St Brelades

St Brelades is a residential care home providing personal care to up to 37 people. The service provides support to people living with dementia. At the time of our inspection there were 33 people using the service.

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

Improvements had been made at the service since our last inspection. However, further improvements were required to ensure people always received a good quality service.

Medicines management had improved. Further improvement was needed to ensure people were always offer medicines overtly before they were administered covertly. Medicines records were now accurate and medicated patches were applied in line with the manufacturer’s guidance.

Care plans have been improved to provide guidance to staff about how to manage risks. However, information was not always stored in the same place so staff could refer to it quickly in an emergency. Action had been taken when accidents and incidents happened, but systems were not in operation to look for patterns and trends.

Further improvements were required in relation to quality assurance processes, acting on feedback and planning improvements to ensure the quality of the service continued to develop. Relatives continued to tell us laundry was not always well managed and items continued to go missing. New checks and audits were being implemented but time was needed for these to be imbedded to ensure any shortfalls were identified and action taken to address them.

Development plans were in place but did not cover all the plans the registered manager had to improve the service. Detailed plans would support the registered manager and provider to assure themselves the service was continuing to develop.

The culture at the service had improved. People were no longer discriminated against because of their needs and were free to use all areas of the building. The dementia environment had improved, but further work was needed to ensure people are empowered to understand and interact with their environment as much as possible.

People were protected from the risk of infection. A relative told us “It’s always been excellent, clean and tidy. It’s just like walking into somebody’s home”.

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. The provider’s quality rating was now clearly displayed. Notifications had been submitted as required.

People were protected from the risk of abuse because all staff had now completed safeguarding training. Staff were confident to raise concerns with the registered manager and were assured she would act.

Staff recruitment had improved. There were enough staff who know people well and have the skills and competence to meet people’s needs. Staff now felt supported, appreciated and motivated. Staff were confident to make suggestions and these were acted on.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 7 July 2022). 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.

This service has been in Special Measures since 21/6/2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 May 2022. Breaches of legal requirements were found. This inspection was carried out in part to follow up on action we told the provider to take at the last inspection. 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, fit and proper persons employed, staffing, good governance, safeguarding service users from abuse and improper treatment, notification of other incidents and requirement as to display of performance assessments.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. 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 Brelades on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. At our next inspection we will check the improvements made have been maintained and the service demonstrates consistently good practice over time.

St Brelades is a residential care home providing personal care to up to 37 people. The service provides support to people living with dementia. At the time of our inspection there were 33 people using the service. The service is a large, converted property and accommodation is arranged over two floors.

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

People told us they were happy living at St Brelades. Relatives told us they felt their loved ones were safe and well cared for. However, we found a lack of strong leadership had failed to develop a culture of good dementia care and people were not always treated equally and with respect. The provider and registered manager’s checks and audits were ineffective and had not identified a number of shortfalls at the service.

When people and relatives had shared their views, these had not been acted on to develop the service. Relatives told us their loved one continued to wear other people’s clothes despite feedback about this. Not all the staff had been asked for their views of the service. Staff who had been asked had told the management team they did not always feel appreciated, however this had not been addressed and continued.

The registered manager and provider had not told us about all significant events at the service so we could check action had been taken to prevent them occurring again. The provider’s rating was not displayed to inform people and visitors of the quality of the service.

Risks to people were not constantly managed to protect them from harm. Some risks had not been assessed and action had not been planned to mitigate other risks. People’s medicines were not well managed, and some people had missed doses of important medicines. Effective systems were not in place to record medicines stocks and identify errors. Lessons had not always been learnt when things went wrong and there was a risk incidents would occur again.

Staff had not been recruited safely and robust checks had not been completed on staff’s conduct in previous roles. There were enough staff to meet people’s needs however, staff had not been supported to develop the skills they needed to fulfil their roles. Most staff had not completed in-depth dementia care training.

The service was clean, and people were protected from the risk of the spread of infection. One relative commented, “They handled Covid restrictions really well and made sure everyone was provided with the proper PPE. The cleanliness of the home has always been very good. The cleaners do a good enough job.’’

