We inspected St Dominics Residential Home on the 8 January 2019.

About the service: - St Dominics caters for up to 39 older people. At the time of our inspection 39 people were using the service. The service had spacious living areas and was set over two floors. The service was set in a residential area with easy access to the local community and had a large garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

People’s experience of using this service: People and relatives were very complimentary about the service and staff. One person said, “I am happy here, the staff are doing a good job.”

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received the appropriate training. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of people.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. Staff were trained to deliver support to people at the end of their life.

The service was well-led. The registered manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Rating at last inspection: Good (report published 7 January 2017)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We inspected this service on 28 September 2015 and the inspection was unannounced.

St Dominics Residential Home provides personal care for up to 39 older people, some living with dementia. There were 34 people living at the service on the day of our inspection and two people were in hospital.

During our last inspection carried out over two days, 25 April and 2 May 2014, we found that this service was not compliant in some areas. There were concerns around arrangements for gaining people’s consent, care plan reviews, staffing and the use of door wedges which might impact swift evacuation of the building in the event of a fire, and quality assurance processes.

During this inspection we found that the manager had taken action and was offering a good service overall. Although we found the service continued the use of door wedges and had risk assessments around their use to safeguard people. However, we had concerns about the quality of the risk assessments. We asked the fire officer for their opinion, they told us that it was recommended that an automatic closure device suitable for the intended occupancy should be fitted to all bedroom doors.

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

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.

There were enough staff to support people safely and staff knew what to do if they suspected someone may be being abused or harmed. Recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in care.

Medicines were managed and stored properly and safely so that people received them as the prescriber intended. Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Staff were clear about their roles. Where people were not able to give informed consent staff and the manager ensured their rights were protected.

People had enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who were becoming unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s needs and references so that they could engage meaningfully with people. Outings and outside entertainment was offered to people and staff offered activities on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that they were confident that any complaints they made would be addressed by the manager.

The service had consistent leadership. The staff told us that the manager was supportive and accessible if they wanted to talk with them. There was an audit system in place to check that the service was offering a good quality service. The audits were in place but some lacked detail. The provider visited the service several times a week to check that the quality of the service was maintained and spoke with people who used the service to pass time and to gave them the opportunity to give their view of the way the service was managed. But the provider did not record the visits. We have asked for the audits to become more detailed and suggested that the provider recorded their visits, we have been told that both have been have been put in place.

People were also given the opportunity to voice their views in an annual survey, we saw the last survey and noted that only positive comments were recorded.

We found that people who used the service were happy with the care and support they received. We examined records, observed practice and found that the care and support was keeping people safe. One person told us, “The food here is lovely, you should stay for dinner. I like that my daughter can visit whenever she likes.” A relative said, “I can come here whenever I like. I feel my relative is well looked after and I would recommend this home to anyone”.

We found that this service was well led by a manager that was well respected and trusted by people who used the service and staff who worked here. There were systems in place that protected people and enabled people to express their views.

People we spoke to were happy living at St Dominic's Residential Home. They told us that they would recommend the home to people and that they had nothing to complain about. They spoke positively about the staff team at the home and the care provided. One person said 'If you need help you don't have to look far, you are never left' and another said 'The staff are my friends'.

As part of this inspection we spoke with six people who used the service, seven care staff, two visitors, the activity co-ordinator and two members of the management team. We looked at five people's care records. Other records we reviewed included, staffing records, quality and monitoring records, health and safety records and satisfaction questionnaires completed by the people who used the service and their relatives.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

People told us that staff always respected them and that they felt safe. Signage around the whole service was well lit and clear, this included all emergency exits which enabled people to move around the service freely and safely.

The rotas seen provided information with regard to how many staff were on duty each shift. However we saw that some people were left for unacceptably long periods of time before receiving the support and care they required. This created unnecessary anxiety and stress to some people because there were not enough staff to respond to people in a timely manner.

We found the service to be unsafe with regard to the current systems in place for the prevention and risks of fire. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the prevention of fire for the people who live, work and visit the service and in relation to staffing .

Is the service effective?

People's health and care needs were assessed but these were not always completed in consultation with either the person themselves, relatives or their advocate. People had a plan of care in place that reflected their healthcare needs. However some of these care plans had not been reviewed or updated to reflect the person’s current and changing needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the assessing and monitoring of people’s care, and how they were going to involve people in the planning of their care.

We found that the service had not followed the appropriate procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards with regard to appropriate assessments being completed for people who were unable to give consent. We have asked the provider to tell us what they are going to do to meet the requirement in law and in relation to ensuring that people who do not have capacity are assessed appropriately to ensure they are safeguarded from harm or inappropriate care.

Is the service caring?

People were supported by staff who were kind, caring and respectful. Care workers

supported people with patience and genuine affection and assisted people who required additional support in a dignified manner and at their own pace.

People commented: "All the staff are very kind. I really like it here especially the daily activities.” People's preferences, interests and choices had been recorded along with the care and support offered in accordance with people's wishes.

Is it responsive?

People who used the service and their relatives involved in the service had completed a satisfaction survey and some of the issues raised had been addressed and an action plan completed.

People were involved in participating in a range of interesting and varied activities both within the service and were also offered regular visits from outside entertainers.

People told us that they knew how to complain if they needed to. One visitor stated that they had been provided with information on how to raise a concern when they first moved their relative into the service. There was information displayed around the service on how to make a complaint.

Is the service well led?

The service had a quality assurance system in place but records seen showed us that not all areas of the service were monitored or reviewed regularly. This included the records that relate to the monitoring of the environment, health and safety monitoring and the monitoring of individual care records.

We have asked the provider to tell us what they are going to do to meet the requirement in law in relation to quality assurance.