Archived: St Martins

St Martins provides accommodation and personal care for up to 16 adults and older people, some of whom may be living with dementia, mental ill health, physical or sensory disabilities. At the time of our visit 14 people lived at the home. This included two people in short term discharge to assessment beds which are used to support timely discharges from hospital. One person was in hospital. Accommodation is provided in a single storey converted house.

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

Ineffective governance and lack of provider and management oversight meant previously demonstrated standards and regulatory compliance had not been maintained. The provider’s systems and processes designed to identify shortfalls to ensure the service was delivered safely, and to drive improvement were ineffective. This demonstrated lessons had not been learnt since our last inspection. The introduction of new systems and processes were not well-managed. This meant staff did not have all the information they needed to provide safe care. Systems used to share information with staff were not effective.

Risk associated with people's care and the environment were not always identified, assessed and well-managed. The prevention and control of infection was not managed safely and in line with government guidance. Staff had been recruited safely and understood their responsibilities to keep people safe. People felt safe. However, people's quality of life was negatively affected by staffs’ limited availability. The provider was exploring a range of ways to try to address staff recruitment challenges. People's medicines were not managed and administered safely in line the provider's procedure and best practice guidance.

Staff training was not up to date and some staff had not completed an induction to ensure they had the information, knowledge and skills to fulfil their role. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had access to health and social care professionals.

People and relatives spoke highly of the staff who cared for them. Staff were caring in nature but did not have the time needed to provide person centred care. People’s rights were not always promoted and upheld. Confidential information was securely stored.

People's needs were assessed prior to moving into St Martins. However, assessments needed to be further developed to ensure protected characteristics under the Equality Act 2010 were fully considered. The manager was planning action to address this. Care records did not always provide staff with the information they needed to deliver personalised, safe care or contained out of date and conflicting information. People and a relative felt able to raise any complaints and concerns. People had limited opportunities to take part in meaningful activities.

Feedback from people, relatives and staff was used to drive service improvement. Despite our findings, people and a relative told us they were satisfied with the service provided and staff felt supported by the manager.

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 good (published 7 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety, poor environmental standards and staffing levels. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to governance of the service, management or individual and environmental risk, including fire safety, staffing and restrictions on people’s liberties.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

People felt safe and were protected from avoidable harm. Care was provided by staff who understood people’s needs and how to keep them safe. Medicines were managed in line with regulatory requirements. There were enough staff to respond to people’s requests for assistance and meet their needs. Risk associated with people’s care and environmental risks were assessed and regularly reviewed. Staff knew what they needed to do to manage and reduce risks.

People received the support they needed to meet their nutritional, physical and mental health needs. Staff were mostly recruited safely and received the support and on-going training they needed to be fulfil their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People and relatives spoke positively about the staff who provided their care and support. Staff were caring in their practice and understood the importance of providing individualised care. People’s privacy and dignity was respected, and their independence promoted. Staff recognised the importance of supporting people to maintain relationships with family and friends. Visitors were made to feel welcome.

People’s needs were assessed prior to moving to St Martins to ensure these could be met and information about the serve was available in a way they could understand. Personalised care plans enabled staff to deliver care in line with people’s wishes and preferences. Complaints were managed in line with the provider’s procedure. Plans were in place to improve the availability and range of meaningful activities available to people.

The provider had not maintained a good level of organisational oversight of the service. This meant some previously demonstrated standards had not been sustained. However, people and relatives were positive about the quality of service they received. The management team and staff worked in partnership with other professionals to improve outcomes for people. The management team were committed to addressing areas where improvement was needed.

Rating at last inspection: Good (report published March 2017).

Why we inspected: This was a scheduled inspection based on the previous rating.

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

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

St Martins provides care and accommodation to a maximum of 16 older people. The home is located in Coventry in the West Midlands. On the day of our inspection there were 14 people who lived at the home. The home provides care and support to older people and people who live with dementia.

The service was last inspected on 23 May 2016 when we found the provider was not meeting the required standards. We identified a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not ensure there were sufficient number of suitably qualified, competent and skilled staff to meet people’s care and welfare needs. Staffing levels also impacted on the availability of staff to provide the support people needed to take part in interests and hobbies that met their individual needs and wishes.

We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us an action plan which detailed the actions they were taking to improve the service. The provider told us these actions would be completed by 24 May 2016.

