About the service:

St Heliers Hotel is a residential care home providing personal care to up to 30 older people most of who were living with dementia. At the time of our inspection 21 people were living at the service.

People’s experience of using this service:

¿ People told us they were happy living at St Heliers Hotel, and they felt safe. However, we found action had not always been taken to keep people safe from known risks. Accidents and incident documentation was insufficient and did not show how the registered managers reacted to known risks or accidents when they occurred to reduce the likelihood of them reoccurring. Environmental concerns identified at the previous inspection had not been acted on in a timely manner.

¿ People and staff had positive feedback about the leadership of the service. However, we found concerns identified in the previous two inspections had not been prioritised and improvements had not been implemented effectively. For example, staff recruitment continued to be insufficient. There had been a lack of learning and knowledge of good practice implemented by the registered managers.

¿ The service was mainly free of odour and clean. Maintenance throughout the service varied; we identified some areas where improvements were needed, for example decorative improvements within two bedrooms, and on one staircase.

¿ People received their medicines as prescribed. Staff had received training in a range of subjects, including medicines administration and were competency tested. Staff were aware of their responsibility to safeguard people from possible abuse.

¿ People were supported to eat and drink enough to sustain a balanced diet. When people’s needs changed, healthcare professionals informed us they worked closely with staff to ensure people’s needs were met. Staff understood the need to involve people in their care and promote choice.

¿ People told us they were treated with care and compassion. Staff understood people’s backgrounds and life histories and used this information to enhance their care. People were supported to keep their independence.

¿ People’s opinion on the service was sought, however improvements could be to how the information could be used to improve the service.

Rating at last inspection:

The last inspection was carried out on 19 and 20 October 2017. The service was rated Requires Improvement.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found improvements had not been made in the areas identified at the previous inspection. We have rated the service Requires Improvement overall, and Inadequate in the Well-led question. This is the third time the service has been rated Requires Improvement.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 19 and 20 October 2017 and was unannounced.

St Heliers Hotel is a care home providing care and support for up to 30 older people. There were 23 people living at the service at the time of our inspection, including 3 people staying for short term respite care. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. Some people needed support with all of their personal care, and some with eating, drinking and their mobility needs. Other people were more independent and needed less support from staff.

St Heliers Hotel is a large proportioned terrace house. Accommodation is provided over four floors, with passenger lifts allowing stair free access. There are communal sitting and dining rooms together with a sun lounge and bar. Large enclosed gardens are accessed at the rear of the property.

The service had two registered managers in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

St Heliers Hotel was last inspected on 31 March and 1 April 2016. At that inspection we identified breaches of four regulations. These included risk assessments not in place for a person who had come to the service for short term care, hot water from some taps exceeded maximum permitted temperatures, suitable measures were not in place to safeguard against the risks of Legionella, an oxygen cylinder was not stored in line with requirements, some recruitment checks were incomplete, elements of some care plans were not tailored to individual preferences and clear links were not always made between some conditions and other associated care needs, for example diabetes and foot and eye care. In addition auditing carried out for the purpose of identifying shortfalls in the quality and safety of the service provided, had not been wholly effective. Following the last inspection the provider sent us an action plan explaining how these shortfalls would be met.

At this inspection we found required improvement had been made in some areas. People and relatives gave positive feedback about the service. However, there were a number of concerns that had not been addressed.

Some risks to people had not been properly reduced. The risk of falls was not always proactively managed and incidents and accidents were not always managed appropriately to avoid recurrences.

Restrictors were not fitted to all windows to meet published guidance, intended to reduce the risk of falls; central heating radiator risk assessments required review to safeguard against accidental scalding and some hot water taps continued to deliver excessively hot water leading to a risk of scalding.

Proper pre-employment checks had not always taken place to ensure all staff were suitable for their roles. There were enough staff to meet people’s needs.

Although information was available in care plans, some staff lacked knowledge about people’s conditions and associated care needs that may potentially arise.

