The inspection took place on 15 and 21 June 2017 and was unannounced. When we last inspected the service on 20 and 22 July 2016 we found breaches with regulations 12 & 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to manage people’s medicines safely and there were concerns in relation to the maintenance and cleanliness of the home. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements and therefore improved the quality of the service provided at St Anthony’s.

St Anthony's is a residential care home located in Watford. It is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection 20 people were living at St Anthony’s.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People were supported to take their medicines by trained staff. We found that staff followed safe practices and medicines were accurately documented and stock levels checked were correct.

We found that the environment had improved with several areas of the home having been re-decorated since the last inspection took place.

People felt safe living at St Anthony’s. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so.

Staff received regular one to one supervision and felt supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staffs were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The registered manager had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise any concerns with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The registered manager had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 20 and 22 July 2016 and was unannounced. At our last inspection on 14 November 2013, the service was meeting the requirements. St Anthony's is a residential care home located in Watford. It is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection 20 people were living at St Anthony’s.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People were supported to take their medicines by trained staff. However we found that staff did not always follow safe practices and medicine were not always documented correctly and stock levels were not correct.

We found that the environment was not always safe. There were cables on the floor by people`s beds, holes in the carpets and no handrails to support people to access the garden safely. There was no action plan to address these and appropriate steps were not always taken to reduce potential risks and drive improvement.

Relatives and staff were complimentary about the registered manager and how the home was operated. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People told us they felt safe, happy and well looked after by staff working at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced for their roles. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support. Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff was knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were involved in the planning, delivery and reviews of the care and support they received. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

People were supported with activities at the home; however the provider was still seeking to employ an activities person to improve the quality of the activities provided?. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

We carried out an inspection at St. Anthony's Residential Care Home on 15 August 2013 and found that the provider had not met the standards required for the prevention of infection within the home. The provider was asked to provide an action plan to show how they would meet the required standards. We re-inspected the provider on 14 November 2013 to review the actions they had taken. We found that the provider had taken the steps required to meet the standards for infection control in the home.

When we spoke with staff we were told that since receiving further training as a result of our inspection they had a better understanding of infection control and now worked as a team to prevent and control the spread of infection and to keep the home clean.

People we spoke with told us that the home was always kept clean and that their rooms were cleaned daily. People who used the service said that they had 'a good laugh' with the staff and that the staff were 'caring' and always had 'time to talk'.

We visited St Anthony's on 15 August 2013. On our arrival we saw that some people were in the communal lounge and some people had chosen to remain in their rooms. People were being served their morning tea and had all had their personal care needs met. When we spoke with people who used the service we were told that the staff were 'absolute gems' and they made people 'laugh'. We were told that the carers were 'very nice and we get on well with them'. People told us that the home had a routine which was followed but that it allowed time for the carers to spend time with people, either talking with them or reviewing the cross words. Staff we spoke with told us that they enjoyed spending time with people and talking about 'their past experience's'. staff told us that they never had to rush things with people and they allowed people to 'do things at their own pace'.

We did however find some issues with the infection control standards in the laundry area of the home which we raised with the provider during our visit.

People told us that their experiences of living at the small care home was good. People stated that they were cared for by "A pleasant and well mannered group of staff". We heard that people were given the opportunity to be involved in activities in the house if they wished to be. We heard that everybody was given choices about food and drink and encouraged to retain their independence. The people who we spoke with described the home as "Comfortable" and that their "Bedroom was nice".

We noted that when we spoke with relatives and friends who visited the house that they always felt they were welcome. We saw a confident team of staff who were trained and experienced. We saw that the contact with health and welfare staff in the community is well established with frequent visits from different professions.

When we visited St Anthony’s, on 08 December 2011, people using the service and their relatives who contacted us by telephone, between 09 and 15 December 2011, told us that they received the care and support they needed from the staff who support them.

People who told us about their experience of living at St Anthony’s or visiting their relatives, told us ‘ you couldn’t ask for better’. They said the staff were all ‘very good’, ‘very helpful’, ‘kind’, friendly, cheerful and ‘caring’. One person describing the staff told us ‘nothing was too much trouble’.

People told us that they were being supported by a consistent team of permanent staff who they knew and were aware of their needs. Relatives confirmed that they were kept up to date with any changes and involved in meetings to review people’s individual care needs.

People visiting St Anthony’s told us they were always made to feel welcome and offered a cup of tea what ever time they called.

People told us they enjoyed their meals and the cook visited them to discuss the menu choices and offer alternative options to suite their individual preferences.

People told us that their rooms were comfortable and the house was always clean. One person commented that people could be encouraged to move around more as the seating arrangements in the main lounge limited people’s mobility.