CQC report explained · a residential care home
What the CQC found at St Paul's Residential 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
- People were generally protected from abuse and risks were mostly assessed and managed safely. However, some as-needed medicines records, repositioning records and recruitment checks were incomplete.
- Effective?
- Good
- This area was not inspected during this focused inspection, so no new rating was given.
- Caring?
- Good
- This area was not inspected during this focused inspection, so no new rating was given.
- Responsive?
- Good
- This area was not inspected during this focused inspection, so no new rating was given.
- Well-led?
- Requires improvement
- Leadership and management had improved, but the provider's systems for monitoring and improving quality and safety were still not fully embedded or effective.
What inspectors found, June 2023
St Paul's Residential Home is Rated Requires Improvement; inspectors found major progress but incomplete medicines, repositioning, recruitment and quality checks.
This was an unannounced focused inspection on 2 and 4 May 2023. Inspectors spoke with people, relatives, staff and professionals. They observed care and checked care records, medicines records, staff recruitment files and management records.
The home had made substantial improvements since the previous inspection. Risks were generally assessed and managed safely, people said they felt safe, infection control was satisfactory, and the home had a stable staff team.
Some systems were still not fully in place. Records for as-needed medicines and repositioning were incomplete, and recruitment checks were not always fully recorded. The quality monitoring systems had not yet been fully embedded.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. This inspection only assessed those two areas, while the other ratings were carried forward from the previous inspection.
Improved risk management
The home had improved its approach to risk, including fire safety, care plan reviews and legionella management.
“Aside from the concerns we noted and shared on inspection, risks to people were now assessed and managed safely and monitored routinely.” from the report
People felt safe
People told inspectors they felt safe, and staff had safeguarding training and information about whistleblowing.
“People and relatives told us they felt safe and were positive about the staff who supported them.” from the report
Stable staff team
People were supported by regular staff who knew their needs. Staffing levels were based on the support people required.
“People were supported by a regular staff team who were familiar with their support requirements.” from the report
Better communication
Relatives and staff described more open communication and said management was approachable and responsive.
“Relatives now felt well informed and updated about their family members care and well-being.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infection and used protective equipment safely.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
As-needed medicines records
needs fixingRecords for medicines given when needed were not always complete. Staff did not always have instructions explaining when and how to give them.
“Medicine related records for 'when required' medicines were not always complete and staff did not always have associated protocols to guide them” from the report
Repositioning records
needs fixingPeople who needed repositioning to protect their skin did not always have up-to-date records showing that care had been provided.
“People who required repositioning to maintain their skin integrity did not always have an up-to-date record to support staff's actions.” from the report
Quality monitoring
seriousThe provider's checks had not identified or resolved the problems with medicines, recruitment and repositioning. This was a continued breach of Regulation 17.
“The provider had failed to ensure their systems to monitor and improve the quality and safety of the service were fully embedded and operating effectively.” from the report
- 01How do you now check that records for medicines given when needed are complete and that staff have the correct protocols?
- 02How do you check that people who need repositioning are repositioned as stated in their care plans?
- 03Has the recruitment record audit been completed, and how do you check employment gaps and missing references?
- 04What actions are in the Regulation 17 action plan, and when will you review whether they have worked?
- 05How will you show that the improvements found at this inspection are being sustained?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 14 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, March 2023
St Paul's Residential Home remains Requires Improvement; inspectors found progress, but medicines, environmental risks and management systems still needed action.
This was an unannounced targeted inspection on 26 January 2023. Inspectors checked whether earlier warning notices about safe care and treatment and good governance had been met. They spoke with people, staff, relatives and professionals, and reviewed care, medicine and management records.
The home had made improvements. Everyone had a care plan, the environment had been partly improved, and there was better engagement with relatives. Inspectors also found that infection control arrangements were generally suitable, although some areas were only partly assured.
Important problems remained. Some people did not receive medicines as prescribed. Fire and legionella actions had not been completed, some care plans were not up to date, and quality checks had not reliably found these problems.
The overall rating stayed Requires Improvement from the previous inspection. This targeted inspection did not give new ratings for the full key questions. Safe and well-led were inspected but not rated, and the home remained in breach of Regulations 12 and 17.
Environmental improvements
The home had dealt with some problems found at the previous inspection, including damaged walls and clutter.
“Concerns we identified in the environment, at our September 2022 inspection, had been addressed.” from the report
Skin care support
Topical cream records were clear, and people who needed support with their skin had detailed care plans. Staff worked with district nurses.
“Topical cream charts were detailed and clearly documented the support people had received.” from the report
Mental capacity safeguards
Inspectors found that the home was working within the principles of the Mental Capacity Act and that required legal authorisations were in place.
“We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place” from the report
Listening to relatives
Management had sought relatives' views and used concerns and suggestions to make improvements. Relatives spoke positively about the management and changes.
“Relatives spoke positively about the management and improvements being made at St Paul's Residential Home.” from the report
Medicines were not always given correctly
seriousThree people were put at risk of not receiving their medicines as prescribed. Staff did not always identify this because medicine stocks were not checked accurately.
“People did not always receive their medicines as prescribed.” from the report
Fire and environmental risks remained
seriousActions from fire and legionella assessments had not been completed. Portable heaters in four rooms had no risk assessments when inspectors visited.
“Both assessments had actions and recommendations to be completed; however, no action had been taken to meet these and ensure risks to people were minimised.” from the report
Care plans were not always current
needs fixingAlthough everyone had a care plan, some plans did not accurately describe people's needs or the support staff said they provided.
“One person's care plan provided information about their care and support which did not reflect the support staff and management told us they provided” from the report
Checks did not find problems
seriousManagement monitoring systems were not used consistently and had not identified the medicine, care plan, fire or legionella concerns found by inspectors.
“Quality assurance and monitoring systems were being implemented however these had not been fully embedded and were not fully effective at identifying and addressing shortfalls.” from the report
- 01What has changed since the inspection to make sure every person receives medicines exactly as prescribed?
- 02How are medicine stocks and administration records now checked, and how quickly are errors acted on?
- 03Have the new fire risk assessment and all fire drill actions been completed?
- 04What has been done about the actions from the legionella risk assessment?
- 05How do you now check that care plans accurately reflect each person's current needs?
This was a targeted inspection of parts of Safe and Well-led, focused on earlier warning notices, so it did not assess the full five key questions or change the previous overall rating. This explanation was written from the published report of 4 March 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 Paul's Residential Home
7 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- June 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2023Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- November 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- July 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2020Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- May 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- April 2017Goodstayed GoodSafe: Good
- May 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 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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