laundry were not clean and were observed to be disorganised without the appropriate separation of laundry. We found areas of the home that required urgent maintenance and updating to reduce the risks associated with cross infection. We found areas of the home including bathrooms and bedrooms, accessible and cluttered with tins of paint, oil, broken tiles and rubbish. There was a lack of personal protective equipment (PPE) available to staff on the first floor.

During our onsite visit, we identified concerns in relation to infection prevention control (IPC). This placed people at risk of injury or infection. We found that not all areas within the service were maintained to a high standard, for example scuffed walls and doors, worn carpets and stains on walls, bed linen and ceilings. This placed people at risks such as infection as they did not allow for effective cleaning. Cleaning records were inconsistently complete and there was no IPC lead within the service. We were not assured the provider was making sure infection outbreaks could be effectively prevented or managed. The provider had failed to act on previous infection control audits to reduce the risk of transmission.

People did not raise any concerns about their medicines with us. Relatives told us people were supported to take their prescribed medicine. While the people and relatives we spoke to said they were happy with the medicines, our assessment found elements of care did not meet the expected standards. Thickeners used to thicken fluids for people with swallowing problems were not recorded when they had been administered. Instructions for medicines which should be given at specific times were not always available. Administering medicines as directed by the prescriber reduces the risk of the service user experiencing adverse effects from the medicine.

Staff told us they had completed a training and induction process for medicines management. Staff told us they had access to information which supported them to manage medicine’s safely and effectively. Staff could describe how they would follow up urgent queries and access urgent medicines.

We found ongoing concerns with medicines management and administration. Systems in place had failed to ensure the proper and safe management of medicines. Stock balances were incorrect. These included medicines being used to treat gastroesophageal reflux disease, hypertension and for the prevention of blood clots. This meant we could not be sure people had received their medicines as prescribed. Not keeping accurate balances of medicines increases the risk of the service user suffering ill health and not having enough medicines in stock to meet the needs of service users. The amount of medication carried forward each month was not recorded on the MAR charts. Therefore, making it difficult to establish that medicines had been given as signed for by staff. During daytime hours the medicines trolley was stored in the lounge/dining room, which was very warm. The medicines trolley was not secured to an anchor point when not in use. Manufacturers recommend that most medicines should be stored below 25 degrees. However, there was no thermometer in the room to monitor the temperature. This meant that we could not be assured that medicines were safe to use. Controlled drug records showed that an entry for the receipt of 1 controlled drug had been duplicated on 2 separate pages within the controlled drugs register. This resulted in the stock balance being recorded incorrectly. Records showed that staff did not always complete regular balance checks in accordance with national guidance and had not identified the discrepancy.