CQC report explained · a residential care home
What the CQC found at St Marks Residential Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk management was not embedded. Inspectors found gaps in moving and handling guidance, fire safety risk assessment, hazardous substance storage, and some PRN medicines guidance.
- Effective?
- Requires improvement
- Staff had induction and some useful training, and people received support with food, drink and healthcare. However, there was no effective plan to monitor training against people's needs, and some environmental and capacity records needed improvement.
- Caring?
- Requires improvement
- Inspectors saw kind relationships and relatives were generally positive. However, people were not always involved meaningfully, residents' meetings did not clearly show individual views, and one person had to remind staff to respect their independence.
- Responsive?
- Requires improvement
- Care plans and activities had improved, but records were not always accurate or consistent. Some information was not dementia-friendly or accessible, some activities were not suitable for people with advanced cognitive impairment, and end-of-life plans needed more development.
- Well-led?
- Requires improvement
- Management had made improvements but quality systems were still not strong enough to identify risks independently or show that changes were effective and lasting. This was a continued breach of Regulation 17.
What inspectors found, June 2023
Rated Requires Improvement and no longer in Special Measures; inspectors found progress but ongoing risks and weak management checks.
This was an unannounced inspection carried out over visits on 6 and 8 February 2023, with inspection activity continuing until 6 March. Inspectors spoke with people, relatives and staff, observed care, and checked care plans, medicines, recruitment, training and management records.
The home had made improvements since the previous inspection. Relatives and professionals described friendly staff, better food, activities and the environment. Inspectors also saw warm relationships between people and staff, and people were supported to access health services.
However, all five areas were rated Requires Improvement. Risks were not always identified or managed, some medicines guidance and care records were incomplete, and information was not always accessible or suited to people living with dementia. The home's checks were often reactive and had not reliably shown that improvements were lasting.
The home had been in Special Measures since April 2021 and was previously rated Inadequate overall. It is no longer in Special Measures because it is no longer rated Inadequate, but it remains Requires Improvement and has not achieved an overall Good rating since 2015.
Kind relationships
Inspectors saw positive relationships between people and staff. Relatives also described staff as friendly, considerate and caring.
“Throughout the inspection, we saw positive relationships between people and the staff who supported them.” from the report
Improving activities
The range of activities was developing, including one-to-one activities, group games, crafts and trips. Staff also used people's personal interests to plan activities.
“A 'dream tree' had been created, to support staff in identifying individual activities they would like to do.” from the report
Food and hydration
Inspectors found a choice of food, support for specialist diets and monitoring of people's weights. A hydration trolley had also been introduced.
“The cooks were aware of people's individual preferences and dislikes, specialist diets and safe preparation of foods for people who had problems swallowing.” from the report
Access to healthcare
People were supported to access a range of health professionals. Relatives said they were kept updated about changes in health and healthcare appointments.
“People were supported to access healthcare services and support such as GP, asthma specialist, chiropodist, dietician and speech and language therapists (SALT)” from the report
Improved recruitment
Recruitment procedures had improved since the last inspection. Applications now included a full employment history, with gaps explored and recorded.
“This inspection found improvements had been made to ensure safe recruitment procedures in place.” from the report
Risks were not reliably managed
seriousThe home's own checks did not identify several risks. These included unsafe or incomplete moving and handling guidance, unsecured hazardous substances and a person being left in a cold room.
“Systems had not been fully established to monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Weak quality checks
seriousManagement often acted after inspectors identified problems rather than finding them through its own checks. Records did not consistently show that improvements had worked or been sustained.
“The provider's governance systems were still not strong enough to demonstrate how the management of the service, are able to sustain and drive improvements.” from the report
Care records and medicines guidance
needs fixingSome care records contained conflicting, missing or outdated information. PRN medicines protocols were not always complete or personalised.
“Not all PRN protocols had been reviewed and revised to ensure staff have relevant, accurate and personalised information regarding how and when PRN medications should be used” from the report
Information was not always dementia-friendly
needs fixingSome written information was not in a suitable format for people living with dementia. Residents' meetings did not clearly show how people with limited or fluctuating capacity had been helped to express their views.
“Information given to people in easy read format, despite several attempts by management, was more suited to a learning disability service.” from the report
Some activities did not meet people's needs
minorOne quiz was too complex for most people with advanced cognitive impairment, so only one person could take part. Inspectors said activities were still being developed.
“The quiz was complex and not suitable for most people with advanced cognitive impairment.” from the report
End-of-life plans needed more detail
needs fixingEnd-of-life care plans did not fully explain how to meet people's emotional needs. Further palliative care training had been planned for staff.
“End-of-life care plans should provide staff with guidance on how to support the person to live as well as possible until they died.” from the report
- 01What action has been taken to make moving and handling plans complete, including what staff should do if someone needs help up from the floor?
- 02How do you check that PRN medicines protocols are complete, personalised and clear about what to do if the medicine does not work?
- 03How do your quality checks now identify risks without relying on the external consultant or CQC to find them?
