The inspection took place on 30 and 31 January 2018, the first day was unannounced.

St Anthony’s is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and personal care for 29 people in one adapted building. The service is accommodated over three floors and arranged into three flats, ‘Beacon View’ accommodated six people; ‘Forest View’ accommodated six people and ‘Tree Tops’ accommodated five people. the service also had single studio rooms and flats which people lived in. There were 25 people using the service at the time of the inspection. The service provides support for people who have a learning disability living with some with mobility and sensory needs.

St Anthony’s was designed, built and registered before the Care Quality Commission (CQC) ‘Registering the Right Support’ policy and other best practice guidance was published. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and other complex needs using the service can live as ordinary a life as any citizen.

The service did not have a registered manager at the time of inspection, but a manager has subsequently been registered. An acting manager was appointed in July 2017 and had begun the process of registering with the Care Quality Commission (CQC) at the time of the inspection. 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.

At the last focussed inspection on the 23 February 2017, the service was rated Good overall and was rated Requires Improvement in the ‘safe’ domain. A breach of legal requirements was found. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet legal requirements in relation to a new breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulation 2014, Safe care and treatment. They provided an action plan on 28 April 2017 detailing what they would do and by when to meet the breach. We undertook a comprehensive inspection on 30 and 31 January 2018 to check whether the required action had been taken, improvements made and the breaches met. We found that they had. The overall rating for St Anthony’s remains Good. This report discusses our findings in relation to this.

Risks to people had been assessed and there was clear guidance for staff in how to support people. Care plans and risk assessments were comprehensive and provided detailed guidance for staff in how to support people with their needs including; moving and handling, skin integrity, bathing, nutrition and choking. Staff received the training they needed to support people and worked closely with healthcare professionals completing assessments relating to the risks that were managed.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar incidents occurring. Risks associated with the environment and emergencies including fire and infection control were identified and managed. People were supported to have their medicine safely when they needed it. The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to maintain good health and had access to health care services.

People and relatives told us they felt the service was safe. One relative told us, “My relative

We inspected St Anthony on the 23 February 2017 and the inspection was unannounced. St Anthony is a residential care home which provides support and personal care for up to 29 people who have a learning disability. At the time of our inspection there were 25 people using the service. The service is accommodated over three floors and arranged into three flats. ‘Beacon view’ which accommodated six people; ‘Forest view’ which accommodated six people and tree top flats which accommodated five people. The service also had a variety of single studio rooms and flats which people lived in.

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. The registered manager was not present on the day of the inspection and had been off for a period of time due to sick leave. An acting manager was overseeing their post.

At the last inspection on the 18 July 2016, the service was rated Good overall and Requires Improvement in the ‘safe’ domain. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Anthony on our website at www.cqc.org.uk

At this inspection we found the service had made improvements to the management of medicines. However, we found new concerns in relation to the management of risk and supporting people to remain safe. The rating for the safe domain of this service will remain as ‘Requires Improvement’

The service had made improvements since the last inspection to the management of medicines. Medicines were administered safely and medication administration records (MAR) had no unexplained gaps or omissions. Medicines were stored safety and at the correct temperature. There were clear guidelines in place when people needed medicines and ‘as and when’ basis. However, we have made a recommendation on the management of pain for people with limited communication.

Before the inspection, we received information of concern that the management of choking was potentially not robust. We found that a range of risk assessments was in place. However, clear guidelines were not consistently in place to manage the risks associated with choking, skin breakdown, moving and handling and hot water. We have identified a new breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to recognise and respond to abuse. There had been no safeguarding incidents since our last inspection. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

This inspection took place on 18 July 2016 and was unannounced. At the last inspection of the service on 25 June 2013 we had found the service was meeting all the regulations we looked at.

St Anthony is a residential care home which provides support and personal care for up to 29 people who have a learning disability. At the time of our inspection there were 27 people using the service. There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not always managed safely. You can see what action we told the provider to take at the back of the full version of the report.

There were appropriate policies and procedures in place that ensured people were kept safe from harm. Staff received training in safeguarding adults and incidents and accidents involving the safety of people using the service were recorded and acted upon. There were arrangements in place to manage foreseeable emergencies. Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance for staff, that would protect people from harm, by minimising risks.

There were sufficient numbers of staff on duty to meet people’s needs and there were safe recruitment practices in place to ensure people were cared for and supported by staff that were suitable for their role. People were supported by staff that had appropriate skills and knowledge to meet their needs, as staff received appropriate training.

There were processes in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs and ensure their well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff treated people in a kind and caring manner and care plans contained guidance for staff on how best to communicate with people. People were supported to maintain relationships with relatives and friends. People were supported to understand the care and support choices available to them. People received care and treatment in accordance with their identified needs and wishes.

People’s diverse needs, independence and human rights were supported, promoted and respected. People were supported to engage in a range of activities that met their needs and reflected their interests. People were provided with information on how to make a complaint.

There were systems in place to evaluate and monitor the quality of the service provided and the provider took account of the views of people using the service through meetings and surveys.

People who used the service had complex needs and were not all able to tell us about their life at the home. We used a number of different methods to help us understand their experiences. These included looking at records, talking to staff and observing care practices. We spoke with three people who told us they liked living at the home. One person said "I like living here". Another person commented "I am happy".

We found that improvements had been made to the service since our last inspection in February 2013.

People were encouraged to express their views and be involved in making decisions about their care and treatment. There were new support plans in place which people kept in their rooms. We observed that people were supported in making choices about their daily lives.

We found that care plans and risk assessments gave detailed and up to date information which meant that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

We saw that the provider was carrying out refurbishment of rooms and communal areas. Although some areas were tired looking and needed redecoration, we noted that these had been identified and a plan put in place to make improvements.

A new check list had been put in place to make sure that recruitment records contained all the required information. We found that the necessary background information was in place before staff were offered a position.

We used a number of different methods to help us understand the experiences of people who used the service because people's complex needs meant they were not fully able to tell us about their experiences. One person told us "I like it here" and "staff look after me". Another person, when asked if they liked the home, said "Yes".

We observed that people were relaxed and appeared at home in St Anthony. We saw that staff treated people with respect and supported people appropriately. We found that people were not always able to understand the information that had been written about them. One person told us "I can't read it". People were not always enabled to be involved at a level they could understand.

We found that care plan information was up to date and contained detailed information about people's needs and how these should be met. Staff were knowledgeable about the people they supported.

We found that improvements had been made to the environment which helped to maintain standards of hygiene and infection control. Staff were aware of their responsibilities in relation to infection control and had received appropriate training.

We observed that staff appeared competent and skilled in their roles. However, the recruitment process was not robust and meant that the provider could not be certain that people were of suitable character before they started employment.

People told us “everyone gets on” at St Anthony and they were treated with kindness and respect. They were happy with the care and support they received and felt safe living at St Anthony. People told us staff were kind and caring. People felt confident any concerns they had would be sorted out.