At this inspection on 1 March 2017 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken and there was no longer a breach in Regulations of the Health and Social Care Act 2008.

Staffing levels had been improved. There were enough staff on duty to respond to people’s needs and to keep people safe and protected from risk. Increased staffing also meant during quieter periods of the day, staff were able to support people with activities that met their individual needs and interests. The registered manager and director of the service were addressing this through a joint project with a health care professional.

The service had a registered manager who had been in post since September 2016. This is a requirement of the provider’s registration. 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.

The provider had developed systems to gather feedback from people and relatives and used the feedback received to improve the service provided. Audits to monitor the quality and safety of the service were being regularly completed and were effective.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed.

The provider conducted pre-employment checks, prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed. Staff completed training the provider considered essential to meet people’s needs safely and effectively.

The registered manager understood their responsibility to comply with the relevant requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Improvements had been made in the completion of mental capacity assessments which were detailed and decision specific. Care workers gained people’s consent before they provided personal care and knew how to support people to make decisions.

People told us they felt safe living at St Martins and staff understood how to protect people from abuse. Risks related to the delivery of care and support for people who lived at the home had been identified and staff understood how these should be managed.

Staff respected and promoted people’s privacy and dignity. People were encouraged to maintain their independence, where possible. People told us care workers were caring and knew how people wanted their care and support to be provided.

People who lived at the home were supported to maintain links with friends and family who could visit the home at any time.

Care workers completed an induction when they joined the service and had their practice regularly checked by a member of the management team. However, staff files did not contain information to show staff inductions were linked to the Care Certificate. The director of the service was taking action to address this. Staff felt supported by the management team.

People were encouraged to eat a varied diet that took account of their preferences and received the support needed to maintain their health and wellbeing. People had access to a range of health care professionals when they needed.

People and relatives were involved in planning and reviewing their care, where appropriate. Care records contained relevant up to date information for care workers to help them provide the care and support people required.

Everyone we spoke with told us the management team were available, supportive and approachable. Complaints were managed in line with the provider’s procedure.

St Martins provides accommodation with personal care for up to 16 people. The home is located in Coventry in the West Midlands. There were 14 people who lived at the home at the time of our visit. Eleven people who lived at the home were living with dementia.

A requirement of the provider’s registration is that they have 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. There was a registered manager in post. We refer to the registered manager as the manager in the body of this report.

The service was last inspected on 30 November 2015 when we found the provider was not meeting the required standards. We identified one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The provider sent us an action plan telling us the improvements they were going to make. The provider told us these improvements would be completed by 19 February 2016.

At this inspection we looked to see if improvements had been made. Improvements had been made in how people’s capacity was determined. Mental capacity assessments had been completed and the local authority had approved DoLS applications for nine people who lived at the home. The provider had taken sufficient action in response to the breach of regulations.

However, further improvements were still required. Some mental capacity assessments were not decision specific. Records of best interest meetings, and to show family members had the legal authority to make decisions on behalf of people who lacked capacity to make decision for themselves, were not always completed. The provider recognised further improvements were still required and was taking steps to address these.

There were not enough staff on duty to respond to people’s needs and to keep people safe and protected from risk. Staffing levels also impacted on the availability of staff to provide the support people needed to take part in interests and hobbies that met their individual needs and wishes.

Most care records we reviewed were up to date and described people’s routines and how they preferred their care and support to be provided. Staff had a good knowledge of the people they were caring for.

People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, quality questionnaires had been developed for future use. The deputy manager and provider spoke to people, staff and visitors to gain their views about the service provided during their visits to the home.

The provider had procedures to check the quality of care people received, and to identify where areas needed to be improved. However, these systems were not always effective. This was because audits were not always detailed and some areas requiring improvement had not been identified.

People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

People and their relatives told us staff were caring and kind. People were treated as individuals whose preferences and choices were respected. Staff treated people with dignity, and supported people to maintain their privacy and independence.

Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report incidents to the manager. The provider had effective recruitment procedures that helped protect people, because staff were recruited that were of good character to work with people in the home. Staff had received the training they needed to support them to meet the needs of people they cared for.

Assessments had been carried out to determine risks to people’s health and safety. Action was taken to reduce any identified risks. People accessed health care services when needed, and received healthcare that supported them to maintain their wellbeing. We saw there was a good choice of food, including snacks and drinks available. There were processes which ensured people received their prescribed medicines.

