St Audrey's is registered to provide accommodation and personal care for up 38 older people. At the time of our inspection 10 people were living at St Audrey's. This was due to extensive renovations to the home in order to meet fire safety regulations.

We previously inspected St Audrey's on 05 August 2016 and found improvements were required in relation to how the service was monitored, and how people’s records were accurately maintained, including how the registered manager identified and responded to incidents that may put people at risk of harm. At this inspection we found the required improvements had been made.

The home had a registered manager in post who had been registered since September 2015. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this inspection people told us they felt safe and staff were aware of how to maintain people’s safety. Staff had reported incidents that required review and investigation to keep people safe from the risk of harm. Risk assessments were in place and regularly reviewed to ensure safe and effective care was in place to manage those identified risks. There were sufficient numbers of staff deployed to provide care safely to people living in St Audrey's. People were supported by staff who had undergone a robust recruitment process to ensure they were of good character to provide care to people. People's medicines stored safely and managed well and people received their medicines as the prescriber intended.

Staff felt supported by the manager who enabled them to carry out their role effectively. Staff received training relevant to their role and new staff received a comprehensive induction. Staff were aware of how to support peoples to make decisions who may lack the capacity to make those informed decisions, and people consent was recorded in line with their wishes. People's nutritional needs were met and their food and fluid intake along with their weight was robustly monitored. People were able to choose what they ate from a varied menu with support from staff to eat their meals independently. People we spoke with told us they had access to a range of health professionals.

Staff spoke to people in a kind, patient and friendly way, and staff and people and their relatives have developed a clear rapport and understanding of one another. People's dignity was maintained, and people were assisted promptly when required to protect their dignity. People's privacy was maintained.

People received care from staff that was responsive and met their needs. Staff were aware of people's individual needs and how to meet these, and were knowledgeable about how people chose to spend their day, and accommodated this. People were provided with a range of activities based on their preferences, and were actively encouraged to spend time away from the home with family and staff. Complaints had been responded to by the Registered Manager in a robust manner.

People, staff, relatives and health professionals felt the management team were visible around the home and sought their views and opinions about how the home was run. We were told that the management team responded positively to feedback and proactively encouraged people to do so. People's personal care were records were regularly reviewed to ensure they were complete and actions that were identified were addressed. The registered manager completed a range of audits in relation to areas such as infection control, medicines, health and safety, training and development, and where they identified areas for improvement they took action to ensure these were completed. Notifications that are required to be submitted to CQC were made when required.

St Audrey’s is registered to provide accommodation and personal care for up 38 older people. At the time of our inspection 18 people were living at St Audrey’s.

We previously inspected St Audrey’s on 26 November 2015 and found breaches of regulations 10, 11, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served warning notices in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan setting out how they would meet the regulations.

We inspected St Audrey’s on 05 August 2016 and found that significant improvements had been made. However, we also found there areas of improvement still required, particularly in relation to how the service is monitored.

The home had a registered manager in post who had been registered since September 2015. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this inspection we found there were sufficient numbers of staff were deployed to provide care safely to people living in St Audrey's. The registered manager had not consistently been made aware of incidents that required review and investigation to keep people safe from the risk of harm. People were supported by staff who had undergone a robust recruitment process to ensure they were of good character to provide care to people. Risk assessments had not always been developed to positively manage risks. People’s medicines were not consistently stored safely and stocks of medicines held, did not tally with the stock records held in people’s care records.

Staff felt supported by the manager who enabled them to carry out their role effectively. Staff received training relevant to their role and new staff received a comprehensive induction to support them to carry out care effectively. People’s nutritional needs were met and their food and fluid intake and weight was robustly monitored. People were able to choose what they ate from a varied menu. People we spoke with told us they had access to a range of health professionals. Records demonstrated they were referred to specialists when their needs changed and this was confirmed by visiting professionals.

Staff spoke to people in a kind, patient and friendly way, and staff and people and their relatives have developed a clear rapport and understanding of one another. People’s dignity was maintained, and people were assisted promptly to when required to protect their dignity. People’s privacy was maintained.

People received care from staff that was responsive and met their needs. Staff were aware of people’s individual needs and how to meet these, and were knowledgeable about how people chose to spend their day, and accommodated this. People were provided with a range of activity based on their preferences, and were actively encouraged to spend time away from the home with family and staff. Complaints had been responded to by the Registered Manager both formally and informally, however some people were unclear about how to complain independently.

People did not consistently receive care that was well led and regularly monitored. People’s personal care records were regularly reviewed however did not always identify inaccurate recording of peoples current needs. Audits of people’s care records were not effectively reviewed to ensure actions were completed, and notifications were not consistently made to CQC when required. People felt the manager was visible around the home and sought their views and opinions about how the home was run, and responded positively to feedback.

