CQC report explained · a residential care home
What the CQC found at House of St Martin
Not yet rated: the CQC has not published a rated inspection for this home, which is usual for a new registration.
What inspectors found, May 2021
House of St Martin was rated Requires Improvement; inspectors found staffing, care records and oversight were not reliable enough to keep people consistently safe.
This was a focused inspection following concerns about staffing, staff skills, care standards and reports of bullying or intimidation. Inspectors visited on 31 March and 7 April 2021. They spoke with people, staff and professionals, observed care, and checked care plans, medicine records, training and quality checks.
Most people said they felt safe and enjoyed living at the home. Medicines were generally managed safely, infection control was good, and staff understood safeguarding. A new manager was viewed positively and had started making improvements.
However, there was high staff turnover and heavy reliance on agency staff. Staff did not always have the training or information needed to support people's complex needs. Risk assessments, care plans, incident records and quality checks were incomplete or not followed up properly.
The overall rating fell from Good at the previous inspection in 2019 to Requires Improvement. Safe, Effective and Well-led were all rated Requires Improvement. Caring and Responsive were not assessed during this focused inspection.
Safeguarding awareness
People said they generally felt safe. Staff had safeguarding training and knew how to report concerns, and the report says concerns raised with the home had been followed up.
“Staff had received safeguarding training and knew about the different types of abuse.” from the report
Infection control
Inspectors were assured that the home followed current infection prevention guidance, used protective equipment correctly and had an up-to-date infection control policy.
“Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.” from the report
Medicine support
People's prescribed medicines were generally given safely. Staff had relevant training and competency checks, and medicine audits were being carried out.
“People received their prescribed medicines safely.” from the report
Positive view of new management
People, staff and professionals spoke positively about the new manager. The manager was visible, approachable and had begun improvements to induction, infection control, health and safety and monitoring.
“People and staff spoke positively about the new manager and temporary manager.” from the report
Access and independence
The home had single rooms, including rooms people could lock, and had bought wheelchair-accessible transport. This supported privacy and access to the local community.
“Since we last visited, the provider had purchased a transport vehicle which was suitable to meet the needs of wheelchairs users.” from the report
Staffing and continuity
seriousHigh staff turnover and heavy agency use meant people were not always supported by staff who knew their needs. Some people delayed intimate care because they did not know the staff on duty.
“People did not always have their needs met because of staffing and skill shortages.” from the report
Training gaps
seriousStaff lacked training for several important needs, including personal care, continence, skin care, diabetes, epilepsy, learning disabilities and managing challenging behaviour.
“The service had no training to support staff to meet people's personal care, continence care, skin care needs.” from the report
Care plans not person-centred
needs fixingSome plans did not record people's choices, health needs or goals clearly enough. Staff were not always given guidance about how to support people to reach their goals or manage health conditions.
“People's care plans were not person centred or focused on meeting people's care needs and minimising any risks.” from the report
Weak quality checks
seriousThe home's monitoring systems repeatedly identified overdue training and care plan reviews, but these issues were not dealt with. Complaint records did not always show investigations or outcomes.
“The service had a number of quality monitoring systems, but these were not working effectively to highlight, and address risks related to the three breaches of regulations found at this inspection.” from the report
Suitability of the service
needs fixingInspectors questioned whether one large home could meet the wide range of needs of people with learning disabilities, autism, mental health needs and other complex needs. People also reported boredom and limited activities during lockdown.
“The environment of care with 31 people living in one house with large noisy shared communal facilities were not ideally suited to the needs of people with learning disabilities, autism and mental health conditions.” from the report
- 01How many permanent staff are now working at the home, and how much agency staffing is currently being used?
- 02What training has each member of staff completed for the needs of the person we are considering placing here?
- 03How are risk assessments, care plans and handovers now checked to make sure they contain current and complete information?
- 04What has changed in the way incidents, safeguarding concerns and complaints are recorded and followed up?
- 05How will the home support the person's individual goals, choices, activities and independence?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not assessed, and the previous comprehensive inspection was published in May 2019. This explanation was written from the published report of 15 May 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2019
Rated Good overall; inspectors found kind, safe care, but effective support required improvement.