People and relatives spoke positively about the deputy manager who was approachable. They were able to talk with the deputy manager if they had any concerns and felt their concerns would be dealt with. The manager ensured staff had regular meetings in which their performance and development was discussed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

St Martins is a care home providing personal care and accommodation for a maximum of 16 older people. The home is located in Coventry in the West Midlands. There were 14 people living at home at the time of our visit. Half the people at the home were living with dementia.

A requirement of the provider’s registration is that they have 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. St Martins had a registered manager who was on leave at the time of our visit. However, we spoke with the ‘floor manager’ and one of the directors. As part of our inspection process we spoke with the registered manager on their return from leave to gain clarification about information we had gathered during our visit. We refer to the registered manager as the manager in the body of this report.

People were not always supported in line with the principles the Mental Capacity Act 2005 (MCA), People were able to make some everyday decisions themselves, which helped them to maintain their independence. However, not everyone at the home was able to make decisions about how they spent their time, and the activities they might enjoy.

People and their relatives felt the manager and floor manager were approachable. Staff said they were supported by the management team. We found the arrangements made by the provider for management cover for the home during the manager’s absence were not fully effective.

People and their relatives told us they felt safe with staff, and staff treated them well. Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report these incidents to the manager. The provider had effective recruitment procedures that helped protect people, because staff were recruited that were of good character to work with people in the home.

There were enough staff at St Martin’s to support people safely, though staffing levels did not always enable people to have the support they needed to take part in interests and hobbies that met their individual needs and wishes. People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

Risk to people’s health and welfare were assessed and care plans gave staff instruction on how to reduce identified risks. However, risks to people’s health and safety were not always minimised as staff did not consistently follow the advice of nutritional health professionals.

People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing. There were processes in place to ensure people received their prescribed medicines in a safe manner.

Overall, care records were up to date and described people’s routines and how they preferred their care and support to be provided by staff. Staff had a good knowledge of the people they were caring for. People and their relatives thought staff were caring and responsive to people’s needs.

Staff had received the training they needed to support them to meet the needs of people they cared for. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence. People were given privacy when they needed it.

People and a relative told us they knew how to make a complaint if they needed to. People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, the floor manager worked alongside people at the home, and gathered verbal feedback from people during their day to day activities. The manager and provider spoke to people, staff and visitors to gain their views about the service provided during their visits to the home.

The provider had established some procedures to check the quality of care people received, and to identify where areas needed to be improved. The provider was updating quality assurance processes, to develop more effective recording systems. We saw information was used to identify any patterns or trends and to make improvements to the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with the director of the service, four staff, four people who lived at the home and two relatives. We also spent time sitting with people in the lounge and dining room observing the care they received. The manager was not available on the day of our visit.

We looked at the records of four people who lived at the home, three staff, and quality assurance records.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

At our last inspection in April 2014 we found the service in breach of the Health and Social Care Act regulations 2008.

Previously we found the service did not comply with the regulations relating to consent to care and treatment, care and welfare of people, staffing, assessing and monitoring quality, and records.

During this visit we found staff had received training to help them understand the mental capacity act and deprivation of liberty safeguards. People had given consent to care and treatment, and people's mental capacity had been assessed to determine their cognitive abilities to make decisions for themselves. This meant the provider was now compliant with the regulation relating to consent to treatment.

We saw care records gave clear and up to date information about the care needs of each individual and staff we spoke with worked to the updated care plans. People or their relatives had been involved with care planning. People and their relatives told us they were happy with the care provided at St Martins. This meant the service was now compliant with the regulation relating to care and welfare.

We looked at staff records which demonstrated all staff had undertaken the necessary recruitment checks prior to working at the home. Staff had attended training considered essential to support people safely and effectively. This meant the service was now compliant with the regulation relating to staffing.

We looked at records, spoke with staff and people about the way the service monitored and assessed its quality of care. We saw there were regular checks on the care provided to people and there were now systems in place to assess the quality of care. This meant the service was now compliant with the regulation relating to assessing and monitoring the quality of service provision.

We were able to find the information required in the records requested. Records were up to date and sufficiently detailed to support staff to meet people's needs. Records were kept safely and securely. This meant the service was now compliant with the regulation relating to records.

