About the service:

St Anthony's - Care Home with Nursing Physical Disabilities is registered to accommodate 26 people. The people living in the home have physical disabilities. At the time of our inspection 23 people were using the service. St Anthony's - Care Home with Nursing Physical Disabilities accommodates people in one building adapted building. There are various communal lounges and dining areas, a conservatory and a garden area that people can access.

People’s experience of using this service:

The care people received was not always effective. People were not always supported to have maximum choice and control of their lives. Due to the recent history of non-compliance with the regulations and a history of repeated requires improvement and inadequate ratings, the provider needed further time to embed the improvements we have identified to ensure that they can be sustained in practice.

The care people received was safe. Individual risks were considered. Safeguarding procedures were in place. Medicines were managed in a safe way. There were enough staff available for people. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

Staff received training that helped support people. People received support from health professionals when needed. People enjoyed the food and were offered a choice. The environment was adapted to meet people’s needs.

People and relatives were happy with the staff and supported in a kind and caring way. People were offered choices, remained independent and their privacy and dignity was maintained.

People received care that was responsive to their needs. The care they received was individual and specific to their needs. People had the opportunity to participate in activates they enjoyed. There was a complaints procedure in place.

There were systems in place to ensure the quality of the home was monitored. When areas of improvements were needed action was taken. Staff and people felt listened to and supported by the registered manager and had the opportunity to raise concerns.

We were notified of significant events that occurred within the home and the provider was displaying their previous rating in line with our requirements.

More information is in the full report.

Rating at last inspection:

Inadequate (Last report published 24 January 2019)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

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.

This comprehensive inspection visit took place on the 19,20 and 21 September 2018 and was unannounced. Following the inspection, we asked the provider to send us confirmation they had addressed some of the concerns we found during our inspection. We received this within the timeframe we requested.

St Anthony's - Care Home with Nursing Physical Disabilities 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. St Anthony's - Care Home with Nursing Physical Disabilities is registered to accommodate 35 people. The people living in the home have physical disabilities. At the time of our inspection 23 people were using the service. St Anthony's - Care Home with Nursing Physical Disabilities accommodates people in one building adapted building. There are various communal lounge and dining area, a conservatory and a garden area that people can access.

There is a registered manager in place. 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 overall rating for this service is Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At this inspection we found risks to people were not managed in a safe way. Risk assessments were not always in place when needed. When incidents had occurred, the information had not been used to mitigate or reduce the risk of reoccurrence. When needed, incidents had not always been investigated or considered as safeguarding concerns by the provider. People were not protected from potential abuse as incidents were not reported appropriately when needed. People had to sometimes wait for the supported they needed as there was not always enough staff available for people. Improvements were needed to the management of medicines and all medicine was not administered as prescribed, the systems in place to monitor medicines were not effective in identifying concerns.

Peoples capacity was assessed however there was no evidence decisions had been made in people’s best interests. People are not supported to have maximum c

This inspection visit took place on the 14 December 2017 and was unannounced. St Anthony’s 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. St Anthony’s is registered to accommodate 34 people in one building. Some of the people living in the home have physical or learning disabilities. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary. At the time of our inspection 29 people were using the service. St Anthony’s accommodates people in one building. There is a large communal lounge and dining area, a physiotherapy room, an activity room and various garden areas that people can access.

There is a manager registered with us however they are no longer working at the service. Following our last inspection the provider had taken action around the management of the home and an acting manager is now in place. Full information about CQC’s regulatory response to this concern found during inspections is added to reports after any representations and appeals have been concluded. 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.

At the last inspection on 14 June 2017 we asked the provider to take action to make improvements in relation to risk management including behaviour management and the environment, mental capacity act, medicine management , complaints, peoples cultural needs and the management of the home these actions has been completed. However we identified that further improvements were needed in relation to decision making in people best interests, checking staff knowledge after training, ensuring people’s care was responsive to their needs and the auditing within the home.

Decisions were not always made in people’s best interests and relatives were signing consent forms on behalf of people. Staff did not always demonstrate an understanding of mental capacity and DolS. Further improvements were needed to ensure people who may be restricted were supported in line with these requirements. Staff knowledge needed to be checked after training had occurred to clarify their understanding and knowledge. People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice

People’s care was not always responsive to their needs and documentation needed to be updated to reflect the support people needed in key areas such as pressure management. The provider sought the opinions of people and relatives who used the service; however this information needed to be used to make changes. Audits within the home needed development to ensure all concerns were identified and used to drive improvements.

We found that risks to people were managed in a safe way and when people needed specialist equipment this was provided and maintained for them. There were safe systems in place to manage medicines and staff understood safeguarding and how to protect people form harm. There were enough staff available for people and there were infection control procedures in place for staff to follow.