The registered manager had applied for and obtained appropriate legal authorisations to deprive some people of their liberty.

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 (31 January 2018).

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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 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 Brelades on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, medicines, recruitment, staff skills and competency, checks and audits and gathering and acting on people’s views at this inspection. We also found we had not been notified of all significant events that happened at the service and the rating had not been displayed.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

St Brelades is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Brelades accommodates up to 37 people living with dementia in one adapted building. There were 37 people using the service at the time of our inspection. St Brelades exclusively offers a service to women.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the last inspection on 3 November 2015, we asked the provider to take action to make improvements to the way people’s capacity to make decisions was assessed and how decisions main in people’s best interests were recorded and this action had been completed.

The registered manager had oversight of the service. The registered manager and management team checked that service met the standards they required and worked to continually improve the care people received. However, processes were not in operation to complete regular checks and audits of all areas of the service and use these to drive improvement. We have made a recommendation about checks and monitoring the service.

Staff felt supported by the management team, they were motivated and enthusiastic about their roles. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff and community professionals we spoke with told us they would be happy for their relatives to live at St Brelades. Records in respect of each person were accurate and complete.

Staff were kind and caring and treated people with dignity and respect. They had taken time to get to know each person well and provide the care they wanted in the way they preferred. People received the care and support they wanted at the end of their life. Since our last inspection the provider had begun to implement the Gold Standards Framework (GSF) for end of life care. The GSF is a recognised approach to ensuring that everyone receives appropriate and individualised care which takes account of their wishes and preferences at the end of their life.

Staff knew the signs of abuse and were confident to raise any concerns they had with the management team. People were not discriminated against and received care tailored to them. One person’s relative said, “The staff know my relative inside out now and every part of her day is catered for just how she likes it to be. She is most content now she is being so thoroughly cared for in every aspect of her day and night”. Complaints were investigated and responded to. People had enough to do during the day, including taking part in activities they had enjoyed.

Assessments of people’s needs and any risks had been completed and care had been planned with them and their relatives, to meet their needs and preferences and keep them safe. One person said, “I am really so safe here and content”.

Changes in people’s health were identified quickly and staff contacted their health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet of food they liked and that met their cultural needs and preferences.

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 service support this practice. The registered manager knew when assessments of people’s capacity to make decisions were needed.

There were enough staff to provide the care and support people needed when they wanted it. One relative told us, “There are always plenty of staff on duty at any one time and my relative informs me that it is the same during the night she wouldn’t have to wait for assistance in the night”.

Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The service and equipment were clean and well maintained. The building had been adapted to meet people’s needs and make them feel comfortable. People were able to use all areas of the building and grounds and were encouraged to make their bedroom feel homely.

The registered manager had informed CQC of significant events at that had happened at the service, so we could check that appropriate action had been taken.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall, and took prompt action to display the overall rating on their website.

Further information is in the detailed findings below.

One relative told us, “The home is welcoming and offers a peaceful environment. People receive individual holistic care and families are also looked as well”.

We found that the service obtained suitably detailed information about people’s needs to enable staff to provide effective care. People were asked for their consent before any care or treatment was given.

We saw that people who used the service and/or their relative/representative had been involved in the planning of their care. They received care and support that was well planned and sensitively delivered.

People maintained good physical and mental health as the service worked closely with health and social care professionals. Activities were provided which people looked happy to join in with. For example, creative activities were on offer during the afternoon of the visit.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The staff were given appropriate training and support, and had opportunities to develop their own professional portfolios.

Effective quality assurance procedures ensured that people were provided with a good service.

People maintained good health and mental health as the service worked closely with health and social care professionals. Activities were provided which people looked happy to join in with. For example, a hairdresser was at the home washing and drying people’s hair, an exercise class was held during the morning and art and craft activities were on offer during the afternoon.

People said that they were happy with their rooms and with the environment in general. Visiting relatives told us “I think (my relative) is very happy here. She has been lovely today, the best she has been for a long time” and “This home is very well staffed and very well run” and “It is very good here, it has been known for years as a very good home.”