We carried out an unannounced inspection of this service in February 2017 and we found breaches of legal requirements in relation to risk management, governance and staffing. The provider submitted an action plan about how they would make improvements and we also met with them.

We inspected again in November 2017 and found that improvements had not been made and there was a further concern in relation to recruitment. The service was rated ‘Inadequate’ and placed into special measures. We took immediate enforcement action to restrict admissions to the service. We also placed conditions on the provider’s registration requiring them to send us a report to inform us how people were being cared for in a safe environment by skilled staff.

During February and March 2018, we carried out a further unannounced inspection and we found that although some improvements had been made the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety and the service remained in special measures.

You can read the report from our last focused and comprehensive inspections, by selecting the ‘all reports’ link for St Marks Residential Care Home on our website at www.cqc.org.uk

During this comprehensive inspection undertaken in August 2018 we found that improvements had been made.

This service 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 Marks Residential Care Home is an adapted building, located close to the town centre, sea front, GP surgery and public transport. The service provides accommodation and personal care for up to 17 older people. This includes people requiring support with medical and physical frailty, and people living with dementia. There were nine people living in the service when we inspected.

There was a registered manager in post, who was also a director of the company which owned the service. 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.

Since our last inspection of the service, while improvements had been made and we found no breaches of legal requirements, further improvements were still required. We viewed the appointment of an experienced person in care, as Nominated Individual, to be a very positive step, bringing stability, support and guidance to the management team. However, further improvements were still required. This is to ensure that quality assurance arrangements are continually robust and effective to drive, sustain and embed improvements to achieve continued compliance with regulatory requirements. We made a recommendation to support them in maintaining staffing levels, to ensure sufficient staff are consistently, and effectively deployed to meet people’s needs.

There were systems in place to safeguard people from abuse and staff had been recruited using safe recruitment practices. Staff were aware of their responsibilities and knew how to report concerns. However, further improvements were needed in the completion of records, to confirm the action staff had taken to ensure people’s safety and welfare.

Improvements had been made in infection control, décor and maintenance of the service, as part of an on-going refurbishment. This was providing people with a brighter, clean, well maintained, and safe, environment. We made a recommendation to support the provider in identifying where the layout of the service could be further improved to support people living with dementia.

Systems were in place to reduce / eliminate any risks ass

We undertook an unannounced focused inspection of St Marks Residential Care Home over three days: 21 and 22 February and 5 March 2018. We reviewed the progress of the provider’s planned improvements following our comprehensive inspection on the 6 and 9 February 2017 and focused inspection on the 9 and 13 November 2017. These had found the provider was not meeting some legal requirements. This inspection was also prompted in part by information we had received from whistle blowers and safeguarding reports to the local authority.

People living at St Marks Residential Care Home 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. The service provides personal care for up to 17 older people, some people living with dementia. There were 14 people living at the service when we inspected.

At the inspection in November 2017 we identified continued breaches of legal requirements. There was poor leadership, management and provider oversight of the service. This led to people receiving poor care where risks to their health and welfare were not adequately protected. We took urgent enforcement action to mitigate the risks to people and restricted any new admissions to the service until we were satisfied improvements were made.

St Marks Residential Care Home is in Special Measures, which resulted from an Inadequate rating following a focused inspection undertaken in November 2017. The purpose of Special measures is to ensure providers found to be providing inadequate care significantly improve. We keep services placed into Special Measures 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 be providing inadequate care should have made significant improvements within this time frame.

You can read the reports from our previous inspections by selecting the ‘all reports’ link for St Marks Residential Care Home on our website at www.cqc.org.uk

Since the last inspection the provider has employed several different external consultants to help improve quality and safety. The local authority safeguarding and quality monitoring teams also continued to monitor the service through regular visits and support, mitigating the risks to people using the service and reviewing the provider’s improvement plan.

Despite this support the Commission continued to receive concerns from members of the public and professionals about the provider’s ineffective oversight of the service. This included concerns about the provider’s ability to improve the overall quality of the service. As a result there continued to be concerns about the ability of the provider to drive improvement and ensure people received safe, effective care. We therefore carried out this focused inspection to check progress against their improvement plan and check how those living in the service were being protected from the risk of potential harm. The inspection team inspected the service against two of the five questions we ask about services: is the service safe and well led.

There was a registered manager in post, who was also a Director of the company which owned the service (the registered provider). 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 this inspection we found although some improvements had been made, sufficient action had not been taken to mitigate the risk of harm and the provider remained in breach of the Regulations. The provider had delegated some of the improvement goals to

We undertook an unannounced focused inspection of St Mark’s Residential Care Home over two days; 9 and 13 November 2017 and met with the provider on the 28 November 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection carried out on the 6 and 9 February 2017 which found it was not meeting some legal requirements. The team inspected the service against three of the five questions we ask about services: is the service well led, safe and effective.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

This service 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 Marks Residential Care Home is an adapted building, located close to the town centre, GP surgery and public transport. The service provides personal care for up to 17 older people, some people living with dementia. There were 14 people living in the service when we inspected.