People’s privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day. They told us they were offered the opportunity to participate

We inspected this service on 14 June 2017 and it was an unannounced inspection. Our last comprehensive inspection took place in September 2016. We found that actions were required to improve the care of people. At this inspection we found insufficient improvements had been made which included the way risks to people including behaviours and medicines were managed, how people were protected from potential abuse and when concerns were reported externally. Improvements were also needed to ensure people were supported with capacity and consent and ensuring effective systems were in place to identify when improvements within the service were required. The provider sent us a report in December 2016 explaining the actions they would take to improve. At this inspection, we found that the necessary improvements had not been made.

The service was registered to provide nursing support for up to 34 people with physical disabilities. At the time of our inspection 31 people were using the service.

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.

Risks to people were not always managed in a safe way. When people displayed behaviours that may challenge we could not be sure the behaviour management plans and staff understanding that were in place would be effective in reducing the risks to the person. We could not be assured the provider understood when people were at risk. There were no environmental risk assessments in place in relation to a recent flood that occurred within the home. Staff were unable to demonstrate understanding of the fire procedures within the home.

When people needed as required medicines in an emergency situation staff were unable to access this in a timely manner. Guidance for as required medicines was not always in place for staff to follow. Staff demonstrated an understanding of safeguarding however some incidents and accidents had not been reported as required. Staff were available in communal areas however people and relatives felt they had to wait for support when they pressed the call alarm.

Complaints were not always recognised and responded to in line with the provider’s policy. Information recorded in people’s care files did not always match the care they received. Health professionals felt that the home lacked leadership. When employment checks had been completed the provider had not assured staffs suitability to work within the home. Some of the audits that were introduced were not always effective in identifying concerns or areas of improvement.

When people lacked capacity to make decisions for themselves we saw capacity assessments were sometimes unclear. When people were being restricted unlawfully this had not always been considered by the provider. We could not be assured the provider was working with in the principles of MCA or fully understood this.

Staff received training however we could be assured their knowledge in these areas was checked. People did not always receive support from health professionals in a timely manner. We could not be sure staff always understood how to support people, to make choices

People enjoyed the food and were offered a choice; they were able to participate in activities they enjoyed. Staff felt supported and were given the opportunity to raise concerns. Equipment was maintained and tested to ensure it was safe to use. People and relatives were happy with the staff. Relatives and visitors were free to visit anytime and felt welcomed.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to

At the last comprehensive inspection on 25 April 2016, we asked the provider to take action to make improvements. We found concerns that people had to wait for support with their care needs and risks to people were not managed in a safe way. We found people did not receive their medicines safely. We also found when people were unable to consent capacity assessments and best interest decisions were not always completed. We could not be assured the provider was notifying us about significant events that occurred within the home and we did not see how information was used to bring about improvements to the service. At this inspection we found some areas of improvement however more improvements were needed.

The service was registered to provide accommodation for up to 34 people. At the time of our inspection 29 people were using the service.

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.

Risks to people were not always fully considered. When people displayed behaviours that may harm themselves or others the actions that were in place were not always effective in reducing the risks. We found evidence to suggest that other health professionals did not devise or agree with the strategies that were being used.

When people lacked capacity to make decisions for themselves we saw capacity assessments were sometimes unclear. When people were being restricted unlawfully this had not always been considered by the provider. We could not be assured the provider was working with in the principles of MCA or fully understood this.

The values of the service did not always offer a person centred approach and concerns with the culture of the home were identified, for example people’s privacy and dignity was not always upheld.

The systems that were in place to monitor the quality of the service were not always effective. When concerns had been identified we could not always see this information was used to drive improvement.

People felt safe and staff knew how to recognise and report potential abuse. Staff shared knowledge of people to help offer them support. The provider ensured staff suitability to work within the home. When needed people received support from health professionals and they were happy with the food and the choices available. People were given the opportunity to participate in activities they enjoyed.

Medicines were managed in a way to protect people from the risks associated to them. There were enough staff available for people and they did not have to wait for support. When people were able to mobilise independently they told us they made choices about their day and were encouraged to be independent

Staff felt listened to and were given the opportunity to raise concerns. People knew who the registered manager was and how to complain. The provider understood their responsibility with us and notified us of significant events with in the home.

We found breaches 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.

We carried out an unannounced focused inspection of this service on 2 August 2016 to see if the provider had met the requirements as set out in the warning notice. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and ensuring people were protected from potential abuse. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Anthony’s - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk

The service is registered to provide accommodation and nursing for up to 34 people, who have physical disabilities. At the time of the inspection 33 people were using the service.

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.

We saw there were not enough staff to support people, this is a continued concern raised at the last inspection. People told us they had to wait to receive the support they needed and the use of agency staff was impacting on the care people received. The provider on occasions was working below the recommended numbers as identified using their dependency tool. People were not receiving their medicines as prescribed and we could not be sure medicines were administered on time. Risks to people were not managed in a safe way and risks were not assessed or reviewed when needed. People were at risks of not receiving medicines they needed to keep them safe.

