This inspection took place on 28 January 2016 and was unannounced.

St Bernards Residential Care Home Limited provides care and accommodation for up to 43 older people. There were 39 people living at the home at the time of our inspection, of which a small number of people lived with dementia. The home had recently been extended and refurbished to further enhance the living environment for people, to include people who lived with dementia. The extension had been designed based on research and best practice from national and international exemplar services in order to ensure best practice principles.

The home was compliant with our regulations at the time of the last inspection in August 2014.

A registered manager was 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.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life. The provider and staff team were passionate about providing high quality care tailored around people’s individual needs and preferences and spent time to understand the experiences of people who lived at the home.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia and ‘person-centred’ care, to ensure best practice based on recent evidence based research. There were processes to monitor the quality and safety of the service provided and actions were taken to drive continuous improvement for the benefit of the people who lived there. This was through regular communication with people, visitors and staff, surveys, checks on the staff team to make sure they worked in line with the provider’s policies and procedures and a programme of other checks and audits.

People and their relatives told us that staff were extremely kind, caring, thoughtful and compassionate, people were afforded privacy and treated with dignity and respect. They told us they believed this constituted outstanding care. People told us they had formed excellent relationships with the provider, staff team and other people who lived at the home, built on trust and respect.

The provider and staff team were passionate about ensuring people were involved in decisions about their care and how they led their lives. Staff took time to understand people’s life stories, so that people received support in the ways and at the times they preferred. Staff were creative in supporting people in ways that supported their individual needs. Should people lack capacity to make their own decisions, staff understood the principles of the Mental Capacity Act (MCA) and their advocates or families and other health professionals were involved in making decisions in their best interests. Staff obtained people’s consent before they provided care and support.

Staff with a range of skills were available at the times people needed them to receive support in all aspects of their lives. Staff had received training so that people’s specific care and support needs were met and we saw that this was put into practice. Staff told us the provider proactively ensured they had many opportunities to further develop their skills and knowledge. Staff told us they felt supported and valued by the provider and that they prided themselves on providing high quality care. They told us they were able to share their views and opinions about the service and any suggestions put forward were acted upon.

Staff understood their responsibility to safeguard people from harm and had a good understanding of who to report concerns to both withi

We last inspected this service on 22 January 2014. At that time we found that the temperature of the medication storage area consistently exceeded recommended levels. Staff were not recording how many tablets had been administered when the dosage was variable and when creams had been administered. There were no protocols for PRN medication. At this inspection we found that these issues had been addressed and the manager had made the required improvements.

At St. Bernards, there were 32 people at home on the day of our inspection. We observed people during the day. We talked with the manager and the owners of the home. We looked in detail at the care records of four people. We visited on a weekday and we spoke with three relatives. We spoke with three people and three members of staff. One person told us, “It is perfectly lovely here, the staff are very kind.”

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

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Staff understood their role in safeguarding the people they supported. This meant people were kept safe. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse. The staff and manager had a good understanding of the safeguarding procedures.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which ensured people’s rights and choices were protected.

We saw that risk assessments and health and safety measures were in place to keep people safe.

Is the service effective?

The service worked well with other agencies and services to make sure people received their care safely and effectively. A relative told us, “Nothing is too much trouble for the managers.” We saw that people were treated with dignity and care. Care plans specified people’s individual needs, for example, a person’s mobility, or food requirements. One member of staff told us, “I think we treat people beautifully, I’m supported to do my job.” All the people we spoke with told us they were satisfied with the care and support they received.

Is the service caring?

We saw the staff and manager were patient and gave encouragement when they supported people. All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with dignity and respect. A person told us, “They are very kind. They do what I want and talk to me. I’m quite alright.” We observed people during the day and saw that people were treated kindly and affectionately. We saw that people looked comfortable and relaxed in their home.

Is the service responsive?

There were cooks and domestic staff to ensure good food was provided and the environment was clean. We saw clear and detailed recording that ensured the manager could make timely and informed decisions about a person’s care and support. A relative told us, “Staff are very understanding of individual needs. They tell me straight away if there’s a problem and they are on the ball.”

Is the service well-led?

The manager was aware of their responsibilities in meeting the essential standards of quality and safety. We looked at quality assurance systems. There were systems in place to ensure the quality of the service was regularly assessed and monitored. There was a clear structure of supervision responsibilities within the staff team. Staff had regular training and learning opportunities. Staff we spoke with told us they thought the manager was approachable and provided good support. One member of staff told us, “The manager is lovely. They know what it’s like here and they help me to do my job.”

At the time of our visit St Bernards Residential Care Home was providing accommodation and care for 37 people. We spoke with five people and four visiting relatives about their experience of the service. People we spoke with were all very satisfied with the care they received and spoke highly of the staff. They told us:

“It is a very homely and caring atmosphere.”

“Excellent. I think the carers are absolutely first class. They are always caring.”

Comments about staff included:

“Super – they can’t do enough for you."

“Tremendously helpful."

“Lovely, very caring, very nice."

Staff demonstrated a good understanding of people’s needs and their individual likes and dislikes. We saw staff interacted with people in a kindly and reassuring manner. There were sufficient numbers of suitably qualified staff on duty to meet the needs of people. A visiting relative told us, “The owner has got a good quantity and quality of staff. There is always a lot of staff.”

We saw people were provided with a range of suitable and nutritious food and regularly offered drinks through the day. There was a relaxed atmosphere at lunch time and people were not rushed.

We checked how the service managed the administration of medicine. We found some improvements were required to ensure people's safety.

People we spoke with told us that if they had to complain they would talk to senior staff. We saw any complaints had been dealt with appropriately.

People living at St Bernards told us they were very happy there. They said that staff cared for them very well and they were content.

We spoke to five people who use the service. All were highly complimentary of the provider and amongst comments they made were “the staff are brilliant”, “it’s always very friendly” and “nothing is too much trouble.”

One person living at the home called back the staff member who served her dinner after she walked away from the table and said “thank you, dinner is lovely”.

Other comments included: "They always ask me what I would prefer" "They are very kind and helpful" "It is lovely here" "The staff look after me very well" "They know what I like" "They are so kind to me" "Nothing is too much trouble for them" "I have no

complaints".

They told us they felt safe there. They said: "It’s very secure here, I feel safe" "I know the staff look after me well" "I could talk to any of them if I had a problem".