There was a registered manager in post, who was also a director of the company which owned the service. The registered manager was also registered to manage another care home for older people in Clacton which they owned. 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 this inspection we found that sufficient action had not been taken and the provider remained in breach of the Regulations. We found that some parts of the service presented risks to people and there was a lack of robust assessments and controls in place to protect people and keep them safe. The environment was not always well maintained and we continued to find concerns with cleanliness and infection control.

We continued to have concerns about the numbers of staff their knowledge and skills. Staff did not always demonstrate adequate knowledge about how to support people safely. For example there were risks associated with aspiration and choking, moving and handling, infection control, unstable wardrobes, window restrictors, storage of hazardous fluids and trip hazards.

The quality of the training staff received was not effective enough to demonstrate they were able and competent to meet the needs of the people using the service. The provider did not have systems in place to ensure they were up to date with best practice guidance and there was a lack of effective learning from safeguarding incidents to reduce the risks to people from reoccurring.

Improvements were needed in the medicines systems to ensure staff followed safe, person centred practice. The use and timing of ‘as and when required’ medicines, to ensure people received them safely in line with best practice, and their effectiveness monitored. This included staff being given clear guidance on the use of anti-anxiety medicines, to enable staff to demonstrate that non-medicines strategies had been tried first.

There were quality assurance systems in place but these were not robust or effective. They were not driving improvement and had not identified the issues that we found at the inspection.

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 th

This unannounced inspection took place over two days, 6 and 9 February 2017. St Mark’s Residential Care Home was previously inspected over three days in February and March 2016 and was rated requires improvement with breaches of regulations in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to providing person centred care, staffing and good governance. Following that inspection the provider sent us an action plan to tell us what improvements they were going to make. You can read the report from our comprehensive inspection of March 2016 by selecting the ‘all reports’ link for ‘St Marks Residential Care Home’ on our website at www.cqc.org.uk

St Marks Residential Care Home provides personal care for up to 17 older people, some people living with dementia. There were 16 people living in the service when we inspected.

The service has a registered manager, who was also the provider. The manager was also registered to manage another care home for older people in Clacton. 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.

Improvements had been made in the staffing levels, however further work was needed. We have made a recommendation to support the provider in the deployment of staff. This is to ensure the service consistently has sufficient staff, with the right skills and knowledge to monitor and support people with complex needs.

Training was being provided for staff, but it did not always provide staff with the knowledge and skills to effectively carry out their role. The majority of training was provided by the registered manager. We identified concerns about staff’s understanding of current good practice and the ability to put training into practice. For example, where staff did not demonstrate knowledge of safe care and best practice in areas such as moving and handling, dementia care and infection control.

Further improvements were needed to support people with their mental and emotional needs by ensuring they had access to activities that provide mental stimulation. We recommended that the service explores the relevant guidance on best practice to enhance people’s wellbeing through meaningful occupation.

People complimented the quality of the food. However, we found people were not always supported to ensure that they had enough food and drinks to support their health needs. Records were incomplete and not assessed, we could not be assured that people had been given enough to eat and drink. Where people of low weight turned down food, or had a low appetite, this was not always being effectively managed. This put people at risk of losing, or not maintaining their weight.

Staff’s practice was not always shown to be caring or respectful. We saw some good interactions, and people told us they liked the staff. However, some support given focused on the provision of tasks and was not always person centred or individualised. It did not promote people’s wellbeing or ensure that people felt valued. We have made a recommendation to support staff in promoting dignity in care.

Improvements were seen in the development of people’s care plans. They were more individualised and reflected people’s wishes and preferences. However, some areas needed to be developed further, and in a way that reflected best practice. This is to ensure staff were being given clear guidance on meeting a person’s needs, that ensured their safety and wellbeing. For example supporting people’s mental health, and managing pain relief.

People were not always supported to have maximum choice and control of their lives and staff were not always supporting them in the least restrictive way possible.

People told us they felt safe, a

St Mark’s Residential Care Home provides accommodation and personal care for up to 17 older people, some living with dementia.

There were 13 people living in the service when we inspected over three days. This was an unannounced 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.

During our inspection we found multiple breaches of the health and Social Care Act 2008 (Regulated Activities) regulations 2014. The registered manager was also a director of St Mark’s Care Home Limited was clear that they would be taking action to make improvements. You can see what action we told the provider to take at the back of the full version of this report.

Staffing numbers were not assessed to reflect people’s dependency needs and impact of the layout of the building. As a result the service could not demonstrate that there were enough staff to ensure people were provided with care that was safe and promoted their independence and autonomy as far as possible.

Improvements were needed to ensure people’s environment and equipment, including bedroom furniture, provided by the service were maintained, safe and fit for purpose.

