St Augustine's Care Home (St Augustine’s) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Augustine’s accommodates up to 52 older people. The service is divided into four units. Units A, B, C and D. Unit B specialises in providing care to people living with dementia. The service places a strong emphasis on the teachings of the Catholic church with support also being provided by the religious Sisters who live in the adjoining convent. People have access to the on-site chapel.

This inspection took place on 21 February 2018 and was unannounced. There were 48 people living at the service at the time of our inspection.

We previously carried out an unannounced comprehensive inspection of this service on 1 February 2017 when we rated the service as Requires Improvement.

The last two years have been a period of considerable change at St Augustine’s with significant management and staffing changes having taken place. Since July 2016, a management team have been running the service whilst seeking to find the right manager to take over the role. In January 2018, a new manager was appointed and is currently in the process of applying for registration. 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.

Despite having only been in post for five weeks at the time of this inspection, the feedback we received from people, relatives, staff and other professionals was that the new manager was a good appointment. She was working well with the management team and collectively they had produced a development plan for the service. The culture of the service was open and positive and what the service needs now is a period of stability for the changes to be embedded and sustained.

The management team had successfully recruited a team of permanent staff and as such people were now being supported by sufficient staff who knew them. Appropriate recruitment checks had been undertaken to ensure suitable staff were employed. A bespoke programme of induction and training enabled staff to have the skills and support to deliver their roles effectively.

There were appropriate systems, processes and practices to safeguard people from abuse. Risks to people were identified and managed safely whilst allowing people the freedom to live the lives they chose.

People’s needs and choices had been better assessed to ensure support was delivered in a way that achieved effective outcomes. Assessment information was then used to form individualised plans of care so that people were supported in a person centred way.

People were supported to lead healthy lives and encouraged to eat and drink so as to maintain a healthy and balanced diet. Staff worked collaboratively and in partnership with other healthcare professionals to ensure people received holistic personal and health support. The management team were taking continuous steps to ensure medicines were managed safely and that people received their medicines as prescribed.

The environment was adapted and decorated for the purpose of the services provided. The service was clean and improvements to the management of infection control had recently improved significantly.

The atmosphere in the service was relaxed and friendly and people’s emotional and spiritual needs were met. People had opportunities to engage in activities that were meaningful to them. People had good relationships with the staff who supported them with genuine compassion and care.

People were involved in making decisions about their care and staff unders

St Augustine's Care Home provides residential care for up to 52 elderly people, some of whom were living with dementia. The home is divided into four units. Units A, B, C and D. The service places a strong emphasis on the teachings of the Catholic church with support also being provided by the religious Sisters who live in the adjoining convent.

This inspection took place on 1 February 2017 and was unannounced. There were 48 people living at the service at the time of our inspection..

We previously carried out an unannounced comprehensive inspection of this service on 28 June 2016. At that inspection a number of breaches of legal requirements were found. As a result the service was rated Inadequate overall and the provider was placed into Special Measures by CQC. As part of this decision, we met with the provider to discuss our concerns. We also issued two Warning Notices which required the provider to take immediate action in relation to staffing levels, and the effective governance of the home.

Since our last inspection we have continued to engage with the provider. We required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. We also asked the provider to submit us copies of weekly staffing information and provide assurances that safe staffing levels had been maintained. This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant that the provider had complied with the Warning Notices we had issued and we have now taken St Augustine’s Care Home out of Special Measures.

The service did not have a registered manager in post. 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. The previous registered manager had not been working in the service for a number of months and their registration has now been cancelled with us. The day to day management of the home was being undertaken by the registered manager of one of the provider’s other services who had been based at the service since July 2016.

There has been a period of considerable change at St Augustine’s over the last six months. Whilst it was evident that the quality of care had significantly improved, the leadership of the home now needed to be embedded and sustained through the recruitment of a permanent manager and strengthening of the staffing team.

The provider had maintained safe staffing levels through the provision of agency staff. Considerable efforts had been made by the management team to ensure wherever possible the same agency staff were used and they were appropriately inducted to the service. Appropriate checks were undertaken to ensure only suitable staff were employed. The provider also had also introduced systems to improve the vetting of temporary staff.

