St Annes Residential Care Home

St Anne's Residential Home is a residential care home providing personal care to up to 19 people. The service provides support to older people. At the time of our inspection there were 19 people using the service.

People’s experience of the service and what we found:

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.

There was a lack of documentation in some areas of care, this meant people might receive inappropriate, ineffective, or unsafe care and the registered manager would not be aware of this. For example there was no plan to ensure people’s oral hygiene was managed. The registered manager had not always told CQC of incidents that were legally notifiable.

People were not always included in writing their care plans and staff struggled to use the care planning system, telling us they felt they needed more training. Staff were not able to access risk assessments for people for guidance.

The registered manager did not have oversight of the service as they had failed to carry out any audits, checks or reviews for 8 months. Staff said they needed more support in the form of supervisions and they wanted to see the registered manager more active in the home. Staff said they didn’t feel the registered manager acted on their complaints or concerns.

While the registered manager said she was always happy to talk to people, relatives, or staff, there had been no recent surveys or questionnaires sent out to prompt responses, meaning it was unclear what the majority of people and families felt about care at the home.

The provider’s staff training matrix showed staff training had not been kept up to date, and the registered manager acknowledged training was an issue. The registered manager said she checked staff competency by watching them provide care, but this was not recorded and staff said they were not aware of this.

The quality of the food provided by the service was inconsistent. Kitchen staff were unclear if anyone had allergies or special diets due to food intolerance, and relied on care staff to select the correct food for people. A person told us they bought in their own food as they didn’t feel the service was able to manage the diet they needed effectively.

People were mostly content at the home, although feedback from people varied. A person told us, “On the whole they [staff] are very nice.” Another person told us, “I don’t normally see [manager]. [Manager] is not about much.” They also told us, “The staff never normally check in with me. They don’t just come by and see if I’m ok.”

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 17 October 2019

Why we inspected

The inspection was prompted in part due to concerns received about neglect by staff, a lack of staff training and issues with oral hygiene and nutrition and hydration. CQC had received anonymous complaints about care at the home. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of effective and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Anne’s Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, notifications of incidents, good governance, and requirement to display rating.

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

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and effective care. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Anne’s Residential Home accommodates a maximum of 19 older people, some of whom were living with dementia in one adapted building. At the time of this inspection 18 people were living at the home. The adapted building is owned and maintained by the Franciscan Missionary Sisters of Littlehampton. The service was tailored for, but not limited to, people from the Roman Catholic Church. There is a shared lounge and dining room as well as an activity lounge, chapel, kitchenette facilities and a beautiful garden for people to enjoy. Accommodation is over two floors which are accessible via stairs or lift.

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

People felt safe and told us they enjoyed living at the service. Risks to people had been assessed and staff followed guidance to keep people safe. There were enough staff to meet people's needs. Medicines were managed safely, and staff had been trained in infection prevention and control. Lessons were learned if things went wrong and systems supported people to stay safe and reduce the risks to them, ensuring they were cared for in a person-centred way.

People spoke positively about the staff who supported them and had confidence in their skills and experience. Staff had regular supervision and an annual appraisal. People enjoyed the food and were able to choose what they had to eat and drink. People had access to a range of healthcare professionals and support.

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.

People and relatives were positive about the care and support received at St Anne’s. They told us staff treated them with kindness and we observed friendly interactions throughout the day. People were encouraged to be involved in daily decisions about their care and support and were treated with dignity and respect. Relatives were made to feel welcome.

People received personalised care that was responsive to their needs. Activities were organised according to people's preferences, interests and suggestions. People and relatives told us they felt comfortable to make a complaint and knew how to do this.

Quality assurance systems and monitoring completed by the registered manager and senior staff facilitated on going improvement of services provided.

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 30 August 2018) there was a breach of regulation 17. 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 regulation 17.

Why we inspected

This was a planned inspection based on the previous rating.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 Anne’s Residential Care Home is registered to provide accommodation for persons who require nursing or personal care, for a maximum of 19 people. At the time of the inspection 17 people were living at St Anne’s Residential Care Home, some of whom were living with dementia. The adapted building also accommodates a convent. There is a shared lounge and dining room as well as an activity lounge, chapel and kitchenette facilities. Accommodation is over two floors which are serviced by a lift.

St Anne’s Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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 were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, staff were not always clear about who was able to give consent and documentation that recorded people's understanding of specific decisions did not reflect the person's views or those who knew them well.

Although there was a quality assurance system in place at the service, this had not supported the identification of all areas of inconsistency in documentation we found during the inspection.

Medicines were ordered, received and stored safely. There was a lack of documentation around “as required” medicines, and we have made a recommendation about this.

People told us they felt safe. There were robust systems in place to manage falls, accidents, incidents and safeguarding concerns. There was sufficient staff available to meet people’s needs and plans in place in case of emergency.

The service worked well with other organisation to promote people’s health and wellbeing. The provider sought, and responded to, the views of people, their relatives, staff and other professionals.

People were treated with kindness, respect and compassion with their independence promoted. Staff knew people and their interests well and had developed good relationships.

We found one 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 this report.

People told us about their life at the home and the activities they participated in. We looked at a sample of records. We found that events had been properly and timely recorded and had been responded to appropriately. This gave us a good insight into how the home was run and provided us with evidence that the home met people's needs and expectations.

We talked with the manager and three members of staff. Staff told us that they felt people were well looked after and experienced a good quality of life. Staff also told us that they enjoyed looking after people and felt well supported in their roles with access to appropriate training and guidance from their manager. We found that the home had systems in place for monitoring the quality of care and support the home offered.

The home employed dedicated maintenance and housekeeping staff and the home was found to be clean and well maintained at the time of our inspection. We spoke with five members of staff including the registered manager. We found staff to be knowledgeable about the needs of the people they supported and committed to their roles. Staff told us that they felt well supported by the management team and said that St Annes Residential Care Home was a nice place to work.

We found that the home had effective systems in place to train staff. We looked at a range of records maintained by the home, including the care plans for four people. We found that all records viewed were well maintained with evidence of having been regularly updated.