People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice. People who were assessed as not having capacity to make complex decisions had not been formally assessed about their capacity to make some specific day to day decisions. Deprivation of Liberty Safeguards applications were made where needed.

Auditing carried to identify shortfalls in the quality and safety of the service provided had not been wholly effective.

Medicines were managed safely; people received their medicine when they needed it. However we have made a recomme

This inspection took place on 31 March and 1 April 2016 and was unannounced.

St Heliers Hotel is a care home providing care and support for up to 30 older people. There were 19 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes. Some people needed support with all of their personal care, and some with eating, drinking and their mobility needs. Other people were more independent and needed less support from staff.

St Heliers Hotel is a large proportioned terrace house. Accommodation is provided over four floors, with passenger lifts allowing stair free access. There are communal sitting and dining rooms together with a sun lounge and bar. Large enclosed gardens are accessed at the rear of the property.

The service had two registered managers in post. The provider had taken this step so there was a manager present at the service every day. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

St Heliers Hotel was last inspected on 11 September 2014, when concerns were identified about the management of medicines and some aspects of staff recruitment processes. The provider sent us an action plan telling us how they had addressed these shortfalls.

At this inspection we found required improvement had been made in some areas. However, we identified other shortfalls where some regulations were not being met.

Risk assessments were not in place for a person who had initially come to the service for short term care, this placed them at risk of injury and unsafe care because steps were not taken to identify or reduce any risks.

Management of water within the service was not safe; hot water from some taps exceeded maximum permitted temperatures, hot surfaces such as radiators were unguarded with no risk assessments in place and suitable measures were not in place to safeguard against the risks of Legionella.

An oxygen cylinder was not stored in line with requirements, representing a fire and safety hazard.

Recruitment checks were incomplete because some mandatory checks had not taken place to ensure all staff employed were suitable to work at the service.

Elements of some care plans were not tailored to individual preferences and clear links were not always made between some conditions and other associated care needs. This did not provide staff with the best and earliest opportunity to be responsive to changes in people’s needs.

Auditing carried out for the purpose of identifying shortfalls in the quality and safety of the service provided had not been wholly effective.

Medicines were safely stored and administered; the service was clean and appropriate fire safety checks had taken place.

People were supported by enthusiastic staff who received regular training and appropriate supervision. There were enough staff to meet people’s needs.

Staff were caring and responsive to people’s needs and interactions between staff and people were warm, friendly and respectful.

Staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and applied these principles correctly.

People enjoyed their meals, they were supported to eat when needed and risks of choking, malnutrition and dehydration had been adequately addressed.

People commented positively about the openness of the management structure and were complimentary of the staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full v

The inspection was carried out by one inspector over a time period of seven hours. During this inspection, the inspector focused on answering five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

There were 28 people who used the service at the time of our inspection. Many of the people living at the home had dementia; therefore communication with them was limited. However, we did speak with three people who used the service who were able to tell us about their experiences. We also spoke with visitors of people who used the service.

We looked at the care records of the people who used the service. Care records are documents which identify a person's needs and how staff can meet those needs, including assessments of identified risks for each person. We also looked at staff training records, medication records, the service's satisfaction surveys and policies and procedures.

We met and spoke with the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC) and shares the legal responsibility for meeting the requirements of the law with the registered manager. We met and spoke with three members of care staff, one of whom was the assistant manager.

Is the service safe?

We found that people who used the service had been protected from the risk of abuse. Staff had been trained in the safeguarding of vulnerable adults and understood their role in doing so. Training included the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No recent applications had been submitted. Staff we spoke with did not know about the briefing to providers published by the Care Quality Commission (CQC) in April 2014 regarding the deprivation of liberty in care homes. We noted that this guidance had not been included in the relevant policy or referred to in practice. This was in relation to reviewing decisions about making applications for deprivation of liberty safeguards. We spoke with one of the providers. We brought this to their attention.

