This inspection took place on 18, 19, 20 and 22 August 2016 and was unannounced.

At our last inspection on 1 and 2 April 2015 we found accurate records had not been maintained relating to decisions made in people’s best interests, their care planning, risk assessments and the support staff received. The provider forwarded to us an action plan of how this would be addressed. They told us this would be fully completed by 31 August 2015. During this inspection we found this breach in regulation had been fully met.

The care home provides care to up to 69 people. People who received care were predominantly older people and some lived with dementia. At the time of this inspection there were no vacancies and there was a waiting list.

The registered manager had been in post since June 2015 and just after our last inspection in April 2015. 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 service kept people safe and there were arrangements in place to ensure this remained the case. These ensured people were protected from abuse, discrimination and poor practice. People also lived in a safe, well maintained building, which was kept clean and where good infection control practices protected people from avoidable infection. People received their medicines safely and when needed. There were plenty of staff to meet people’s needs and staff were exceptionally well trained and supported to do this. People and relatives told us staff were caring and compassionate. One relative said, “They care for [name] as if [name] were their own Mum, they go above and beyond”. People’s dignity and privacy were maintained at all times.

People told us their health and care needs were met consistently and met to a high standard. The service was able to be extremely effective. One relative said, “I want the best for [name] and I can’t fault one of them [the staff]. They do everything well” and one person said, “They really treat me well, I have not looked back since I have been here”. Staff supported people to make independent decisions about their care and treatment and to have these respected. People had good access to health care professionals and staff acted as advocates for people ensuring they gained access to NHS health support when required. Proactive measures were in place to identify a decline in health quickly and prevent an admission to hospital if possible.

Where people were assessed as lacking mental capacity they were fully protected by staff who adhered to the appropriate legislation. People who were at risk of not eating and drinking enough had individual support to maintain their nutritional well-being. People’s choice of food was extremely good and the service went out of their way to accommodate all food preferences and wishes. Staff promoted independence and supported time with family and friends. Where people could not engage in care planning or care reviews their relative and representatives were actively encouraged to be involved on their behalf.

The service was extremely well managed with staff fully engaged and committed to the manager’s vision and expectations. The registered manager provided exceptional support to the staff and in turn they were able to carry out their work to a high standard which people benefited from. There were numerous comments about the registered manager’s exceptional management skills and support. These included: “It’s run very well”, “There is a chain of command which is followed and everyone works as a team”, “She’s a tonic to everyone”, “I’m able to see her any time, communication is good and things get done” and “I have not met anyone or any member of staff who has a bad thing to say about [name of registered

This inspection was carried out by an adult social care inspector, a pharmacist inspector and an expert by experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with eight people who use the service, three relatives, one visiting health care professional, the registered manager and 10 members of staff. We also observed how people were cared for. We reviewed records relating to people's care such as people's care plans, risk assessments and medicine administration records. We also reviewed records relating to the management of the service. For example, a selection of policies and procedures and quality assurance and monitoring records.

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

Is the service safe?

People were safe because staff had been given information about people's risks and strategies had been put in place to manage these. For example, specialised equipment had been introduced to reduce the risk of people developing pressure ulcers.

The service was safe because staff adhered to the policies and procedures which underpinned the service’s aims and objectives which was to keep people safe. For example, staff followed procedures that safeguarded people from abuse. The staff we spoke with were aware of the kinds of abuse people could be at risk of. They knew what to do if they witnessed, suspected or received an allegation of abuse. Two people who use the service told us they felt safe.

The service had a safe system in place for the storage of and recording of medicines, but guidance for staff relating to when some medicines should be given and for what reason was missing. This increased the risk that people would not receive their medicine correctly and safely. A compliance action has been issued in respect of this and the provider must tell us how they will address this.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The service was effective because people received care that met their individual needs, choices and preferences. Care plans did not reflect people’s individuality but gave staff basic guidance on how to meet the person's care needs. One person said, “I can say I’m happy and well-cared for”. Another person said, "I consider myself extremely lucky because I’m being well looked after. I get on well with the staff and people like coming here to see me”.