Staff understood their responsibilities to ensure people were kept safe and knew who to report their concerns to within the service. However, if the need occurred, not all were aware of the external agencies to contact. People were supported to keep safe when using the service and when out in the community, without taking away their independence. There were appropriate arrangements in place to safely support people with their prescribed medicines.

Staff received training to support people’s needs. However where we identified shortfalls in staff’s knowledge of supporting people with dementia, fire safety and providing clean and safe environment showed further work was needed. This was to ensure that staff put into practice what they had learnt, and where required given access to further training. We recommend the service explores available training and resources, based on best practice, in dementia care.

The service was aware of the changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). Where needed appropriate referrals were made to external professionals. Further work was required to record the level of people’s capacity, and how they were supported to make daily decisions about their care and any restrictions made are lawful, and in the person’s best interest.

Improvements were needed to ensure consistency in the quality of food provided to meet people’s individual dietary needs, and preferences. We recommended that the service explores the relevant guidance on how to support people of poor appetite and weight to protect their health and wellbeing.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff.

Improvements were required to ensure people, or where appropriate, those acting on their behalf are consulted and encouraged to contribute to the planning of their care. This is to ensure that people received personalised care that was responsive to their needs and preferences.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate and on-going care and treatment.

Improvements were needed to support people with their mental and emotional needs by ensuring they had access to activities that provide mental stimulation.

Staff had good relationships with people who used the service and their relatives. The majority of staff’s interactions with people were caring, respectful, supported people’s dignity and carried out in a resp

Our inspection team was made up of one inspector who answered our five questions. There were 15 people using the service at the time of the inspection.

Below is a summary of what we found. The summary is based on our conversations with the manager, two staff, three people who used the service, a visiting community nurse, a social worker and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. A visiting community nurse told us, "The home is very good, staff follow instructions and advice we give to them relating to people’s health care needs.”

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs. Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training in administering medication. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person said, "I am happy here."

Is the service effective?

It was clear from what we saw, and from speaking with staff, that they understood people's care and support needs and that they knew the people well. A person who used the service told us, "The staff are polite, caring and they treat me with respect."

People's health and care needs were assessed with them, and they were involved in writing their plans of care, where they were unable to do so staff had spoken to their relatives or friends to gain their views. Specialist dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, religious and faith needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Where people's care needs had changed appropriate referrals to the doctor, district nurse and dentist had been made and any recommendations had been acted on. The manager had regular contact with the relatives of people who used the service and health care professionals. Both of the health care professionals we spoke with were complimentary about the professionalism of the manager and the staff. They told us, "The home makes appropriate referrals to us."

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Health care professionals who we spoke with told us, "The staff had kept them informed of people's changing health needs.

We saw the responses from the stakeholder survey. People had commented positively about the quality of the care provided to the people who lived in the home. The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

The two staff we spoke with told us they were clear about their roles and responsibilities and they received excellent training, support and supervision from the manager. They told us that this enabled them to provide excellent care and support to people who used the service. We saw that staff had a good understanding of the aims of the service. This helped to ensure that people received a good quality service at all times.

We inspected St Marks Residential Home on 23 December 2013.

We received positive comments from people living at the home, and from relatives that were visiting people who lived at the home.

We saw that staff spoke kindly to people living at the home and there was a calm and relaxed atmosphere.

A healthcare professional that we spoke with told us: “The staff are helpful and caring, they speak kindly and with respect to the people living at the home.”

Safeguarding procedures were in place to ensure people were safe, and the staff were supported through training to provide appropriate and safe care for people.

The home demonstrated they had enough qualified, skilled and experienced staff working to meet people’s needs.

We saw the home had an effective system to assess the quality of the service they provided.

People who use the service were given appropriate information and support regarding their care or treatment.

We observed that staff members were polite and attentive towards people using the service, in particular those people with no verbal communication. We saw that staff made good eye contact with people that were unable to communicate and used touch, such as holding people’s hands or stroking their upper arm to reassure them when they reached out to staff.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at St Marks to be positive.

One person who used the service told us they could not remember being consulted

about or involved in developing their care plan or having been consulted when it was

reviewed and updated. They also told us that they were able to make choices

about some aspects of their care. For example, we spoke with two people about how

they are supported to choose what to eat each day and activity choice. They told us that staff offer them a choice of meals each day and that they can also choose where they have these, for example in the comfort of their own room, dining area or one of the lounges. They are also able to make a decision as to whether or not they participate in social activities. One person told us "I prefer to stay here (the lounge) we don't do much but I like it that way"

People told us they were satisfied with the level of care and support they received

at St Mark's. One person with whom we spoke told us "It is not home but it's ok."

People told us that they feel well looked after by the staff at St Mark's. One person said "The staff are kind and look after us".

People spoken with indicated that they were happy with their rooms and found them comfortable.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.

People told us that they liked living at St Marks Residential Care Home, it was very comfortable and the care they received was very good. A person who used the service said "I like the exercises as it gets my body going and the time I spend with staff" and a relative told us "It's a lovely place, lovely staff and very glad my X is here."