People were protected from abuse and potential harm as staff had received training in safeguarding and the provider understood how to raise concerns and report them appropriately.

We found breaches 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 inspected this service on 25 April 2016 and it was an unannounced inspection. Our last inspection took place in November 2013 and we found no concerns with the areas we looked at.

The service was registered to provide accommodation for up to 34 people. At the time of our inspection 34 people were using the service.

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. The registered manager was currently absent from the service.

People’s medicines were not managed stored and administered in a safe way. We found that medicines were not always administered as prescribed. There was no guidance in place to ensure staff understood when to give people ‘as and when’ required medicines.

People told us they had to wait for support and we found there were not enough staff to meet people’s needs in a timely manner. Risks to people were not always manged to ensure people were supported in a safe way. Some people were not protected from potential abuse as concerns were not reported to the local authority. The provider had not notified us about significant events within the home.

When people were unable to consent, mental capacity assessments and best interest decisions were not always completed. The provider had considered when people were being restricted unlawfully but had not assessed how people could be supported in the least restrictive way. People told us they were not involved with reviewing their care and felt when they had raised concerns theses had not been actioned.

When people needed support to be made more comfortable we did not see staff provide this for them. People did not feel staff were compassionate towards them.

The systems that were in place to improve the quality of the service were not always effective. When concerns were identified action had not been taken. Records for people were stored insecurely. People’s care was reviewed but we did not see changes that were made from this.

People told us staff knew them well and staff had the training to support people. People privacy and dignity was upheld and when needed they were referred to health professionals for support. Equipment was maintained and tested so that it was safe for people to use. The provider had a system in place to ensure the suitability of staff who worked within the service.

People told us they enjoyed the meals and there were choices offered to them. People were offered the opportunity to participate in activities they enjoyed and were encouraged to be independent. People knew who the registered manager was and staff felt supported.

We found breaches 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.

We inspected St Anthony’s Nursing Home on a planned, unannounced inspection which meant the service did not know we were coming. We spoke with people who used the service, a relative, the manager and staff throughout the inspection.

We saw that people who used the service had consented to their care, treatment and support or had been supported to do so by significant others.

We found that people’s care and welfare needs were being met. People who used the service told us they were happy at St Anthony’s.

We checked that the service was managing medication appropriately. We found the service had systems in place to ensure that medication was handled safely and securely.

We found that the service was following the correct recruitment procedures when employing new staff.

The service had a complaints procedure for people who used the service or their relatives to use if they felt the need to complain about the service.

We inspected St Anthony's Nursing Home on a planned unannounced inspection which meant the service did not know we were coming.

We spoke with people who used the service and their relative's. They told us they were happy with the quality of care they and their relative received at St Anthony's Nursing Home.

We saw that people received appropriate care and support from external agencies and that people were treated with dignity and respect. People who used the service were involved in the decision making about the care they required.

We looked to see how people who used the service were safeguarded from abuse or the risk of abuse. We found the service had processes in place to protect people.

Staff we spoke with told us they liked working at St Anthony's Nursing Home and that they felt supported in their role. They told us and we saw that they had adequate training to fulfil their role competently.

The service had systems in place to monitor the quality of the service being delivered to ensure continuous improvement.

We spoke with 11 people who use the service, three relatives and eight staff to include the manager and a physiotherapist. People who were able to share their experiences of living at St Anthony’s were very positive about the care, treatment and support that they receive. Everyone we spoke with told us that that they were well cared for and that the care staff were “very good” and “very friendly”. People said that they lead busy lifestyles and that their independence is promoted as much as possible.

People told us that they were happy with their bedrooms and that they are able to personalise them. They told us that they enjoyed their meals and that they were provided with a varied choice of food. They said that their rooms were kept clean and that staff respected their privacy and dignity and that communication between them and the staff was “good”. Comments received included, “I love it here. I have my independence and we are not forced to do anything that we don’t want to. Everybody is on your level; we are like one big family”. “It’s the nicest home in the Country; I’m more than happy with my care”.

Feedback from relatives was overall positive although prior to our visit we did speak with one person who expressed a number of concerns about the care and welfare of their relative. Comments received during our visit included, “We visit regularly and are made welcome. The staff are friendly”.

Staff we spoke with told us that they are provided with many training opportunities to develop their skills and knowledge and to keep people safe. They considered that the care plans were reflective of people’s individual needs and one member of staff provided sound examples of how they promoted privacy and dignity when supporting people with personal care.

Staff told us that they received regular formal supervision to discuss their work practice, performance and identify any training needs. They told us that regular team meetings are held in addition to daily handovers so that they are kept well informed about any changing needs. They considered they were able to meet people’s individual needs but that an additional member of staff on duty would provide them to spend more quality time with the people they support. They told us that people’s health and nutritional needs were met and that people are provided with a good choice of meals. Comments included, “We work well as a team”. “We all try to do our best for service users but there’s only so many hours in a day”.