The service was effective because staff were aware of people’s preferences, abilities and behaviour's. One person said, “I tell them when I can do things and I tell them what I can do and what I can’t do. They (the staff) realise I can do a certain amount myself”. The person said “they recognise my difficulties”

The service was effective because it delivered care with people’s consent and where consent could not be given care was delivered in people’s best interests.

The registered manager explained that between 80% and 90% of the people who use the service had dementia. The service was effective because it involved the people who knew the person well, usually a close relative, in the planning of the person's care. Where possible they included the person receiving the care.

Is the service caring?

The service was caring because we observed people being treated with respect. Arrangements were in place to preserve people's privacy. We did not observe any situations where a person's dignity or privacy was compromised.

The service was caring because people who could no longer look after their appearance looked well presented. On the day of the inspection a hairdresser was in attendance. We noticed a variety of hair styles which indicated that the hairdresser had taken into account personal preferences and individuality.

The service was caring because care was delivered in a respectful, thoughtful and kind manner.

The service was caring because they wanted to improve people’s quality of life and did this by ensuring those closest to the person remained actively involved in their relative’s life.

The service was caring because it recognised that when able, it was important for people to be independent. Examples of this were seen during mealtimes, activities and in the opportunities given to people to make simple choices.

Is the service responsive?

The service was responsive because it responded to people’s altered needs.

The service was responsive because staff provided individualised care and support recognising people’s diversity although the completed care plans did not always record this well.

The service was responsive because it sought additional support or intervention when needed. Referrals were made to health care professionals when needed and advice followed. One relative said “yes they’re very good” when we spoke to them about staff calling the person's GP when needed. A visiting health professional said "they (the staff) are knowledgeable about their residents and they make appropriate referrals to us"

Some people had been identified as having potential problems relating to one area of bodily function, their bowel actions. Some of the care records did not always demonstrate adequate monitoring or action being taken when there was a potential problem relating to this. It meant the service potentially may not be as responsive to organising the proper treatment to avoid, for example, further constipation. We spoke with the registered manager about this and they told us they would put actions in place to address this.

The service was responsive because people, predominantly their relatives, knew how to share their concerns or raise a complaint. People who use the service and their relatives said they were happy to speak to the registered manager or staff if something concerned them. Examples were given to us of where relatives had raised concerns and these had been acted on. This meant the service had been responsive to people's individual concerns in order to improve people’s experiences.

Is the service well led?

The service was well led because the registered manager provided strong leadership and was approachable. Feedback from people who live in the home, their relatives and staff confirmed this. One relative described the registered manager as "a brilliant fellow".

The service was well led because staff felt valued and wanted to carry out their tasks well. When asked two members of staff said "yes I feel valued here" and one went on to say, “I have been supported and encouraged”.

The service was well led because it had a system to manage and report accidents and incidents. These were monitored and action taken to make sure they did not happen again.

The service was well led because there were arrangements in place to monitor and improve the services provided. Complaints and concerns were listened to and responded to in order to improve the service.

The service was well led because the provider was actively involved in monitoring the services provided and the performance of the registered manager.

You can see our judgements on the front page of this report.

The people we met had dementia and they were unable to express a view about the care and services they received. We used various methods to find out if the care being provided to people met their needs and kept them safe. We found people's needs were met and the service actively supported people to be involved in making choices and decisions about their care.

People were receiving their medicines safely and correctly and their health needs were being addressed. One visitor told us they had noticed a marked improvement in the care being provided by St Faith's compared to the person's previous care home.

We found that staff were provided with appropriate support and training so that they could look after people safely and to a good standard.

There were arrangements in place to assess and monitor the quality of care and services being delivered. This meant that people were cared for in a service that was able to proactively identify shortfalls, address them and make improvements to the services provided.

During the inspection we gathered information about how the service ensured people who lacked mental capacity were protected under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. There was specific evidence to show that this had taken place. Arrangements were in place to make sure people's specific and sometimes specialised needs were met. Records showed us that these needs were well assessed and the care had been well planned. There were examples where staff had been able to be flexible in their approach when meeting these needs. One relative said "I have been very pleased with the care" and "I am always able to talk to staff".

