Mental health facility rated 'inadequate' by regulator

A nursing home for people with mental health needs and dementia has been put into special measures after regulators raised concerns over the use of restraint, poor staff training, medication management errors, and staff treatment of residents.

The Care Quality Commission (CQC) has downgraded the overall rating for St Anselm’s Nursing Home in Deal, Kent, from ‘good’ to ‘inadequate’ and placed it into special measures following an inspection which finished in February.

When we inspected St Anselm’s Nursing Home, we found a disorganised and inconsistent culture where there were pockets of good practice, but also several areas where the service wasn’t providing the standard of care we expect 

The home is run by a company of the same name and was housing 21 residents at the time of the visit.

Inspectors found six breaches of regulation relating to providing people with person-centred care, consent, safe care and treatment, dignity, staffing and the overall management of the service.

They found that:

• The service did not ensure staff had sufficient training. Staff were supporting people with diabetes and epilepsy, but hadn’t received training in these conditions. This meant they could be working without the knowledge and skills they needed to keep people safe
• Leaders did not give staff clear guidance on the use of restraint or support them to de-escalate incidents. When restraint was used, these incidents weren’t well documented or learned from, so it was notalways clear if restraint was the appropriate course of action
• The service had not always assessed people’s capacity to make decisions for themselves and couldn’t show that decisions made for them were in their best interest. For example, people who disturbed each other at night continued to share rooms with no review of whether this was in their best interest
• Leaders did not ensure there was enough information in people’s care plans so staff had to rely on verbal information or what they already knew about people’s needs. This meant new staff and agency staff wouldn’t have the information they needed to care for people appropriately

Its move to special measures will involve close monitoring to ensure people are safe while they make improvements. It also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this does not happen.

Catriona Eglinton, CQC deputy director of adult social care in Kent, said: “When we inspected St Anselm’s Nursing Home, we found a disorganised and inconsistent culture where there were pockets of good practice, but also several areas where the service wasn’t providing the standard of care we expect.

“We could see managers were passionate about the people they supported, and relatives told us staff were kind and caring. However, leaders hadn’t put the systems in place to ensure staff could deliver safe, person-centred care, and they weren’t involved enough in the day-to-day management of the home to tackle known issues.

“For example, when inspectors raised concerns about how some staff were speaking to people, and about cleaning materials being left unattended, managers were aware of these issues, but hadn’t addressed them.

“Inspectors also had serious concerns about how the service was managing people’s medicines. Some medicines needed to be administered at certain times or spaced at certain intervals, and the records we saw indicated this wasn’t always happening. We also found one person had been given too many doses of their medicine for more than a month, and then no medicine for three days when it ran out.

“Unfortunately, we observed some staff treating people without patience or respect. On more than one occasion, we saw staff sighing loudly in frustration when they needed to help someone. We also saw a staff member helping someone to eat while talking to other staff instead of speaking to the person they were supporting. People living at St Anselm’s should be able to expect more respect from the staff supporting them.

We take the finding of the commission extremely seriously and are fully committed to ensuring the highest standard of care, safety and governance are consistently delivered across our service 

“We’ve told St Anselm’s leaders exactly where they must make immediate and significant improvements and have instructed them to submit an action plan setting out how they will do this. In the meantime, we’re monitoring the home closely to keep people safe.”

In response to the findings, a statement from St Anselm’s Nursing Home says: “We take the finding of the commission extremely seriously and are fully committed to ensuring the highest standard of care, safety and governance are consistently delivered across our service.

“Since the inspection we have taken significant steps to address the CQC findings and we will continue to work closely with CQC and provide regular updates on our progress.

“Our priority remains the wellbeing, dignity and safety of all residents in our care.

“We would like to take this opportunity to thank the families of our residents for their continued support and reassure them and the local community that we are taking decisive and transparent action to address the matters raised to strengthen the quality of our service.”