The inspection was unannounced and took place on 14 and 15 May 2018.

St Catherine’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 Catherine’s is registered to provide accommodation with nursing and personal care for up to 40 people. There are currently 39 bedrooms, one of which is for double occupancy. There are two units within the home which are all based on one floor. On the day of our inspection there were 27 people living in the home.

St Catherine’s has a registered manager, however they had resigned from their post two weeks prior to our inspection. There was an interim manager in post who had been in the home just under a week. 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 last inspection took place on 2 and 6 November 2017. At that inspection we identified four breaches of the relevant regulations in respect of the safe management of risk, not acting within the principles of the Mental Capacity Act 2005, poor paperwork and ineffective quality assurance systems. The service was rated inadequate overall and placed in special measures. We took further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection, we found that significant improvements had been made and the service is no longer in special measures. We found that the provider was still in breach of one regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found that care records were not always being updated following any changes or when advice had been given by professionals. Care plans did reflect people’s preferences as well as life history and their needs. We found additional monitoring sheets where people were identified at high risk were not consistently completed.

We found that the provider had no effective systems to monitor and improve the standard of care provided in the home. The manager did not have oversight of the risks to people within the home and subsequently actions had not been taken to address these risks.

The registered provider had some quality assurance systems in place. Some shortfalls were identified through these systems and these were being to be addressed. However, we continued to find other shortfalls in the quality and standards within the service that were not identified by the provider’s quality assurance systems. We saw that there had been improvements since the last inspection and these needed to be sustained and built upon.

Relatives and people living there were positive about the permanent staff working at St Catherine’s and we observed positive relationships between permanent staff and people living in the home. However, we also received a number of negative comments about the high agency staff usage and how their approach was variable dependent upon how many times they had visited the home. There were sufficient staff to meet the needs of the people living in the home. We did receive negative comments from relatives about the levels of agency staff working within the home as this impacted on the quality of the care given as they were not familiar with their family members. The provider had met with the agencies that they used to try and ensure that the same agency staff attended the home provide consistency. The provider was actively recruiting for mo

The inspection was unannounced and took place on 2 and 6 November 2017.

St Catherine’s Care Home is a nursing home based in Nantwich and is registered to provide accommodation with nursing and personal care for up to 40 people. There are currently 39 bedrooms, one of which is for double occupancy. There are two units within the home which are all based on one floor. On the day of our inspection there were 31 people living in the home.

The home does not have a registered manager. The manager in post who assisted with this inspection was applying to be registered but has now resigned from the service. 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 last inspection took place on 23 January 2017. At that inspection we identified four breaches of the relevant regulations in respect of the safe management of medicines and people’s risk assessments not being followed, people being restrained without best interest decisions being recorded, people’s privacy not being respected and actions had not been acted upon when improvements to the service were needed and identified by the provider’s audits. At this inspection, we found that there were improvements in some areas; however the provider was in breach of four regulations.

We are taking further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people were not managed safely and there was no clear guidance for staff on how to reduce the risks identified. There was no oversight or learning from incidents and accidents that happened in the home.

Staff had completed safeguarding training and we saw instances where incidents had been recorded, however the provider’s systems for reporting to the local authority were not robust. We found some safeguarding incidents had not been appropriately referred to the local safeguarding team. There was no managerial oversight of the

This inspection took place on 23 January 2017 and was unannounced. At our last inspection in November 2015 we found that the service required improvement in relation to providing a safe, effective and well led service.

St Catherine’s Care Home provides support and care for up to 40 people, some of whom may be living with dementia. At the time of this inspection 39 people used the service.

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.

Risks to people's health and wellbeing were assessed but not always managed to keep them safe from harm. Staff did not always follow the plans put in place to reduce and mitigate risks for people. Accidents and incidents were not thoroughly reviewed to try to avoid repetition. Staffing levels were not reviewed when there were changes in people’s level of need.

Medicines were not managed safely. People did not always receive their medicines as prescribed and the systems in place to manage the risks associated with them were not always followed.

The principles of The Mental Capacity Act (MCA) 2005 were not consistently followed. The provider was not ensuring that people were consenting to, or when they lacked mental capacity were being supported to, consent to their care.

People offered positive and negative comments in regard to the food. Where people were at risk of malnutrition care plans were in place to ensure people were eating sufficient amounts to keep them healthy.

People were supported to access other healthcare professionals to maintain their health and wellbeing. However not all concerns were followed up in a timely way.

People’s privacy, dignity, preferences and views were not always respected and upheld. Leisure and social activities were provided, but not all people received the support they needed to engage in meaningful activity.

There was a complaints procedure but not all people were aware of it.