In particular there were good arrangements to manage people's complex nutritional needs that sometimes arose from having dementia. There were systems in place to manage allegations of abuse which included evidence that the service had liaised appropriately with external agencies. Staff were recruited in a robust manner and received appropriate induction training. People's complaints were correctly acknowledged, investigated and responded to. There was evidence to show that the service had taken relevant action following a complaint in order to learn from it and improve the service.

People told us that they feel well cared and that staff were patient with them. They told us that they can see their local doctor and other health care professionals when needed.

People who could told us how they make choices about their food but for many, although they are supported to eat and drink, the current system may not be the best and most appropriate way. We have suggested that the service may want to review this and include more immediate and visual choices on the actual day of the meal.

Although people were not able to tell us, we witnessed people being supported to partake in an activity and they looked as if they were enjoying this.

One relative told us that they had visited several other care homes before choosing St Faith's for their relative.

This inspection took place on 1 and 2 April 2015 and was unannounced.

At the last inspection on 28 July 2014 we asked the provider to take action to make improvements to the guidance provided for staff in relation to some medicines. The registered provider told us they would meet these legal requirements by 30 November 2014. We found these actions had been met, although this guidance needed to be more personalised.

During this inspection one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. This related to a lack of accurate record keeping. You can see what action we told the provider to take at the back of the full version of the report.

The service predominantly cared for older people who live with dementia and could accommodate up to 69 people. At the time of the inspection 65 people in total were cared for.

There was a registered manager although they had resigned and were due to leave soon after the inspection. 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 recruitment process for a new home manager had already begun.

People’s consent was sought prior to care or treatment being provided. Where appropriate people’s mental capacity was assessed and people who lacked mental capacity were protected under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff understood the principles of the Act and adhered to its code of practice. However, staff had not understood how to effectively record this process on the documentation provided.

Arrangements for the management of medicines were improved. However, the guidance recorded for the use of some medicines lacked detail. These medicines had been prescribed to be used “when required”. Clearer guidance (protocols) for their use, in relation to the person it had been prescribed for, would help define the parameters in which these should be used and improve consistency in how they are administered.

People were kept safe because staff knew how to recognise abuse and report incidents or allegations of abuse. Staff were aware of who to contact if they had concerns about other staff or the service generally. Robust staff recruitment practices kept people safe from those who may be unsuitable to care for them. A continued good investment in staff training and support ensured staff delivered people’s care safely and with knowledge. Accidents and incidents were responded to quickly and monitored to try and prevent reoccurrences.

People’s human rights were upheld and people were not discriminated against. People’s dignity and privacy was maintained. Staff cared for people with compassion and understanding, promoting independence and supporting their retained skills where possible. People were treated as individuals and their care was personalised to meet their needs and capabilities. People who mattered to those who were being cared for were included and made to feel welcome.

People received the support they required to eat and drink. Health related risks were identified and managed well. People had access to appropriate health care and adult social care professionals who also helped to support their physical and mental health needs. People were supported to attend health related appointments.

People were involved in the planning of their care and in making day to day decisions. Where people were unable to do this their family and other representatives were involved on their behalf. Care records however did not always reflect people’s individual needs and sometimes lacked up to date guidance for the staff.

The service needed to recruit a new activities co-ordinator but people were still being supported to join in social gatherings and take part in activities.

People and their relatives knew how to make a complaint if they needed to. Any concerns and complaints were taken seriously, investigated and responded to.

Improvements had been made to the service by the registered manager. However, shortfalls in effective communication had failed to identify that some senior staff had required additional support to carry out their responsibilities. A lack of understanding of what was required to be in place had resulted in some shortfalls. The registered provider’s system for quality monitoring was generally robust and an initiative taken by the newly appointed Chief Executive Officer to independently quality monitor the service’s systems and processes led to the shortfalls being identified. The provider’s senior management team had recently started to take specific action to determine the extent of the shortfalls. Some actions had already started to address the shortfalls others had been planned. Despite these issues staff told us they felt well supported by the immediate senior staff team in the home and we did not evidence any adverse effects on people’s care or wellbeing.