- 04How will you make written information and residents' meetings easier for people living with dementia to understand and take part in?
- 05What has changed in end-of-life care planning since the planned palliative care training in May 2023?
This was an unannounced inspection to check improvements after the previous inspection; inspectors assessed all five key questions and also checked infection prevention and control under Safe. This explanation was written from the published report of 10 June 2023 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 2023
Requires Improvement and still in Special Measures; inspectors found some progress but serious weaknesses in leadership, staffing and personalised care.
This was an unannounced inspection carried out over visits on 31 August and 1 September 2022, with inspection activity continuing until 15 September. Two inspectors spoke with people and staff, and checked care, medicine, recruitment, training and management records.
The home had improved since its previous inspection. The environment was cleaner and safer, mealtimes had improved, and inspectors saw kind and respectful interactions between some staff and people. People and relatives also reported improvements.
Important problems remained. Staffing plans did not reflect people's needs, staff training and supervision were not sufficient, and care records were sometimes inaccurate or not personalised. There were also weaknesses in communication support, oral and end of life care, complaints handling and safety checks.
The overall rating improved from Inadequate to Requires Improvement, but the home remains in Special Measures. Safe, Effective and Responsive improved to Requires Improvement. Caring remained Requires Improvement, while Well-led remained Inadequate.
Cleaner environment
The home was cleaner than at the previous inspection. Soiled furniture had been replaced and infection control measures had improved.
“The environment was a lot cleaner; soiled furniture had been renewed and staff checked mattresses regularly for cleanliness and quality.” from the report
Improved mealtimes
People were offered more support with food and drinks. New equipment and fortified food were introduced for people at risk of poor nutrition or dehydration.
“Our observation of mealtime showed staff were patient and supportive whilst encouraging, prompting and assisting people to eat.” from the report
Positive staff relationships
Inspectors saw some warm and trusting relationships between staff and people. Relatives also said senior staff were approachable and informative.
“Some compassionate and trusting exchanges between staff and people were observed.” from the report
Choking risk support
Staff had training and care plans gave information about the food textures and fluid thickness needed by people with swallowing difficulties.
“Choking risk assessments and associated care plans showed the symptoms each person experienced in relation to how dysphagia affected them and the type and level of support they needed to mitigate their risk of choking.” from the report
Staffing and workforce planning
seriousThe rota did not reflect the staff actually needed for people's individual care. Some staff worked very long shifts or weeks, and there was not enough time planned for bathing and showering.
“The manager had calculated staff hours on a timed task basis and not according to people's specific and individual needs.” from the report
Weak leadership and quality checks
seriousThe provider did not have a clear long-term plan, and audits were not being fully reviewed to identify and fix problems. This was linked to a breach of Regulation 17.
“A quality culture still needed to be established to ensure any future shortfalls would be independently identified and pro-actively addressed, improvements were being embedded and capable of being sustained.” from the report
Inconsistent personalised care
seriousCare records did not always accurately describe people's needs, choices or end of life wishes. This could lead to people receiving the wrong or inconsistent support.
“Some plans contained conflicting information which meant people were at risk of receiving the wrong care.” from the report
Communication support
needs fixingThe home had not consistently made reasonable adjustments for people with hearing loss or recorded how staff should communicate with each person.
“There continued to be a lack of reasonable adjustments for people with a hearing loss and the Accessible Information Standard was not embedded in the culture of the home which meant there was a risk people's care and support was not delivered in a way they could understand.” from the report
End of life and pain support
needs fixingEnd of life plans were brief and did not set out people's individual wishes or how staff should respond to pain. There were no consistent tools for assessing pain in people who had difficulty communicating.
“There were no systems in place for people who have greater difficulty communicating and may not be able to report their pain and discomfort.” from the report
Fire and contractor safety
seriousSome personal emergency evacuation plans were missing, inaccurate or out of date. A hazardous flammable spray adhesive was also left unsecured and accessible to people.
“All of which, in an emergency, could cause confusion and put lives at risk.” from the report
- 01How do you now calculate staffing levels from each person's individual needs, including time for bathing and showering?
- 02What regular training, supervision and development will staff receive, especially for dementia, communication and end of life care?
- 03How will you make sure care plans and daily records are accurate, personalised and updated when people's needs change?
- 04What support is available for people with hearing loss or difficulty communicating, including how pain and discomfort will be assessed?
- 05What action has been completed to correct the fire evacuation plans and keep hazardous contractor materials inaccessible to residents?
This was an unannounced improvement inspection covering the overall service and all five CQC questions, including infection prevention and control under Safe. This explanation was written from the published report of 5 January 2023 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 Marks Residential Care Home
10 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at St Marks Residential Care Home →
- January 2023Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
Read what inspectors found at St Marks Residential Care Home →
- June 2022Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- August 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- December 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Inadequatestayed InadequateSafe: InadequateWell-led: Inadequate
- February 2018Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateWell-led: Inadequate
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 January 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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