CQC report explained · a residential care home
What the CQC found at St Francis Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured that the home was following safe infection prevention and control procedures. They found suitable arrangements for PPE, testing, cleaning, social distancing, visiting and managing outbreaks.
- Effective?
- Good
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Good
- Is the home run well? The manager, the culture, how problems get found and fixed.
What inspectors found, February 2021
Inspected but not rated; inspectors were assured that infection prevention and control measures were in place.
This was an announced, targeted inspection on 16 February 2021. It looked only at infection prevention and control during the coronavirus pandemic.
Inspectors found that the home had measures to reduce infection risks. These included temperature checks, personal protective equipment, testing, frequent cleaning, hand sanitiser stations and staff working on assigned floors.
The home had a safe visiting pod and supported video calls when relatives could not visit. Staff received training and support, and the manager sought advice from health and public agencies.
The service was inspected but not rated. This means the inspection did not give a Good, Outstanding, Requires improvement or Inadequate rating.
Infection control
The home followed infection prevention procedures intended to protect people, staff and visitors from infection.
“The provider followed safe infection prevention and control practices and procedures to ensure people, staff and visitors' safety” from the report
Safer visits
Relatives could use a purpose-built visiting pod with a glass screen and speaker system. Staff also helped people keep in touch by video call.
“Relatives visiting people accessed the safe pod with a glass screen and speaker system specifically built for them to interact with people safely.” from the report
PPE and testing
The home checked temperatures and provided PPE before people entered. It also followed guidance on COVID-19 testing for people, staff and visitors.
“The provider had implemented suitable visiting arrangements to ensure people could receive visits safely.” from the report
Staff support
Staff received training on infection prevention and control. They worked on assigned floors to reduce the risk of infection spreading between areas.
“All staff received sufficient training and support to prevent and control the spread of infection.” from the report
Approach could be developed
minorInspectors signposted the provider to resources to develop its infection prevention and control approach. The report does not explain what specific changes were needed.
“We have also signposted the provider to resources to develop their approach.” from the report
- 01What changes have you made to your infection prevention and control approach since this inspection?
- 02How are visits currently arranged, and is the safe visiting pod still available?
- 03How often are people, staff and visitors tested, and what happens when a test result is positive?
- 04How do you make sure staff use PPE correctly and follow hand hygiene and social distancing guidance?
- 05How do you prevent infection spreading when staff work across different floors?
This was a targeted inspection of infection prevention and control only; the service was inspected but not rated and the other areas of care were not assessed. This explanation was written from the published report of 27 February 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, January 2020
St Francis Residential Care Home was rated Good; inspectors found kind, safe and well-organised care, with some work still needed on the building layout.
The inspection was unannounced and took place on 02 December 2019 and 05 December 2019. One inspector and an Expert by Experience spoke with people, a relative and staff. They also observed care and checked care plans, staff records, safety checks and quality records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were protected from avoidable harm, medicines were managed safely, and staff supported people's health, nutrition and choices.
Inspectors found personalised care plans, respectful staff and a range of activities. The home had improved its staffing, records, mealtime experience and quality checks since the previous inspection. However, inspectors recommended getting advice about making the building easier to use for people with dementia or poor eyesight.
At the previous inspection, published on 01 January 2019, the home was rated Requires Improvement and had two breaches of regulations. This inspection found enough improvement had been made and the home was no longer in breach.
Safe medicines
Medicines were stored correctly, staff had suitable training and records were complete. The home also kept stock records and guidance for medicines given when needed.
“Medicine administration records were fully and accurately completed.” from the report
Personalised care
Care plans recorded people's preferences, including choices about routines, food and communication. Staff were expected to provide care around each person's individual needs.
“Care plans were comprehensive and person-centred.” from the report
Kind and respectful staff
People and relatives said staff were caring. Staff knew people's likes and dislikes and understood how to protect dignity, privacy and independence.
“People and relatives told us staff were caring.” from the report
Improved activities
Inspectors saw activities taking place, and records showed a range of activities inside and outside the home. People said activities had improved.
“Records showed a variety of activities were taking place which included activities outside the home, daily exercises, singing, reminiscence sessions and visiting entertainers.” from the report
Better oversight
Management carried out checks on areas such as call bell response times, medicines and first aid. The previous concern about quality checks had been addressed.
“The provider carried out various quality checks for the service in order to identify areas for improvement.” from the report
Confusing building layout
needs fixingThe extension had no wall signage, and the same colour was used for corridor walls and room doors. Inspectors said this could make it harder for people with dementia or poor eyesight to find their way around.
“We noted the layout and décor of the building was confusing to people with dementia or poor eyesight because the corridor walls and doors to rooms were the same colour.” from the report
Occasional staff shortages
minorOverall staffing was judged enough, but people and staff said there were times when the home was short staffed. The provider was recruiting an additional staff member to cover absences.
“People and relatives told us overall there were enough staff on duty to meet their needs but at times the service was short staffed.” from the report
- 01What changes have you made to the signage, colours and layout since the inspection for people with dementia or poor eyesight?
- 02How do you cover shifts when staff are off sick, and has the additional staff member been recruited?
- 03If my relative needs help with medicines, who will administer them and how will you record this?
- 04How would you manage a Deprivation of Liberty Safeguards application if my relative could not make a particular decision?
- 05What activities would be suitable for my relative, and how would you support them to take part?
This was an unannounced planned inspection based on the previous rating and covered all five CQC questions, including the improvements made since the previous inspection. This explanation was written from the published report of 23 January 2020 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 St Francis Residential Care Home
3 rated inspections over 3 years: the service has held its Good rating throughout.
- February 2021Inspected but not ratedcurrent ratingSafe: Inspected but not rated
Read what inspectors found at St Francis Residential Care Home →
- January 2020Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at St Francis Residential Care Home →
- January 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 14 February 2011.
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.
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