St Audrey’s is registered to provide accommodation and personal care for up 38 older people. At the time of our inspection 27 people were living at St Audrey’s.

The inspection took place on 26 November 2015 and was unannounced which meant the provider did not know we were inspecting. At this inspection we found breaches of regulations 10, 11, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have served warning notices in relation to Regulation 12 and 17 of the Health and Social Care Act 2009 (Regulated Activities) Regulations 2014. We will check that the provider has taken action to remedy the concerns identified.

The home had a registered manager in post who had been registered since September 2015. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this inspection we found there were insufficient numbers of staff were deployed to provide care safely to people living in St Audrey's. The registered manager had not made arrangements to review and investigate incidents and accidents to keep people safe from the risk of harm. Risk assessments had not always been developed to positively manage risks. People’s medicines were not always stored safely and information was not always available to staff about how to manage medicines. People were supported by staff who had undergone a robust recruitment process to ensure they were of good character to provide care to people.

Staff felt supported by the manager who enabled them to carry out their role effectively. Staff received training relevant to their role; however we found that temporary (Bank) staff were not provided with sufficient training to feel confident in their role.

People’s nutritional needs were met however their food and fluid intake and weight was not robustly monitored. People were able to choose what they ate from a varied menu. People we spoke with told us they had access to a range of health professionals. Records demonstrated they were referred to specialists when their needs changed and this was confirmed by visiting professionals.

Staff spoke to people in a kind, patient and friendly way. People’s dignity was maintained, however we observed people were not assisted promptly to change their soiled clothing after lunch.

People did not receive high quality care that was well led and regularly monitored. People’s personal care records were not regularly reviewed, completed or updated when required, and people felt the manager was not as visible around the home as they should have been.

As a result of this inspection the provider agreed to restrict further admissions to St Audrey’s until such time as there were sufficient numbers of staff and they were deployed effectively to meet people`s needs safely at all times.

During our previous inspection at St Audrey’s on 17 September 2014 we found that people’s care records were not reviewed regularly. We also found that medicine records were not always accurate and contained gaps and errors. We told the provider to take immediate action to remedy these issues.

We found during our inspection on 26 September 2014 that improvements had been made in relation to reviewing people’s care records. We also found that gaps and omissions in people’s medical records had been remedied and investigated.

During our previous inspection at St Audrey’s we found that people’s records were not stored securely and were not destroyed in line with the provider’s policy. We also found that people’s care records were not accurate, had not been reviewed regularly and were not reflective of people’s needs. We told the provider and the manager to take immediate action to remedy these issues. They sent us an action plan which informed us how this was to be achieved.

Since our last inspection the manager has left the home, and the provider had recruited a consultancy company to assist with their action plan. They have recently transferred an interim manager from another of their homes to St Audrey’s to support the running of the home. However, this had resulted in a period of ‘lost’ weeks where due to the lack of management some of the actions were unable to be fully implemented.

We found during our inspection on 17 September 2014 that improvements had been made in relation to the storage and maintenance of people’s care records. However, we also found that some gaps and omissions in people’s medical records remained.

We inspected St Audrey’s due to concerns raised with us by health professionals who had recently visited the home. Areas of concern that had been identified were in relation to the management of pressure care, the accuracy of care documentation and the management of medicines.

We inspected St Audrey’s on 25 June 2014. As a result of this inspection the provider voluntarily suspended admissions to the home due to concerns raised through the inspection.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We found that care was not consistently planned, reviewed and delivered in a way that was intended to ensure people’s safety and welfare.

We found that pressure mattress settings were consistent with the weights of people who used the service. However we found one pressure mattress indicated a low pressure fault that had not been identified by staff.

Is the service effective?

We saw that risk assessments and support plans had not been reviewed and updated. Care plans in place for people were not always reflective of their current needs and were out of date.

We looked at the daily care notes for people whose plans we had viewed and saw that in most cases care was not accurately recorded.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted the manager had not acted to fulfil this. Relevant staff had not been trained to understand when an application should be made, and how to submit one.

People’s confidential records were not stored securely and were available for unauthorised people to access.

Care records did not accurately reflect the needs of the people who used the service.

Is the service caring?

We observed staff interaction with people who used the service and noted that interactions were positive. Staff were attentive and kind and appeared to know the people well. Where people had complex health needs care staff were able to eloquently and comprehensively demonstrate through discussion how these were supported.

Our observations of the carers demonstrated that people were treated with dignity and privacy.

The views of people’s families had not always been sought in relation to decisions relating to care or treatment.

People’s care needs were not always met. We found that gaps in medicine records demonstrated that people may not have received their medicine as prescribed. Where people were at risk of developing pressure sores their health needs were not reviewed robustly.

Is the service responsive?

The views of people who used the service were sought however these views and preferences were not always carried out.

