We inspected the service on 20 December 2018. The inspection was unannounced.

St Catherines Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates 39 people.

On the day of our inspection 32 people were using the service.

At our last inspection on 7 and 8 September 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Potential risks to people were assessed and minimised.

Staff were only employed after the provider had carried out satisfactory pre-employment checks. There were enough staff to ensure people’s needs were met safely and in a timely manner.

People were supported to receive their prescribed medicines by staff who were trained and had been assessed as competent to administer medicines. The service was clean and tidy and staff knew how to prevent the spread of infection.

Staff knew the people they cared for well and understood, and met, their needs. People received care from skilled and knowledgeable staff who were trained in a wide range of topics and were well supported.

People were well supported by staff to have enough to eat and drink. Staff assisted people to access external healthcare services to help maintain their health and well-being. The service worked in partnership with other agencies, particularly local healthcare professionals, to provide care that met people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were fully involved in making decisions about their care and support. People and their relatives were involved in the setting up and review of their or their family member’s individual support and care plans.

Staff were kind, caring and friendly. They respected and promoted people’s privacy, dignity, and independence. Staff supported people to maintain existing relationships by welcoming visitors into the service.

People’s individual needs were assessed and staff used this information to deliver personalised care that met people’s needs effectively. People had opportunities and were supported to engage in meaningful activity. The service had strong links with the local community. People’s religious and cultural beliefs were respected and supported.

Staff supported people to have the most comfortable, dignified, and pain-free a death as possible. Staff worked in partnership with other professionals to ensure that people received care that met their needs.

People’s suggestions and complaints were listened to, investigated, and acted upon to reduce the risk of recurrence.

Staff liked working for the service. They were clear about their role to provide people with a high-quality service and uphold the service’s values.

The registered manager and provider sought feedback about the quality of the service from people, visitors and other stakeholders. Audits and quality monitoring checks were carried out to help drive forward improvements. The provider invested in resources to improve the service people received.

Further information is in the detailed findings below.

The inspection took place on 07 and 08 September 2016 and was unannounced. St Catharine's Nursing Home provides accommodation and personal care for up to 39 older people, some of whom live with dementia. At the time of our inspection there were 35 people living at the home.

At our last inspection on 10 November 2015, the home was not meeting the required standards. The provider had not ensured that adequate steps were taken to mitigate the risks of health care associated infection in all areas of the home. At this inspection improvements had been made in those areas, we found that the provider was now meeting the required standards in relation to infection control.

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 told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally if the need arose.

Safe and effective recruitment practices were followed to make sure that staff were of good character, physically and mentally fit for the role performed. There were sufficient numbers of suitable staff available to meet people’s individual needs at all times. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies.

People were positive about the skills, experience and abilities of the staff that supported them. Staff received training and refresher updates relevant to their roles and had regular supervisions to discuss and review their performance and professional development.

People’s medicines were managed, stored and administered in a safe way by staff that had been trained and had their competencies regularly checked.

People’s health needs were met in a safe and effective way according to their individual needs and they were supported to access health and social care appointments when necessary. People were positive about the standard and choice of food provided at the home. Staff were familiar with people’s dietary requirements and preferences.

People were looked after in a kind and compassionate way by staff that knew them well, respected their privacy and promoted their dignity. We saw that staff provided care and support in a patient, calm and reassuring way that best suited people’s needs.

People had access to information and guidance about local advocacy services. Information contained in records about people’s medical histories was held securely and confidentiality was sufficiently maintained. People and their relatives told us they were involved in the planning, delivery and reviews of the care and support provided.

People received personalised care that met their needs and took account of their preferences. Staff had clearly taken time to get to know the people they supported and were knowledgeable about their likes, dislikes and personal circumstances. Opportunities were made available for people to pursue and engage in social interests and take part in activities tailored to their individual needs.

We saw that where complaints had been made they were recorded and investigated properly. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. People were positive about the registered manager and how the home operated.

The service was well led by a registered manager who supported the staff and provided visible leadership. The provider supported the registered manager and staff. There was a quality management system in place which included a system of audits to identify where improvements could be made.

The inspection took place on 10 November 2015 and was unannounced. St Catherines Nursing Home provides accommodation and personal care for up to 39 older people, some of whom live with dementia. At the time of our inspection there were 34 people living at the home.

