The College of St Barnabas is a very large building situated in a rural location outside the village of Lingfield. The service provides nursing care for up to 28 people, all of whom are Anglican Clergy, spouses, widows or widowers.

At the last inspection on 10 July 2014, the service was rated Good. At this inspection we found the service remained Good.

People were kept safe at The College of St Barnabas because staff knew how to keep people safe and the processes to follow when suspicions of or actual abuse had occurred. The provider followed safe recruitment practices that ensured only suitable staff worked at the home. Risk assessments were in place to enable people to remain safe and they provided guidance to staff about the risks and how to maintain people’s safety.

Records of accidents and incidents were maintained and actions to help to prevent the re-occurrence of these had been implemented. There were sufficient numbers of staff to attend to the assessed needs of people. Medicines were managed and stored safely and people received their medicines on time and as prescribed by their GP.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The College of St Barnabas provides nursing care for up to 28 people, all of whom are Anglican Clergy, spouses, widows or widowers. The nursing care is provided in one main building which has accommodation (in the form 27 rooms, one of which is a double room), two reading rooms, three libraries, two dining areas and two Chapels. Within the grounds there are flats where people can live independently. We did not include people who lived in the flats in the inspection as they do not receive nursing or personal care from the provider. However, they used the main building for their meals, religious services and social events and we spoke with some people from the flats during the day.

People and their relatives told us they felt they were safe living at the College of St Barnabas. From the records we saw that the majority of staff had received safeguarding vulnerable adults training and staff were able to tell us what they would do if they had any concerns. Staff had access to a training DVD on the Mental Capacity Act 2005 during their induction as well as a policy related to that and Deprivation of Liberty Safeguards (DoLS). Although the service had not had the need to make a DoLS application the registered manager had a good understanding of when this may be needed.

Care plans contained individual risk assessments in order to keep people safe at the service. These included assessments around mobility, nutrition or skin integrity. Staff said that generally there were enough staff on duty each day, and during sickness they used bank staff which meant people were cared for by staff who knew them. We saw that staff attended to people quickly when they needed help or support. People told us, “I’m looked after very well”, “Oh yes, we’re looked after very well – the nurses are delightful” and, “It’s a lovely place to be, people are very friendly, helpful and so kind, it’s more like a family. It’s 5*.”

Although the service had recently employed an activities co-ordinator, some staff told us they would like to be able to spend more time with people socially. One member of staff told us, “I think this is the area we find most challenging.” Two people reiterated this. One told us, “Perhaps a chat now and again with staff.” Another said they would like to see people from the nursing wing occasionally going out in the garden. The activities co-ordinator told us they were starting to get to know people and their pastime preferences.

There was various information about activities or outings displayed around the building. One member of staff told us, “There is a large amount of theological (religious) based activities for people as this seems to be what they like.” A trustee, who was also the chairperson of the ‘Friends of St Barnabas’, told us of the work they did to provide alternative activities and events. This ensured people had access to the community, friends and relatives.

Staff were encouraged to progress professionally and attend training appropriate to their role. For example, training in health & safety, manual handling, food & nutrition or to take a diploma in health and social care. Staff had annual appraisals and regular supervision with their line managers. They told us that, on the whole, they felt supported by the deputy matron and the matron.

People were encouraged or supported to make their own decisions about their food as there was a weekly menu which gave people choices of meals each day. People who did not like what was on the menu could ask for an alternative. People were served by attentive staff at lunch time. It was a relaxed occasion with people chatting and enjoying the food. One person told us, “The food is good.”

The care plans we read provided evidence that people had access to other health care professionals as and when required. We could see that staff followed guidance from health professionals were appropriate. We heard from one person who said, “If I need to see a doctor, they will arrange it.” This showed us that staff followed local best practice and responded to people’s requests to see external health care professionals.

It was clear to us that people were cared for by kind and caring staff and staff knew people well. One person required some care from staff very quickly and we witnessed this being done in a kind, careful and empathetic manner. One person told us, “I am looked after very well.” Another said, “Oh yes, we’re looked after very well – the nurses are delightful.” Everyone told us they felt staff treated them with respect and dignity and that they could have privacy whenever they needed it.

A relative told us they were involved in reviewing the care and treatment provided to their family member. Staff said, “Through talking to them, asking and double checking what steps you are going to take, gaining their consent all the time” meant that people were involved in their own care.

People were given information on how to make a complaint. The registered manager told us that there had been no formal complaints in the last 12 months. The service held an accident and incident log which recorded details of the incident, together with the outcome and action taken. Again we were told there had been no recent accidents or incidents.

People said the registered manager (who was also the matron) and the deputy matron were very approachable and supportive. One person told us, “If I had any concerns I would go straight to matron.” Staff carried out regular audits of the service which included a monthly trustee’s visit. Any actions from these audits were acted on by the registered manager.

People's needs were assessed and care and treatment was provided and delivered according to individual care plans.

People we spoke with told us they had been extremely happy with their choice of home and were able to keep contact with family, friends, and former parishioners by letter, phone and the internet.

A couple said they lived in the sheltered housing "The Cloisters" for many years and moved to the home as they required more care. "We have everything we need here"

The staff we spoke with felt they had the necessary training and support to undertake their roles. They also told us that the staffing levels had been increased by one staff during the day which had made a big improvement to the quality of care they were able to provide. They also told us they received regular formal supervision and appraisal.

The activity coordinator was fairly new to post and told us she was implementing activities to suit the ethos of the home, for example reading groups, poetry groups, and one to one activity.

Peoples were asked their views at house meetings and through quality assurance surveys and their feedback was acted upon.

Regular audits of health and safety and quality monitoring systems were in place that measured the quality of service provision.

People who lived at The College of St Barnabas told us that it was a lively place to live and that they enjoyed the lovely location and the grounds.

They told us that the staff were kind and caring and that nothing was too much trouble. They told us that they could carry on with their chosen daily routine and that was most important to them.

Some people told us that the food was good and well presented. One person told us that the food was boring and could do with some spices.

We saw that staff were kind and caring and addressed people by their prefered choice.

We saw that the home was clean, comfortable and well maintained.

We spoke to four people who use the service and they all spoke positively about living at the service. People using the service told us they were happy with the care provided, that staff were kind and were available when needed.

A representative of a person who uses the service told us they thought “the care was wonderful and nothing was too much trouble for staff”.

Each of the four people who use the service that we spoke to told us they feel safe and knew who to speak to if they had any worries.