The inspection took place on the 7 and 9 December 2016 and was unannounced. The home was last inspected on 27 August 2014 and met all the legal requirements assessed at that time.

Saintbridge House Nursing and Residential Home is a care home for up to 36 people. At the time of our inspection there were 36 people living at the home.

Saintbridge House Nursing and Residential Home 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 were at risk of receiving care from unsuitable staff because robust recruitment procedures were not always being applied.

We heard positive comments about the care home and the care given to people such as “on the whole I think they do extremely well”, “I’m quite happy” and “pretty good”.

Sufficient staffing levels were maintained and staff were supported through training and supervision to maintain their skills and knowledge to care for people. Risks to people's safety were identified, assessed and appropriate action was taken. People’s medicines were safely managed.

People were treated with respect and kindness and their privacy and dignity was upheld, they were

supported to maintain their independence as much as possible. People took part in a range of activities suitable for their needs.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. The registered manager was accessible to people using the service and staff. Systems were in place to check the quality of the service provided including surveys to gain the views of people and their relatives.

An adult social care inspector carried out this inspection in response to information that had been shared with us by the local authority. The focus of the inspection was to answer four key questions; is the service safe, effective, caring and responsive?

As part of this inspection we spoke with two people about their care and the service they received. We spoke with three other people who use the service whose comments did not relate to the standards we were talking about but who looked relaxed and spoke to us happily about other things. We also spoke to four relatives, six members of staff and the company representative. We reviewed seven people's care records. We also reviewed the service's complaints records and policy, staffs' professional development records and the service's training records.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We have advised the provider of what they need to do to remove the individual's name from our register.

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

Is the service safe?

People were safe because staff had been given information about people's needs and how to manage them. Information about people's risks had been recorded, shared with staff and plans had been made to manage these. For example, specialised equipment had been introduced when people were at risk of falls, people at risk of losing weight received fortified foods and drinks. Risks associated with pressure ulcer development were managed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were safe because the service had proper policies and procedures in place in relation to this. Where people were deprived of their liberty in order to keep them safe this had been done lawfully. The manager was aware of the amendments (March 2014) to the DoLS legislation and had started to take action in response to this. Staff had received training in relation to DoLS and senior staff knew how to make a DoLS referral if required.

Is the service effective?

The service was effective because people received care that met their individual needs, choices and preferences. Care plans sometimes lacked personalisation but gave staff basic guidance on how to meet the person's needs.

The service was effective because staff received training relevant to their role. They also received on-going support with their professional development. Where needed there were arrangements in place to address shortfalls in staff performance and to remind staff of their responsibilities.

The service was effective because it delivered care with people’s consent and where consent could not be given, in people’s best interests.

Is the service caring?

The service was caring because we observed people being treated with respect and dignity. Arrangements were in place to preserve people's privacy. We did not observe any situations where a person's dignity or privacy was compromised.

The service was caring because care was delivered in a thoughtful and kind manner. One person who uses the service said, "They are all wonderful". Another person said "I can have a joke with them (the staff) that is so important to me".

The service was caring because they listened to and involved people's relatives in their care.

Is the service responsive?

The service was responsive because it responded to people’s altering needs.

The service was responsive because they recognised people’s diversity. A good example of this was seen in the kitchen where a person's religious beliefs were respected. A "clean area" had been established in order to prepare one person's food without contamination from other certain foods.

The service was responsive because it sought additional support or intervention when needed. Referrals were made to health care professionals when needed and advice followed. One relative said “"I think it's probably as good as you are going to get, it's not always perfect, but they understand (relative's name)".

The service was responsive because action had been taken in response to people's concerns and complaints.

This scheduled inspection was brought forward after we received information of concern relating to the care of two people. The care of these people had been reviewed by the local County Council and found to be appropriate. Additional shortfalls were identified by the Council during a subsequent review of the service. The provider had been working with the Council to address these. We spoke to representatives of the provider and inspected relevant records. We saw evidence of improved care assessments and of people receiving the support they required. We discussed with the provider the arrangements for avoiding such shortfalls in the future. The provider was experienced in providing such services and had established monitoring systems. We spoke with staff and some were already very experienced in meeting similar needs. Additional training for staff had been planned, which would ultimately benefit those using the service and help address some of the shortfalls.

When we inspected there were 12 people using the service. We spoke to five of them as well as three relatives. One relative said "mum has come on in leaps and bounds since being here". Although those using the service could not speak to us in any detail about their care, they told us they liked living at Saintbridge House. One person said "this is my home now and that's fine with me".

People were being protected and they're rights were being upheld.

We had received a number of concerns and allegations from a whistleblower. Concerns had been raised about the lack of staffing, cleanliness in the kitchen, lack of care plans and risk assessments and lack of support for staff. Because of these concerns we brought forward our planned inspection. We spoke to 13 staff, people who used the service and relatives of people who used the service. We also looked at various documents held by the service. During our inspection we found no evidence to support any of the concerns raised by the whistleblower.

Care plans and risk assessments were in place and had been reviewed regularly. They were individual to each person who used the service and reflected their needs. Staff had received training and felt supported in dealing with challenging behaviour shown by two people who used the service. The provider had an infection control policy in place that was fit for purpose. We did not identify any cleanliness issues in the kitchen. People told us how clean the home was. People who used the service and relatives all told us positive comments including “the staff look after me very well, and I can do what I want to do”. “They are looking after my wife pretty well here, she is happy. I'm involved in all aspects of my wife’s care. I would certainly recommend this home”. “I can see my husband is getting the best possible care. He is safe and being looked after properly”.