People who used the service benefited from safe care and support, due to good decision making and appropriate management of risks to their health, welfare and safety. Risk assessments with clear action plans helped to make sure that people were protected from foreseeable hazards.

However staff personnel records did not in all instances contain all the information required by the Health and Social Care Act 2008. The act requires specific background checks to be completed for people before they are employed to work for the service. We found that some of these background checks had not been completed. This meant that people were at risk of receiving care from people who may not be suitable to work with vulnerable adults. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who used the service had not been protected against the risks associated with the management of medicines. This was because instructions about the administration of medication were not always clear, because medication had not been stored safely and because medication had been administered without having been prescribed. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People who used the service told us that all their needs had been met. One person had commented that their relative “Could not have wished for a more comfortable and secure last chapter of their life”. Staff had received training to meet the needs of people who used the service. Care and support was in line with people's care plans and assessed needs.

Is the service caring?

People who used the service and others who knew them well told us that staff were caring and attentive. We were told by one person that they “Loved it here”. One person told us that, “When the time comes I would choose to live here myself”. Another person told us that sometimes they were, “All tears” but that staff had provided comfort and reassurance whenever they had been upset. We saw staff speaking courteously with people who used the service, and showing compassion and understanding when they were providing support.

Is the service responsive?

People's needs had been assessed before care and support began. Their care plans had been reviewed to reflect changes in their needs. People's care plans included their life history, wishes and preferences. People told us they were given the right support and were helped in areas that were important to them. People told us that they were able to take part in activities of their own choosing.

Is the service well-led?

We found policies and procedures were in place that addressed important aspects of the service. A system of quality assurance to identify how to improve the service had been developed. People and their relatives or representatives had been consulted about how the service was run. Satisfaction questionnaires had been distributed in 2014, collected and analysed. People's views were considered about the quality of care that they received and their views had been acted on. Staff told us that they were listened to and their suggestions were considered and taken into account.

At the time of our inspection, there were 30 people living at the home. We spoke with five people who used the service and two visiting relatives.

People we spoke with told us that they were happy with the care and support they received. One person told us "I love it here” and another person told us “I wouldn’t live anywhere else". A visiting relative told us that the home “exemplifies the best the caring profession can offer”.

People and their relatives told us that they were supported to make their own day-to-day decisions and were involved in how the care and support was provided.

We found that care plans were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible to people who used the service.

We found that the home had suitable arrangements in place to ensure that specialist aids and equipment were available to support people safely. Regular checks were made by specialist contractors to ensure equipment was suitably maintained and safe to use.

We found that the majority of staff had received essential training relevant to their roles and the home’s training plan identified that progress had been made in providing additional training since our last inspection.

The home had a complaints policy in place and a procedure that was followed to enable the manager to respond and address complaints in a timely way.

People told us that they made decisions and choices in their daily life and said “Staff are always polite and can’t do any wrong – they spoil me.” People told us they were always treated with kindness and said “Everything is wonderful. People are very kind.” Each person had a care plan, which gave staff guidance about how people preferred to receive support with their personal, social and health care needs. The welfare of people was promoted by the provision of social activities, for example quizzes, wine tasting and armchair exercises.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People who needed moving and handling equipment, such as a hoist were required to purchase this privately. Prior to moving into the service people may not know about this as they were not informed through the homes literature. The service did not ensure that suitable hoisting equipment was available to meet the assessed needs of everyone who lived in the home.

Staff were enthusiastic and appeared committed to promoting people’s welfare. One person told us “Staff know what you want – you don’t have to ask.” There were gaps in the training that staff needed to care for people effectively. People were asked for their views about their care and treatment and these were acted on. The manager knew how to work with the appropriate authorities about any concerns or allegations of abuse.

People who lived at the home said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home.

People who use the service told us that the manger checked to make sure they were happy with the service.