Inspectors visited over 23 and 24 April 2019. The first day was unannounced and the second was announced. They spoke with 13 people, seven care staff and health and social care professionals. They also checked care plans, risk records, medicines, recruitment, training, complaints and quality checks.
People said they felt safe. Inspectors found good risk management, safe medicines practice, infection control and staffing arrangements. People described staff as kind, respectful and approachable. The home was homely, and people had choices about their routines and activities.
The main weaknesses were under Effective. Care plans did not always describe people's personal preferences, health needs or end of life wishes clearly enough. Staff did not always have the training or guidance needed for epilepsy, diabetes and end of life care. Some wheelchair access arrangements also needed improvement.
The overall rating stayed Good, as it was at the previous inspection in September 2016. However, Effective was rated Requires Improvement. The provider sent CQC an action plan after the inspection and confirmed that a wheelchair accessible vehicle had been purchased.
People felt safe
People told inspectors they felt safe. Staff understood how to recognise and report possible abuse, and risks were assessed with guidance for reducing harm.
“People were safe and protected from avoidable harm. Legal requirements were met.” from the report
Kind and respectful staff
Inspectors saw staff supporting people with compassion and respect. People were involved in choices about their care and daily lives.
“We observed motivated staff who offered care and support that was compassionate and kind.” from the report
Medicines and risk management
Medicines were administered by trained staff whose competence had been checked. Records, stock checks and audits were in place.
“The management of risk to people was robust, and people's medicines were managed well.” from the report
Food and choice
People had plentiful food, choice, drinks and snacks. Inspectors observed people enjoying the lunchtime meal.
“People were provided with food that was well presented and plentiful.” from the report
Incomplete care plans
needs fixingCare plans focused heavily on risks and did not always explain personal preferences, hygiene needs or end of life wishes. Two people had terminal illnesses but did not have end of life plans.
“Care plans were not always person centred and people did not have end of life plans in place.” from the report
Gaps in staff training
seriousStaff had not received training in end of life care or epilepsy, even though people living at the home had these needs. Inspectors recommended that training needs were reviewed.
“Staff had not received training in end of life care or epilepsy even though people living at the home had needs in both areas.” from the report
Health guidance was not detailed enough
seriousSome care plans did not explain what staff should do when health readings were outside normal levels, during a seizure or when specialist equipment needed monitoring.
“People's healthcare needs were not always fully assessed, and care plans did not give full guidance to help staff to promote people's health and well-being.” from the report
Wheelchair access
needs fixingThe home's minibus did not have wheelchair access, which stopped three wheelchair users from using it. The provider later confirmed that it had bought an accessible vehicle.
“Three people who used wheelchairs told us that this prevented them from using this transport, although alternative arrangements were made.” from the report
Management cover and supervision
minorStaff and a professional said the project manager was supportive but not always available. Staff had not always received regular one-to-one supervision, and the provider planned extra management support.
“The provider needs to make sure they are more accessible.” from the report
- 01Have all residents now got person-centred care plans, including personal hygiene, nutrition and end of life wishes?
- 02What training have staff completed in epilepsy, end of life care and people's physical health needs?
- 03How do staff know what action to take if a person's blood sugar is outside their normal range or if they have a seizure?
- 04Is the wheelchair accessible vehicle now available for residents, and have the narrow doorways been reviewed?
- 05How often is a manager present, and are staff now receiving regular one-to-one supervision?
This inspection covered the regulated care home activity, including the premises and care provided, but did not cover the provider's community houses and housing or tenancy project. This explanation was written from the published report of 15 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of House of St Martin
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- May 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2019Goodstayed GoodSafe: GoodEffective: Requires improvementWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- July 2012
Registered with the Care Quality Commission on 27 July 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
76 live-in carers within about two hours of Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,370 a week. 62 can care for a couple. 12 years' experience on average.
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
“She was not phased by anything, she was adaptable, kind & gave us complete confidence to go away & not worry about a thing!”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.