At our last inspection on 21 October 2014, the home was not meeting the required standards in relation to how consent had been obtained, the way in which risks to people’s health was managed and the lack of meaningful activities provided. At this inspection, although improvements had been made in those areas, we found that the provider was not meeting the required standards in relation to hygiene. This was because some areas of the home, for example toilet facilities, had not been adequately maintained or cleaned to the standards required to protect people from the risks of infection.

There is a manager in post who has 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 can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the provider worked within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met.

Security arrangements at the home meant that a significant number of people who lived there could not leave freely without the help and support of staff or family members. In all cases we found that the provider had followed the requirements of the MCA in order to keep people safe and had submitted applications to the appropriate supervisory body for authority to do so.

People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally if the need arose.

Safe and effective recruitment practices were followed to make sure that staff were of good character, physically and mentally fit for the role performed. There were sufficient numbers of suitable staff available to meet people’s individual needs at all times. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies.

People were positive about the skills, experience and abilities of the staff who supported them. Staff received training and refresher updates relevant to their roles and had regular supervisions to discuss and review their performance and professional development.

People’s medicines were managed, stored and administered in a safe way by staff who had been trained and had their competencies regularly checked.

Staff obtained people’s consent before providing the day to day care they required and this was reflected in the guidance provided. Where ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions were in place people had either consented to them or, where they lacked capacity to do so, best interest decisions had been made in accordance with the MCA 2005.

People’s health needs were met in a safe and effective way that met their individual needs and were supported to access health and social care appointments when necessary. They were positive about the standard and choice of food provided at the home. We saw that the meals served were hot and that people were regularly offered a choice of drinks. Staff were familiar with people’s dietary requirements and preferences.

People were looked after in a kind and compassionate way by staff who knew them well, respected their privacy and promoted their dignity. We saw that staff provided care and support in a patient, calm and reassuring way that best suited people’s needs.

People had access to information and guidance about local advocacy services. Information contained in records about people’s medical histories was held securely and confidentiality sufficiently maintained. People and their relatives told us they were involved in the planning, delivery and reviews of the care and support provided.

People received personalised care that met their needs and took account of their preferences. Staff had clearly taken time to get to know the people they supported and were knowledgeable about their likes, dislikes and personal circumstances. Opportunities were made available for people to pursue and engage in social interests and take part in activities tailored to their individual needs.

We saw that where complaints had been made they were recorded and investigated properly. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. People were positive about the manager and how the home operated. However, while systems were used to quality assure services and manage risks had improved; these were not as effective as they could have been.

At this inspection we found the service to be in breach of Regulation 12 of the Health and Social Care Act (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 inspection took place on 21 October 2014 and was unannounced. We last inspected St Catherines Nursing Home in December 2013. At that inspection we found the service met the essential standards assessed.

The service is registered to provide nursing and personal care for up to 39 older people, some of whom live with dementia and physical disabilities. At the time of our inspection 32 people lived at the home and a registered manager was in place. 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.

People told us they felt safe at the home. We found that staff were knowledgeable about the risks of abuse and reporting procedures. Although we received mixed views about staffing levels, we found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed.

There were suitable arrangements for the safe storage and disposal of people’s medicines. However, prescribed creams and ‘as needed’ (PRN) medicines, such as pain relief tablets, were not managed as effectively as they could have been.

The CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at St Catherines Nursing Home. However, we found that in some cases where people lacked capacity to make their own decisions, consent for their care had not always been properly obtained in line with the MCA 2005.

People had access to healthcare professionals such as GP’s, dentists and chiropodists. However, some people’s health needs had not always been met effectively. We found that people were provided appropriate levels of support to help them eat and drink where necessary. They were looked after by staff who were trained and had the skills necessary to provide safe care.

Most people were happy at the home and we saw that staff treated them with kindness, dignity and respect. Relatives were positive about the care and support provided. We saw that staff helped and supported people in a kind, patient and caring way. They knew and used people’s preferred names and worked at a pace that best suited people’s individual needs. However, there were not enough group or individual activities provided at the home and most people were not provided with adequate support to help them pursue their social interests or access the local community.

People who lived at the home, relatives and staff were positive about the registered manager and felt that most aspects of the home had improved since they took up the post in September 2014. However, we found that action plans drawn up and used by the manager to tackle concerns highlighted in feedback and other quality assurance measures had not always proved effective.

