CQC report explained · a residential care home
What the CQC found at St Lukes Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, February 2022
Inspected but not rated; inspectors found appropriate COVID-19 infection control and visiting arrangements.
This was a targeted inspection on 24 January 2022. It looked at infection prevention and control, visiting arrangements, and whether COVID-19 staffing pressures affected the home.
Inspectors found suitable arrangements for visits, testing, personal protective equipment and staff support. They were assured that the home could prevent and manage infection outbreaks.
The home was inspected but not rated. This means the inspection did not give an overall quality rating or a rated score for the questions it looked at.
Visiting arrangements
Visitors could book suitable times, and visits were staggered where possible. Visitors were screened for symptoms before entering.
“The provider had appropriate arrangements for visiting to help prevent the spread of COVID-19.” from the report
Testing and PPE
The home had arrangements for COVID-19 testing and an adequate supply of PPE. Inspectors saw staff wearing PPE.
“Adequate supply of PPE was in place and systems were in place to ensure there was not a shortfall of PPE.” from the report
Managing illness and outbreaks
The home had plans for people who developed symptoms or tested positive, including ways to use outdoor or communal areas if they did not want to isolate in their rooms.
“Systems were in place should people display symptoms or test positive for COVID-19, which included isolating in their rooms.” from the report
Inspectors raised no specific concerns in this report.
- 01What infection control and visiting arrangements are in place now?
- 02How do you test people and staff when infection is suspected?
- 03How do you support a person who tests positive but does not want to isolate in their room?
- 04How do you manage staffing pressures when staff are unwell or absent?
- 05When was the infection prevention and control policy last updated?
This was a targeted inspection of infection prevention and control, visiting arrangements and COVID-19 staffing pressures; the service was inspected but not rated. This explanation was written from the published report of 9 February 2022 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, September 2021
Rated Requires Improvement; inspectors found kind, personalised care, but safety checks, medicines management and quality monitoring were not reliable enough.
This was the home's first inspection since it registered. It was unannounced and took place on 23 August 2021. One inspector spoke with people, managers and staff, reviewed care plans, staff files, medicines and quality records, then spoke with relatives and professionals.
People were treated with kindness and respect. Staff supported people to make choices, stay independent, access healthcare and take part in activities. Staff training, staffing levels, infection control and personalised care were found to be good.
There were important safety problems. Some health conditions did not have risk assessments, medicines given when needed had no clear protocols, and controlled drugs were not stored securely. The home's checks had not found these problems. The overall rating and the ratings for Safe and Well-led were Requires Improvement, while Effective, Caring and Responsive were Good.
Kind and respectful support
Inspectors found that people were treated kindly, and staff respected their privacy and dignity.
“People were treated with kindness and respect. A person told us, "I like the staff.” from the report
Personalised care
Care plans reflected people's backgrounds, routines, preferences and communication needs. They were reviewed regularly.
“People received personalised support, which was in accordance with their preferences and choices.” from the report
Activities and relationships
People took part in activities, went out and kept in touch with family and friends.
“People were able to meet and maintain contact with family and friends either through face time, telephone calls or going outside to cafes or parks.” from the report
Staff training and support
Staff had completed required training, received supervision and said they felt supported.
“Staff had completed mandatory training and refresher courses to perform their roles effectively.” from the report
Missing risk assessments
seriousRisk assessments were not completed for some health conditions, including diabetes and stroke. This meant there was a risk that people might not receive safe care at all times.
“Risk assessments had not been completed in relation to people's health conditions.” from the report
Medicines not always managed safely
seriousMedicines given when needed did not have clear protocols. Controlled drugs were not stored as securely as required.
“However, we found that there were no PRN protocols in place to ensure they were administered safely.” from the report
Quality checks missed problems
seriousThe home's audits covered risk assessments and medicines but did not identify the shortfalls found by inspectors.
“The audits had not identified the shortfalls we found with risk assessments and medicine management.” from the report
- 01Have risk assessments now been completed for every person's health conditions, including diabetes and stroke?
- 02What written protocols are now in place for medicines given when needed?
- 03Has the controlled drugs cupboard been installed, and how is its security checked?
- 04How often are provider audits now carried out, and how do they identify problems with medicines and risk assessments?
- 05What action has been taken in response to the Regulation 12 and Regulation 17 breaches?
This was an unannounced first comprehensive inspection of the newly registered home, covering all five CQC questions and infection prevention and control. This explanation was written from the published report of 7 September 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.
Every inspection of St Lukes Care Home
Each visit the CQC has published, newest first, back to the day the home was registered.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- September 2021Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2020
Registered with the Care Quality Commission on 1 February 2020.
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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