We spoke with seven people and two relatives of people who used the service to find out what their experiences of the service were like. We also spoke with the manager (who was at the home for a short period of the day), care staff and the deputy manager. The evidence we collected helped us to answer five key questions, these being: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations, our discussions with people, staff and relatives and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

All people we spoke with told us they felt safe living at St Martins. We saw people were treated with kindness and respect but there were some instances where their privacy and dignity was compromised.

Staff knew people's likes and dislikes but were not always fully aware of people's health care needs. This was because they did not have access to up-to-date care plans and risk assessments. This meant people were put at risk of not receiving safe and appropriate care.

Information being recorded regarding accidents and incidents was not being used to help prevent further risks of these happening.

Recruitment records were not sufficiently robust. Where information was omitted, it was not clear this had been followed up to make sure staff were safe to work with vulnerable people.

We could not be confident people always received heir medicines as prescribed.

We were told there was no policy and procedure related to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff did not have an understanding of these to be able to apply the principles of them. This meant people who lacked capacity may not be appropriately supported when decisions about their care and treatment needed to be made.

Is the service effective?

We saw healthcare professionals were involved in people's care to support staff in meeting people's needs.

Staff we spoke with told us they did not have access to key information about people's care needs. They told us they were supporting people based on their previous knowledge of their needs. This meant people may not always receive effective care.

There had been action taken to develop consent forms to help staff provide support in accordance with people's wishes. These were not available for all people in the home. Those that had been completed, had not been placed on people's care files so that staff were aware of them.

We saw some staff had completed mandatory training but some of the training was overdue. We found staff had not attended training linked to the healthcare needs of people living at St Martins to help them support people's needs appropriately.

Is the service caring?

We saw people were supported by kind and caring staff. People and relatives spoken with told us, 'On the whole, they are very good.' 'It's very good. If I wanted any help I would just ask them.' 'Very friendly.'

A relative told us how one member of staff had stayed beyond their working hours to complete a care assessment to allow the admission of their relative to the home. They felt the member of staff was 'wonderful.'

We saw care staff were patient with people and did not rush them when assisting them with care.

Is the service responsive?

Staff asked health professionals to visit people when they had concerns about their health. Staff completed daily records where they identified any concerns relating to a person's care.

We saw charts were in place to monitor people's health although these were not always completed consistently. We saw information of concern on people's charts was not always acted upon. For example, those people who had taken insufficient fluids or had fallen frequently. This meant we could not be confident the service was always responsive to people's needs.

Is the service well led?

We found the service had not been effective in carrying out the required improvements following our last inspection. Although action had been taken to progress improvements, they had not been fully implemented. During this inspection we found additional areas in need of improvement.

We found people's experiences of care were positive at St Martins but the service did not have a fully effective quality monitoring system in place. This was because there were aspects of care and services in need of improvement that had not been identified by the service. We found there were no effective audit processes in place to identify where improvements may be needed.

The manager told us there had been a recent meeting organised with people living at the home and their relatives to gain people's view of the service. We saw the notes of this meeting which confirmed people had been given an opportunity to share their views. Due to this meeting being recent, it was too soon to check suggestions made had been acted upon.

We found choices and options available to people were not always well communicated. We also found it was difficult to determine from records if people were able to consent to care.

People told us they were satisfied with the meals provided. They told us: 'For what it is, it's very good.' 'The food is nice.' We saw the service had sought advice from health professionals where this was required in relation to meeting people's nutritional needs.

Staff told us they had access to all of the required training to carry out their role. We observed staff to be friendly in their approach towards people.

People were positive about the staff supporting them. They told us: 'Pretty good'generally all right.' 'They are alright '.. they are very good.'

People we spoke with told us if they had a concern they would speak with staff or the manager. We saw an appropriate procedure was in place for any complaints to be investigated.

We found records within the service were not always clear to make sure people received consistent and appropriate care.

We saw people had plans of care in place detailing their care needs and how these were to be met by staff. We observed staff being friendly and supportive towards people. During the day we saw staff engaging people in social activities. Some people chose to sleep or watch television and some chose to stay in their room. People were complimentary of the staff. They told us: 'They are very good, I can't fault them at all.' 'Fantastic.'

People were provided with a choice of meals and they told us they enjoyed them. A visitor told us: 'The food is tremendous, they always get an alternative.'

There were quality monitoring processes in place to make sure people were happy with the care and services they were receiving. The results of a quality questionnaire completed by people showed a high level of satisfaction. People told us if they were not happy about anything they would talk with the provider who was regularly available in the home.