The service listened to people’s experiences, concerns and complaints to improve the quality of care they received. The views of people who used the service were sought however these views and preferences were not always carried out.

We found that audits of key areas such as care records and medication had not always been actioned and implemented.

Is the service well led?

The service did not always promote a positive management culture that was positive, and open. We observed friction between care staff and nursing staff, and where the manager was aware of this; little had been implemented to resolve this.

The service did not promote a positive management culture that ensured systems were in place to monitor, assess and review people’s care in a safe and responsive manner.

During our visit to the service we were able to speak with a variety of people who lived at St Audrey's and their visitors. It was a bright sunny day and people had taken the opportunity to sit out in the grounds. The people we spoke with were positive about the support provided by the staff at St Audrey's. One person told us, 'They are like family". People confirmed that the staff were kind and helpful. We observed that there was a calm, sociable atmosphere, with people choosing how they wished to spend their time.

The purpose of our visit was to review, whether people who had received respite care at St Audrey's, had appropriate records in place, to identify their care needs and how any risks associated with their care were managed. We found that the service was meeting the required standards on this occasion. People had care plans in place that provided staff with the information they needed, to meet people's individual needs and preferences. We identified that there were suitable arrangements in place, to assess people's needs before they came to stay. People had been encouraged to visit the service and stay for a meal, so they could decide whether St Audrey's was suitable for them.

During our visit to the service we spoke with nine of the people who lived at St Audrey’s and two of their visitors. People who used the service told us that they were “well looked after” and the staff “were attentive”, “gentle” and “kind”. A visitor told us that they were kept informed about their relative and there was “always someone around to ask”

We noted improvements in the care plans for people who were permanent residents. These records now provided the information staff needed to respond to people’s individual needs. The care plans had been kept up to date and reviewed with the person concerned and/or their representatives as appropriate.

We had concerns about the standard of record keeping, in relation to people who received respite care at St Audrey’s, as they did not have accurate up to date records in place to protect their safety and wellbeing.

We identified that the provider had taken action to increase staffing levels at busy times and an additional care worker had been provided at night. However, staff raised concerns about the management of shifts and lack of time to spend with people who used the service other than when they were attending to their personal care.

The provider has given us information regarding planned improvements to the bathing facilities at St Audrey’s but we had not yet seen the impact of this on people who used the service.

During our visit to the service, on 16 August 2012, we spoke with eight people who lived at St Audrey’s and observed the interaction between residents and staff. Three people described the staff as being ‘very kind’ and ‘good’. One person told us what they liked was being able to get up and go to bed when they wanted to. Another person particularly mentioned enjoying the weekly exercise class.

Two people raised concerns with us regarding inconsistencies in how their care needs were being addressed. They felt they were not getting the regular treatment or support they needed in specific areas.

People told us that concerns about staffing levels and the quality of meals had been raised with the manager, at a resident’s meeting held on the day before our visit.

During our visit the majority of people we spoke with said they did not have problems with individual staff, there were just not enough of them. People said the staff were ‘rushed’ and there were times when their care was delayed or specific activities such as having a bath were put off until a later date. One person told us that some staff could be ‘brusque’ because they were in a hurry and not everyone listened.

We were told that there were delays in being able to offer people a bath because the service only had two baths available that were suitable for people to use. The majority of people would be unable to use the baths provided, in their ensuite bathrooms, due to their restricted mobility and need for assistance.

During our visit to the service, on 09 May 2012, we spoke with eight people who lived at St Audrey’s and three visiting relatives. Overall people were positive about the service being provided and said they liked living at St Audrey’s. People described the staff that supported them as being ‘helpful, ‘attentive’ and ‘friendly’. One person told us the staff always asked them what they would like and said ‘its amazing, it’s very nice here’. Another person who had made repeat visits to St Audrey’s, for short periods of respite care said, ‘I like it very much that’s why I chose to come back’. Two of the relatives we spoke with were positive about the service being provided and told us that communication with staff and the managers was good. One person was concerned that staff did not have time to sit and talk with people during the day.

During our visit to the service we spoke to staff and people who used the service. People who used the service told us that they were, "happy living at St Audrey's", they, "were looked after well" by staff who were, "happy" and "kind". Staff told us that it was a, "good place to work" and they, "enjoyed caring for people".

We noted that there was a person centred approach to the care provided that was evident through the calm and happy atmosphere within the home. The care plans that we reviewed were written in a way that was easy to understand and enabled the reviewer to fully understand the needs of the person

Concerns had been raised by staff about the number of staff on duty and the impact this had on care, however we saw that new staff had been employed and there were adequate numbers of staff on duty on the day of our visit and we saw that there were adequate numbers of staff on the rota for future days.

The provider has recently opened a new bath room complete with wet room area on the ground floor to improve the facilities available to people. As rooms become vacant, they are being upgraded in an on-going scheme to improve the service.