Audits and quality monitoring systems were completed but did not always record all relevant information so they were not effective in driving improvements. Improvements were needed to ensure the systems in place adequately assess, monitor and improve the quality of care.

We found 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.

The home was split into two ‘wings’, one ‘dementia unit’ and one ‘elderly frail unit’. Due to the nature of the home it was inappropriate to engage with the service users from the ‘dementia unit’ due to their communication difficulties. As a result, we spoke to five people from the ‘elderly frail unit’. We also spoke to four members of staff, five relatives from both units, observed care in the dementia unit and reviewed six care plans.

We saw evidence and were told by relatives that the staff liaised with them about any changes in their family members’ care with them and would review care plans with them. All relatives told us they felt involved with the home, staff and their family member. All five relatives said that they felt the staff liaised well with GPs and external professionals. We saw staff maintained records of this in the care plans.

Staff told us they had plenty of time to assist those who needed help to eat their meal and to encourage those who had a poor appetite, we saw evidence of this. We observed staff assisting one person who was blind whilst eating and drinking; she explained clearly to the person what she was eating and gave her clear instructions when trying to assist her. We saw staff were aware of people’s individual needs.

All medicines were appropriately prescribed, for example, by their respective GPs. All the medication charts contained the required information about the service user in order to be able to administer medication safely. When asked, staff were aware of the risks and side effects associated with certain medication, for example, anti-coagulants.

During our visit we spoke with eight people who used the service and a number of relatives who were visiting the home. We also used the Short Observational Framework for Inspection (SOFI) in the unit that provides accommodation for people living with dementia. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who lived in the home told us that they “no concerns about the way they were treated”.

Relatives spoken with told us that they were regular visitors to the home, for some this meant visiting the home on a daily basis, and they had always seen staff treat people with respect and maintain their dignity. They also told us that they were kept fully informed and updated about their family member. They told us that “without exception’’ staff were “kind, caring and always had time to have a chat’’. One relative told us that “staff seemed to know about each person and how best to care for them”.

People who lived in the home told us that, because of the care and support given by staff, their overall quality of life and health had improved. They also told us that senior staff “were always available” and that any worries, concerns or complaints they had were listened to and acted upon.

All of the relatives were very positive about the manner in which they were kept up to date with issues that concerned their family members.

This inspection took place on 19 and 26 August 2015 and was unannounced.

St. Catherines is a purpose built building and supports up to 40 people diagnosed with dementia and nursing care. St Catherines is run by Community Integrated Care (CIC). The service is provided within two separate units, Weaver and Meadow. Each unit has its own lounge, dining room and utility kitchen. All bedrooms are single. There is an accessible car park provided for visitors.

The home has 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.

At our last inspection 28, 29 October and 6 November 2014 the service was not meeting the regulations, in that we did not see they had suitable arrangements in place for obtaining and acting in accordance with, the consent of service users in relation to the care and treatment provided for them. We have received updated action plans from the provider stating what actions have been taken to improve these issues.

Relatives and people living at the home were happy with the behaviours and standards of care provided by staff. We observed how staff spoke and interacted with people and found that they were supported with dignity, respect and good humour.

We found that all staff had an understanding of supporting people when they lacked capacity, with making choices with everyday living. Care staff took appropriate actions to fully support people who lacked capacity to make their own decisions with regard to activities, dressing and choosing food.

The was little evidence to show that current research and guidance was being used which helps care homes develop the environment to meet the needs of the people they support who have varying needs due to living with dementia. We recommend that the environment be developed to meet the specialised needs of people living with dementia.

We found that senior staff had received training including the requirements of the Deprivation of Liberty Safeguards and appropriate referrals had been made to the relevant regulator in respect of depriving people of their liberty.

Care plans contained guidance to enable staff to know how to support each person’s needs. We found work was underway to develop each person’s care plan to incorporating their social support and aspirations; this would help to give better evidence for individualised care that met people’s social needs and requests.

We noted the service had a complaints procedure. Relatives and people living at the home were confident that they could raise their opinions and discuss any issues with staff.

The service operated safe staff recruitment and ensured that staff employed were suitable to work with vulnerable people. Appropriate pre-employment checks were being carried out and application forms were robust to enable the management of the home to have adequate information before employing staff.

At our second visit staff had started to receive formal supervision to assist them in their job roles and in their personal development. Refresher training had been planned but staff training records were incomplete and did not reflect all aspects of the training undertaken or needed for their role.

Various audits at St Catherine’s were carried out on a monthly basis by the registered manager and subsequently reviewed by the area manager. These were in place to ensure that appropriate standards were in place. We found audits had been ineffective at addressing shortfalls in the service in a timely fashion.