About the service: St Clements Nursing Home is a residential care home that provides nursing care and accommodation for up to 25 people, some of whom may be living with dementia. At the time of our inspection, 21 people were using the service.

People’s experience of using this service:

The risks to the quality and safety of the service were identified and acted on. There was enough staff on duty to enable people to remain safe and receive care in a timely way. The environment was safe and people had access to appropriate equipment where needed. People were supported to take their medicines in a safe way.

People, their relatives and staff told us the registered manager was approachable, they felt listened to when they had any concerns.

Staff had received appropriate training and support to enable them to carry out their role safely. Peoples health was well managed and staff had positive links with professionals which promoted wellbeing for them.

Staff were kind and caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensure they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

People's records clearly identified their preferences. Staff provided effective care for people which met their needs through person-centred care planning. This enabled people to achieve positive outcomes and promoted a good quality of life. Complaints were managed within the providers stated process.

Staff were motivated and enjoyed strong team work. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

Rating at last inspection: Good (Published January 2016)

Why we inspected: This was a scheduled inspection based on our previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The inspection took place on 10 December 2015 and was unannounced.

St Clements Nursing Home provides nursing care for up to 25 people, some of whom may be living with dementia. The home is adapted to meet people’s needs and is over two floors. Some rooms are shared. At the time of the inspection 23 people were living at the home. The registered manager told us this was the maximum number of people they could accommodate as some of the shared rooms were currently being used by only one person.

There was 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.

People benefitted from being supported by staff who were safely recruited, well trained and felt supported and valued in their work. There was consistently enough staff to safely meet people’s individual needs.

Staff understood how to protect people from abuse and knew the procedure for reporting any concerns both inside and outside of the service. Medicines were managed and stored safely and adherence to best practice was consistently applied. People received their medicines on time, safely and in the manner the prescriber intended.

People were supported by staff that were well trained, had been inducted effectively and received regular supervision. New staff were in the process of completing the new Care Certificate. Staff demonstrated the training they had been given.

Team work was evident and staff told us they were happy working at St Clements Nursing Home. They felt empowered to voice their opinions and told us they were well supported in their roles. They demonstrated a good knowledge of the people they supported and they assisted people with kindness, compassion and respect. People’s dignity and privacy was maintained and respected.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was not depriving people of their liberty unlawfully and worked within the principles of the MCA DoLS. However, staff knowledge was variable although people told us staff always asked their consent before assisting them. The service had made timely applications to the supervisory body.

People’s care plans were detailed and individualised. They contained important and relevant information to assist staff in meeting people’s needs in a way that was personalised. People and their relatives had been involved in making decisions around the care they needed and wished for. The changing needs of people were reviewed on a regular basis and people and their relatives were encouraged to be involved in this.

Working together with the community healthcare teams, people’s health and wellbeing was well supported and maintained. People had access to a variety of healthcare professionals and staff were prompt at requesting advice and intervention as required.

Although people told us they enjoyed the activities the service provided, we found that people’s individual social and leisure needs were not always met. The service encouraged people to maintain relationships with others and the service actively welcomed family members and visitors to the home.

The culture was one of respect, professionalism and openness. People felt listened to and were confident any concerns they may have would be addressed. Improvement and development of the service was important and people were involved in this. Effective systems were in place to monitor the service and the management team played an active part in gaining feedback from people on a regular basis.

People’s care and welfare needs were recorded in detail and their care plans showed us that they were being met in line with people’s assessed needs.This showed us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Three people spoken with told us that the meals provide were good and that they were given a choice at each mealtime.This and the other evidence reviewed demonstrated to us that people were protected from the risks of inadequate nutrition and dehydration.

We saw that sufficient staff were available to provide individual nursing care and support as required and that each person who required care received this in a prompt and supportive way. This meant that there were enough qualified, skilled and experienced staff to meet people’s needs.

We saw evidence of a clear response to each complaint received by the service and this identified the follow up actions taken by the provider. This meant that there was an effective complaints system available.

The records kept by the service were stored securely and reflected how the service was meeting the individual needs of the people who used this service. This showed us people were protected from the risks of inappropriate care and treatment because accurate records were maintained.

People told us that they felt respected and involved by staff. One person told us that, “The staff always have time for me.” This demonstrated to us that people’s privacy, dignity and independence were respected. We spoke with 12 people who were living in this service. They reported that they were satisfied with the care and attention shown by staff. This showed us that people experienced care, treatment and support that met their needs and protected their rights.

People told us that they felt safe in this service. One person told us that, “If l am concerned about anything l can tell the staff.” This showed us that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff spoken with told us that they were up to date with their mandatory training and had received recent supervision. They reported that they were well supported by senior staff. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We saw evidence of satisfaction questionnaires for service users, visitors, staff and visiting professionals. Evidence was seen that actions had been taken to address any identified concerns. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people received.