Through the use of one page profiles and detailed handovers, information about how to effectively support people was made available to staff who were less familiar with their needs. Whilst it was clear that the management team was taking every effort to provide consistent and safe care, the number of different staff supporting people, was still having some effect on the quality of care that people received.

The changes to the staffing team meant that the supervision and development of staff was at the start of an ongoing journey. Mandatory training was up to date and staff were now in the process of undertaking more bespoke learning in order to develop the necessary skills to support people effectively.

People were safeguarded from the risk of harm, because staff now understood their roles and responsibilities and knew where to go if they had c

St Augustine's Care Home provides residential care for up to 52 elderly people, some of whom were living with dementia. The home is divided into four units. Units A, B, C and D. The service places a strong emphasis on the teachings of the Catholic church with support also being provided by the religious Sisters who live in the adjoining convent.

The inspection took place on 28 June 2016 and was unannounced. There were 52 people living at the service at the time of our inspection. Due to new concerns raised during the feedback calls made after our visit, we sought additional information from the provider which has also been included in making our judgements within this report.

The service had a registered manager in post. 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 had been in post since November 2015.

We previously carried out an unannounced comprehensive inspection of this service on 18 June 2015. At that inspection a number of breaches of legal requirements were found. As result the service was rated Requires Improvement in all domains and five requirement actions for the service to improve were set. Following that inspection, the provider sent us an action plan which identified the steps they intended to take to make the required improvements. Despite telling us that the requirement actions would be addressed, we found two continued breaches of regulations at this inspection.

Since the last inspection we have received a number of concerns from visiting professionals, relatives and staff about the services provided at the service. Some of these concerns are continuing to be investigated through a safeguarding investigation with our partner agencies. As this investigation has not yet concluded, we are unable to include specific details within this report.

Information gathered both through the on-going investigation into St Augustine’s Care Home and this inspection, has highlighted some serious concerns with both the staffing and management of this service.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have taken enforcement action and issued Warning Notices in relation to staffing and quality monitoring. You can see what action we told the provider to take at the back of the full version of the report.

Our last inspection highlighted that staffing levels were not sufficient to meet people’s needs. The provider told us that they had reviewed the number of staff required and increased staffing levels accordingly. During our visit to the service on 28 June 2016, there were more staff on duty. Some staff told us that the number of staff on duty that day were not typical of the usual staffing levels in the service The management team assured us that they had recently increased staffing levels and that the number of staff on duty that day were representative of how the service was now being staffed.

Following our visit, we received new information that the staffing levels we observed had not been maintained. We therefore contacted the provider and requested that they submit their rotas to us. From this information, we saw that staffing levels had not been maintained to the minimum level determined by the registered manager as being safe on any day since our visit. On three separate occasions the service was staffed with less than half the number of care staff required.

Our last inspection identified that risks to people were not always adequately assessed and managed. Whilst the areas that were previously of concern had been addressed, people were still not properly protected by the risks relating to their care. In particular, the management team

St Augustine's Care Home provides residential care for up to 52 elderly people, some of whom have care needs associated with dementia. The home is divided into four units. Units A, B, C and D.

The inspection took place on 18 June 2015 and was unannounced.

The home had a registered manager in post. 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.

Staff did not understand their responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). People could not be confident that decisions made on their behalf fully respected their legal rights.

There were not always enough staff deployed in the home to meet the needs of the people who were living with dementia. This was particularly noticeable in Unit B in which eight of the ten residents were living with dementia.

People were not always protected from the potential risk of harm because steps to mitigate identifiable risks had not been taken.

There were limited activities available in the home for people living with dementia. The home had good signposting throughout, however for people living with dementia there were no sensory items which may keep people engaged.

People reported staff were kind and caring however we found this was not always the case for those living with dementia.

Care plans were not person centred which meant people may not always receive responsive care. Care plans did not always contain sufficient information about the person as an individual to help staff get to know people.

People received adequate food and drinks and were involved in making decisions about the food they ate.

People received their medicines in a safe way. Care was provided to people by staff who were trained and received regular supervision. Staff understood their responsibilities in relation to safeguarding. Appropriate checks were carried out in the recruitment of new staff to help ensure only suitable staff worked in the home.

