CQC report explained · a nursing home
What the CQC found at St Martin's Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, suitable risk assessments, safe medicines management and appropriate safeguarding arrangements. Some care plans lacked detailed guidance for new staff about distraction techniques, and no hand gel was available for visitors during the inspection.
- Effective?
- Good
- People's needs, choices and dietary requirements were assessed and recorded. Staff training was kept up to date, but there was no formal system for clinical supervision of nursing staff, so inspectors made a recommendation.
- Caring?
- Good
- People said staff were kind and respectful. Staff knew people well, sought consent, protected privacy and supported people to remain as independent as possible.
- Responsive?
- Good
- Care was personalised and care plans were reviewed when people's needs changed. However, there was a noticeable lack of activities on the inspection day because the activities coordinators were away.
- Well-led?
- Good
- Inspectors found supportive management, a motivated staff team and systems for checking quality. Feedback was collected and generally acted on, although minor concerns were not always formally recorded.
What inspectors found, May 2019
St Martin's Nursing Home was rated Good; inspectors found safe, kind and personalised care, with some gaps in activities and staff supervision.
This was an unannounced inspection on 02 April 2019. Inspectors reviewed care records, medicines records, staff files, training and management information. They spoke with people, relatives, staff, the manager and two health professionals, and observed care and lunch.
The home was supporting 23 people. Inspectors found enough staff, safe medicines practice, suitable risk assessments and caring staff who knew people well. People and relatives were generally positive about the care.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors noted some improvements were needed, including better cover for activities when activity staff were away and formal clinical supervision for nursing staff.
Enough attentive staff
Staffing levels were routinely achieved and people received prompt help when they asked for it.
“Staff responded promptly to people requests for support throughout the day” from the report
Safe medicines practice
Medicines were safely stored, administered and recorded. Staff were trained and records were regularly checked.
“Medicines records were well maintained, detailed and informative.” from the report
Kind and respectful care
People and relatives described staff as caring. Inspectors saw staff treating people with dignity and supporting their choices.
“All residents I spoke with told me that they were spoken to in a kindly manner and were treated with respect and dignity.” from the report
Personalised care
Care plans included people's backgrounds, preferences and support needs. Staff generally followed these plans.
“The service provided personalised and individualised care and support.” from the report
Supportive leadership
The staff team was established and motivated. Inspectors found managers approachable and quality checks in place.
“The established staff team was well motivated and told us their managers were supportive and compassionate.” from the report
Nursing supervision
needs fixingNursing staff did not have a formal system for clinical supervision. Inspectors recommended that the provider review this.
“at the time of our inspection there were no formal system to provide these staff with clinical supervision.” from the report
Activities on the inspection day
minorThere were no activities coordinators or outside entertainers on the day of inspection. The manager said alternative arrangements would be made in future.
“There was a noticeable absence of things for people to do during the day.” from the report
Support at mealtimes
needs fixingInspectors saw that some people were not asked before clothing protectors were used, and one person was not supported at a suitable pace.
“some people were not asked before clothing protectors were provided and one person was not supported at an appropriate pace.” from the report
Guidance for anxiety support
needs fixingSome care plans did not give enough specific instructions for new staff about using distraction techniques.
“some of the care plans did not included sufficient specific guidance for new staff on how distraction techniques should be used.” from the report
Recording minor concerns
minorThe home dealt with minor issues, but did not formally record the actions taken in response.
“there were no systems in place to document the actions taken in response to minor concerns raised.” from the report
- 01How do you provide activities when the activities coordinators are on annual leave?
- 02How do nursing staff receive clinical supervision, and how often is it reviewed?
- 03How do you make sure people are asked for consent before clothing protectors or other mealtime equipment are used?
- 04How do you make sure people who need help to eat are supported at a suitable pace?
- 05How are minor concerns recorded and followed up?
This was an unannounced inspection covering all five CQC questions, including the premises, care, medicines, staffing, records and management systems. This explanation was written from the published report of 2 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.
What inspectors found, November 2016
Rated Good; inspectors found safe, kind and personalised care across all five areas.
This was an unannounced, comprehensive inspection on 23 August 2016. One inspector and an expert by experience spoke with six people, seven relatives, three staff members and the registered manager. They also checked care records, medicines, staff files, training, recruitment and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were safe, risks were managed, medicines were given as prescribed, and staffing levels met people's needs.
People were treated with kindness and respect. Staff knew people well, supported their choices and health needs, and provided activities. The home had systems to monitor quality and respond to complaints. The previous inspection in November 2014 had also found that the standards inspected were met.
Safety and risk management
People and relatives said they felt safe. Inspectors found that risks were assessed, recorded and reviewed, with enough staff available to respond to people's needs.
“People were safe and secure. Relatives believed their family members were kept safe.” from the report
Personalised support
Staff knew people well and used detailed care plans and life-story information to understand how people wanted to be supported.
“People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.” from the report
Activities and relationships
People had activities they enjoyed and were supported to stay in contact with important people. Visiting times were not restricted.
“People were well supported to maintain relationships with people who were important to them.” from the report
Quality monitoring
The provider used satisfaction surveys and internal and external audits to check the service and identify improvements.
“We also saw that both internal and external audits were used to identify areas for improvement and to develop and improve the service” from the report
Inspectors raised no specific concerns in this report.
- 01How are staffing levels and staff cover managed when someone is off sick?
- 02How will you assess and review my relative's risks and care plan after they move in?
- 03How will you support my relative's preferred food, drinks and any special dietary needs?
- 04What activities would suit my relative, and how would you support them to maintain important relationships?
- 05How can families raise concerns, and how are complaints and feedback used to improve the home?
This was an unannounced comprehensive inspection covering all five key questions; inspectors spoke with six people, seven relatives and three staff members and checked three people's care records. This explanation was written from the published report of 2 November 2016 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 Martin's Nursing Home
2 rated inspections over 2 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 18 April 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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