We recommend that the provider reviews security arrangements for the storage of people’s care records, confidential information and medical histories. We found that cupboards used to store them were not always locked or secured in a way that adequately preserved confidentiality.

At this inspection we found the service in breach of Regulations 9, 10 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches correspond with Regulations 9, 17 and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which came into force on 01 April 2015.

You can see what action we told the provider to take at the back of the full version of the report.

During our previous inspection of St Catherine’s Nursing Home on 14 July 2013 we found that infection prevention and control practices in the home were not adequate. We also found that the provider had not taken appropriate actions to adequately maintain the building and the grounds of the home.

As a result of our findings, we asked the provider to send us a report setting out the actions they would take to meet the standards

The provider submitted an action plan in August 2013 informing us how they would make improvements.

During our inspection on 18 December 2013 we found that the provider had made sufficient improvements to the infection prevention and control practices in the home and had also undertaken a renovation programme and updated several bathrooms, toilets and sluices.

During our previous inspection on 14 July 2013, we found that the provider did not always respect people’s privacy and dignity and take into account people’s views and experiences about how the service was provided. We also found that the provider did not have any systems in place to assess and monitor the quality of the service provided to people who lived in the home. As a result we asked the provider to send us a report setting out the actions they would take to meet the standards. They submitted an action plan to us in August 2013 informing us of how they would make improvments.

During this inspection on 03 October 2013, we found that the provider had taken action to ensure that people were given choices and that they were involved in how their care was planned and delivered. We also saw that new audit tools had been implemented which had ensured that the service provided to people was now assessed and monitored.

Prior to our inspection on 03 October 2013, we had received some information of concern in relation to staffing levels within the home. We had been told that there were times when there were not enough staff on duty to meet people’s needs. During our inspection we reviewed staffing levels and found that there were sufficient numbers of staff to meet people’s needs.

During our inspection we spoke with eight people who lived in the home. One person told us, "Staff are lovely and really do try their best, but they are so busy. There is not much to do during the day at the moment". We found that people who lived in the home and their relatives were not involved in planning their care and that people's privacy and dignity needs were not met. Due to the lack of an activities co-ordinator, people were not offered any form of stimulation or social interaction.

We found that people's care records were current and reflected the needs of people who lived in the home.

During our inspection we found that infection control practice in the home was not adequate to keep people safe.

During our inspection we found that parts of the building and the grounds were run down and not well maintained.

The provider had a recruitment procedure in place to ensure that only people suitable to work with vulnerable people were employed.

We found there were arrangements in place for adequate numbers of suitably trained staff.

There were no monitoring systems in place on a number of aspects of the service. These included areas such as infection control, cleaning and people's care records.

During our Inspection in March 2013 we found that the information in people's care records was not detailed. During our inspection on 17 July 2013 we noted that action had been taken and this had improved.

People using the service told us they received the care they wanted from the staff team. One person said, “They are always here to help us.” The staff members we spoke with were very clear about the current needs of the people using the service and what care they were to provide.

People told us they would be comfortable to raise any concerns they may have with any staff member. They said they were confident that their concerns would be listened to and taken seriously.

A broken storage facility meant that record keeping arrangements in the home did not always ensure that people's personal and private information was held securely. Record keeping was not always comprehensive enough to provide a picture about how people spent their day, what care and support had been provided for them and any other matters relating to the whole person.

On the day of the inspection there were thirty people accommodated in the home. We spoke with five people who live at the home and two relatives. The feedback from people was overwhelmingly positive with much praise for the staff and the care they provided.

People told us that they felt safe in the home and protected from harm.

Comments included, "I don't want to be anywhere else". "Staff will do anything for you and the personal care - you know you can depend on it".

We carried out an early morning unannounced visit to St Catherine’s Nursing Home following information we had received. The information raised concerns about the safety of the people who live there, the number of staff provided at night and whether people were being given a choice of when they wanted to get up.

During our visit which started at 5:15 am, on the 23 January 2012, we were able to speak with five people who have rooms on the ground floor. One person said they were ‘very happy here’ and felt safe and got on well with the staff. Two people told us if they needed anything they ‘only had to ask’. Another person told us the staff were ‘very pleasant’. One person when asked if staff were gentle when they got them up told us that ‘ some were’. People who are more dependent on staff to interpret their needs and not so able to express their views have rooms on the first floor.