This inspection visit took place on the 23 August 2017 and was unannounced. At our previous visit on the 26 February 2014 the service was meeting the regulations that we checked.

Presentation Sisters Care Centre is a care and nursing home for older people some who may be living with dementia. The service is registered to accommodate 36 people. There were 33 people using the service at the time of our visit.

The service had a registered manager. A registered manager is a person who has 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.

People told us and we saw there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff told us that they were supported by the management team and were provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff gained people’s verbal consent before supporting them with any care tasks and helped them to make their own decisions. When people were unable to make their own decisions these were made in their best interests. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals as needed to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were involved in decisions relating to the planning of their care. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

We observed staff caring for people in a friendly and respectful manner. Staff engaged people in conversation while they were caring for them and staff demonstrated knowledge of recent changes in people’s needs and delivered care accordingly.

We spoke with domestic cleaning staff who told us what tasks were on the cleaning schedule. They also told us the colour coding system used to identify what cleaning equipment was used in kitchen, bathrooms and communal areas. This meant that people knew what specific tasks they were responsible for and what systems were in place to prevent cross contamination.

We observed medicines being taken to people’s rooms. We observed that the staff member locked the medicines trolley when leaving it to ensure medicines were stored securely. We saw that the staff member asked people using the service how they were feeling and explained to them what their medicine was before administering it to them.

When we read the staff survey on training we found one staff member had commented, “I have learnt a lot from training courses and I am still doing so.”

We saw evidence that the manager had analysed responses to the questionnaires and identified actions to take in response to the results. One action in response to comments made by families had been to install a comments box in reception. We read some comments that had been made using the comments box. One person had commented, “A lovely outing to Carsington, congratulations to all involved.”

People we spoke with were generally content with the service and said that they received good support. One person told us “they care for us very well". A family member said that they felt the service was safe and that the care was good. There were care planning files in place, and staff training was found to be largely satisfactory. We found however that though the manager was in the process of introducing new systems, care planning and risk management systems did not fully ensure the welfare and safety of people at the home. We also found Presentation Sisters Care Centre did not have adequately robust systems for supervising and supporting staff and monitoring the quality of the service.