Staff supported people to access health care professionals, such as doctors, dietician, district nurse and optician.

People were encouraged to voice their opinions as there was a complaints policy available. Residents meetings took place as well as satisfaction surveys to ensure everyone was involved in the running of the home. Relatives were made to feel welcome.

Staff carried out regular audits to check the quality of the service they were providing. However, the registered manager had not effectively monitored and acted on feedback from relatives, or lack of staff in Unit B.

During the inspection we found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up visit to check whether the provider had taken the action needed to ensure that there were enough staff to meet people’s needs. We also checked whether people were cared for by staff who received adequate training and support. We looked at records to check whether recording of care had improved.

During our follow up visit we spoke with three people and one relative. We also looked at records and spoke with five staff including the manager of the service.

We saw that the atmosphere of the home appeared relaxed and there were enough staff on duty to meet people’s needs. We saw that improvements had been made to both staffing and the environment. For example, a library had been created for people to use and more care staff had been employed.

People we spoke with told us that “The care is very good” and confirmed that there were always enough staff and volunteers to help them.

Staff we spoke with told us that they felt supported by the manager and we saw that staff worked together well.

We saw that record keeping had improved and care plan records were up to date.

There were 49 people living at the home at the time of our inspection.

We spoke with nine people and three relatives and conducted observations throughout the visit. Many people who used the service were unable to communicate well with us due their mental frailty but we saw that carried out observations throughout our visit.

We looked at records and spoke with five staff including the area manager of the service.

We saw that staff spoke with people respectfully and the atmosphere of the home appeared relaxed.

We saw that activities took place in the morning and that people were walking or sitting in enclosed gardens during the afternoon.

People told us that they felt safe and that staff were kind. Staff had received recent safeguarding training.

We saw that the home was clean and well maintained.

There were mixed views from people about the level of staffing and two people and their relatives commented negatively about waiting for staff to assist.

We saw that appropriate training and supervision was not always provided to support staff in their role. We also saw that care records were not always up to date.

This was a follow up visit to check whether the provider had completed the necessary compliance actions following their last inspection in June 2012 where they were found to be non compliant in relation to care and welfare. The inspection was also carried out in response to concerning information about the care and welfare of people using the service.

During the follow up inspection visit we spoke with four people who used the service. We carried out an observation using a specially designed tool over half an hour during the resident’s lunch. This tool enabled us to gather information through observations about the welfare of people who may not have been able to provide responses to our questions. We also conducted observations and saw that both staff and volunteers helped people at a relaxed pace. We observed that people were gently encouraged and spoken to softly and respectfully.

We asked people what they thought about the care that they were given and each person told us that they were happy with the care provided and that staff and volunteers were kind and helpful.

Two people commented on the staff, one saying to us, they “look after me very well.” Another person said “I admire the staff.”

During our discussions people indicated to us that they were happy living at the home and that their individual needs were met. One person said of the staff and volunteers “they always make allowances for me.” Another person told us that “they are all very kind.”

Residents who spoke with us were happy living at the home. They told us that they were satisfied with the staff, the facilities and the meals. We were told that there had been some occasions where staffing levels appeared low, which meant some delays in responding to call bells or interruptions to the care being delivered in one case.

Staff were said to be good, one person telling us that the “Care is very good.” One resident felt that some of her preferences were not addressed in respect to activities. For example, she would like to go into the garden in fine weather but had only been outside once since January.

A visiting relative who spoke with us provided positive feedback on the home, saying that she was satisfied with the care her mother was receiving.

People using services mostly expressed satisfaction with their care. Negative comments made by a person about staff practice and conduct were drawn to the registered manager's attention. Though staff were said to be usually very busy, most people said their call bells were promptly answered. However two people told us this was not their experience and delays in responding to their call bells was a problem. Most people were happy with their rooms. They said the home was comfortable and suitably equipped. One person felt their room was too small. Another expressed the view that a lockable item of furniture should be supplied. One person told us how much they enjoyed the meals and said they had a choice of food. Others also commented favourably on the standard of catering. People said that from time to time they were asked for their views about the home and quality of care.