More Hall Convent is a residential care home for 12 people. There were eight people living at the home at the time of our inspection. More Hall Convent is run by sisters from the religious congregation of Grace and Compassion Benedictines. The home is set in tranquil gardens on the outskirts of Stroud.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This inspection took place 25 July 2018 and was unannounced. At this inspection we found the service remained Good.

People enjoyed living at More Hall Convent and praised the caring nature of the sisters and staff who supported them. People’s care records reflected their preferences and support requirements and provided staff with the information they needed to support people. People’s risks had been assessed and were being managed by staff who knew how to support them to manage their risks.

Relatives were confident that staff supported people well and had no concerns about the quality of care people received. They told us there was good communication between the relatives/staff which ensured all parties were kept up to date of any changes in people’s well-being. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. They told us they enjoyed the meals and activities provided.

There were enough staff to keep people safe. People were supported by an established staff team who had been trained and supported to carry out their role. Staff were safely recruited to ensure people were supported by staff of good character.

Effective monitoring systems were in place to ensure the safe management of people’s care and medicines. Staff understood their responsibilities to protect people from harm and report any concerns. Staff benefitted from good management and leadership. People and staff praised the registered manager and provider.

Quality assurance systems were in place to monitor the service and drive improvements, however records relating to the management of the service were not always detailed or reflected the actions taken to drive improvements across the service. This meant there were not always an audit trial and assurances that actions had been taken. We have made a recommendation that the services seeks additional support and advice in the record the monitoring and governance processes of the service.

Further information is in the detailed findings below.

The inspection was unannounced. More Hall Convent is registered to provide accommodation and personal care for up to 12 older people but only tend to have 10 people at any one time. At the time of our inspection there were 10 people in residence. All bedrooms were for single occupancy and each of the rooms had ensuite facilities.

There was a registered manager in post but they were not available on the day we visited. 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. We spoke with the registered manager after our inspection.

People were kept safe. This was because the staff team were knowledgeable about safeguarding issues and protected people from coming to harm. They knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. All staff had received training in safeguarding adults.

Risks were assessed and appropriate management plans were in place. All the appropriate checks to maintain the premises and facilities had been completed. Where people needed to be assisted to move, their moving and handling needs were assessed and a safe system of working was devised. Medicines were administered to people safely.

Staffing numbers on each shift were sufficient to ensure each person’s care and support needs were met. The staff team was made up of Nuns (Sisters with the Grace and Compassion Benedictine) and ‘lay’ staff. When we talk about staff we are referring to both the Nuns and the care staff. Staff were provided with regular training and were supported by their colleagues and the registered manager to do their jobs effectively.

People were satisfied with the food and drink they were served with. They were provided with the sort of food they liked to eat and any preferences and food allergies were taken in to account. Where concerns had been identified with maintenance of body weight, food and drink intake was monitored. Arrangements were made for people to see the GP, the community nursing services and other healthcare professionals as and when they needed to.

The staff knew the importance of having good relationships with people and their families and were respectful when they spoke well about people.. We found the staff to be caring and friendly and they ensured people’s privacy and dignity was maintained at all times. Where possible people were involved in making decisions about their care and support and families were included where this had been agreed.

People received care and support that met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service. People were asked how they would like their end of life care needs to be met and the staff would work with visiting healthcare professionals in order for them to remain at More Hall Convent where this was possible.

The quality and safety of the service and the care delivered was monitored using a range of different measures to check how things were going. Feedback from the staff team, the people and their families and friends was seen as important and used to make positive changes. The staff team were provided with good leadership and management by the registered manager and the director of care who visited the service often.

We visited More Hall Convent because we had some information of concern shared with us. We wanted to ensure that people were well looked after and that the appropriate health and social care professionals had been contacted for advice and support. We also wanted to check that the home had the appropriate ‘nursing’ equipment to meet people’s needs and aid their comfort.

We looked in detail at the care files for three people whose care needs had recently increased. There were good planning procedures in place and the increases in need had been identified and accommodated in the daily care routines. The staff had involved health and social care professionals where appropriate. Equipment to meet people’s care needs was in place although one request for bed rails from the local authority was outstanding.

We found that the home was sufficiently equipped to meet the needs of the people who lived there. The staff team took the appropriate actions when people’s needs increased and involved the relevant health and social care professionals.

Nine people were in the home when we visited and we spoke with six of them. We also spoke with one relative and three of the sisters (the nuns).

People told us that they were well looked after and were able to make their own decisions about things that affected their daily lives. There was a daily service of Mass in the adjoining chapel and people could choose to attend or not. One person said “I like to sit in the lounge and watch TV or listen to music” whilst another said “I prefer to spend my day in my own room but I go to the dining room for my meals”. A weekly music event was arranged and a harpist and an accordion player had visited recently and played music.

People were provided with the care and support they needed. How the support was provided took account of each person's needs, choices and preferences. Care plans had been agreed by the person where possible and had been updated and amended as required. We found that medicines were well managed and staff who administered medicines had been trained.

People who lived in the home were protected against the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening.

Staff were well trained and supported each other in meeting people’s care needs and ensured that the home was run well. There was plenty of evidence to show that people were asked for their views about the service and that their health and safety was paramount.

Peoples' views were sought with regard to their daily routines and food choices.People's privacy was respected. One person told us "If I am in my room they knock and ask if it is alright to come in."

People were provided with a choice of suitable and nutritious food and drink with a choice of meals offered each day, served with two types of fresh or frozen vegetables.

We found there were effective systems in place to reduce the risk and spread of infection and the three members of staff on duty whom we spoke to were able to talk through infection control measures required when delivering personal care.

We looked at the provider recruitment and selection policy and read six sets of staff records which demonstrated that there were effective recruitment and selection processes in place and that appropriate checks were undertaken before staff began work.

The records supported the fact that people had their complaints listened to and acted on, with the majority of complaints being resolved in a way that was acceptable to the complainant.

People told us that they liked living at the home. We received comments such as, "They're very nice", "the sisters are very good", "I'm very fond of it here" and, "I'm very well looked after." One person said, "The care is so wonderful. There is no discrimination. You don't have to go to chapel if you don't want to. You can join in anything you like. They have volunteers coming in to do music. The catering is wonderful too."

People told us they had been able to bring some of their own furniture and ornaments in to the home where possible. One new resident said, "I'm going to bring in a lot of my own things."

A relative that we spoke with was pleased with his mother's care and told us, "Mum is happier and a lot less anxious than when she was living at home."

People told us they knew how to raise concerns. One person who had recently started living at the home told us, "If there's a problem, I speak to Sister." Another person, who had been living there longer said, "If I wasn't happy, I'd go to Sister. It's not very often that'd I'd be unhappy."

People that we spoke to at the home told us that staff understood their needs and how to look after them.

A relative of one person living at the home told us, "They are really well looked after here. I am not worried about Mum any more."

The service had asked people to fill in a questionnaire about the service. The questionnaire had been sent to residents and their families, and a report had been produced as a result. All the comments received were positive, for example: "It's the little touches that make here so homely i.e. the bowls of fruit, boiled eggs for breakfast and the lovely, friendly staff."