St Jude’s Nursing Home is registered to provide nursing care for up to forty older people who may be living with dementia. There were 39 people living in the service at the time of our inspection.

We carried out this inspection on 10 October 2017. At our last inspection in May 2015 the service was rated as 'Good’. At this inspection we found the service remained Good.

The service had a registered manager in post at the time of 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.

People living in St Jude’s Nursing Home were safe because staff assessed and took action to reduce their risks of avoidable harm and abuse. The provider undertook thorough checks of staff during the recruitment process to ensure they were safe and suitable to provide care and support. Medicines were stored safely and administered in line with the prescribers’ instructions. Staff followed appropriate hygiene practices to reduce people’s risks of infection.

Staff were trained to deliver care to people effectively and were supervised when doing so. People gave their consent to the care and support they received in line with the Mental Capacity Act 2005. People received the support they required to choose and eat nutritious meals throughout the day. Healthcare professionals attended the service regularly ensure people’s health needs were met in a timely manner.

Staff were kind and caring towards people and treated them with respect. People’s privacy and dignity were promoted and staff shared positive relationships with people. People received compassionate care and support to manage their pain as they approached end of life.

People’s needs were assessed and care plans guided staff towards meeting them as people preferred. People were supported to engage in a variety of activities and measures were in place to prevent social isolation. The provider gathered and acted upon feedback from people and their relatives and complaints were dealt with appropriately.

The registered manager developed an inclusive culture within the service. Staff felt supported and able to share their views about improving the service. The quality of care people received was the subject of audits and the service worked closely with other organisations to promote best outcomes for people.

The inspection was carried out by one inspector.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection and information from records. These included policies and procedures, minutes of meetings, care records, staff files and records relating to quality monitoring and quality assurance systems. At the time of our visit 39 people used the service and one person was in hospital. We spoke with five people, six visitors and eleven staff including the home manager and a company director representing the provider.

Is the service safe?

People who used the service told us they felt safe and secure. Their comments included, “I like the staff, they are kind and gentle”, also “They (staff) look after me well”.

Records showed people experienced safe and appropriate care. A range of risk assessments had been undertaken, for example, in relation to people's mobility and nutritional needs, for pressure sore prevention and behaviour management. Risk management plans had been produced and staff followed them. Care plans and risk assessments had been reviewed monthly and updated, as necessary. This meant changes in needs had been identified and responded to, ensuring people were not exposed to unnecessary risk.

Suitable arrangements were in place for obtaining and acting in accordance with people’s consent in relation to their care and treatment. Where people did not have capacity to consent the provider had acted in accordance with legal requirements.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and DoLS. Records showed mental capacity assessments had been carried out for some people. These had been specific to decisions made in their best interest and DoLS authorisations. There was an on-going programme of staff training ensuring staffs’ understanding of their responsibilities under the Mental Capacity Act (2005) and DoLS. The home manager was clear in what circumstances a DoLS application should be made.

Incidents and accidents had been recorded and monitored by staff. This meant the home manager could identify trends regarding such events and implement prevention measures, minimising risks to people.

Records showed environmental risk assessments and audits had taken place for the protection of people who used, visited or worked at the service

Procedures were in place to protect people from abuse. Staff had received safeguarding vulnerable adults training and knew how to respond to allegations or suspicions of abuse.

Procedures for dealing with emergencies were in place and staff trained to competently implement them.

Is the service effective?

People experienced effective, safe and appropriate care and treatment that met their needs and respected their rights. Comprehensive needs assessments had taken place and individualised care plans produced. These took account of peoples' diversity, rights and preferences. Records showed people and/or others acting on the behalf had been involved in this process. Care plans had been reviewed monthly and updated as necessary. This meant changes in peoples' needs had been identified and responded to. We saw people had access to health and specialist services. They had the equipment they needed to meet their needs.

Contact with relatives established they considered the service effective in the way people’s needs were met. People told us staff respected their privacy and dignity and our observations of staff working practices verified this feedback. Staff respected people’s choices, for example, where they spent their time and with whom and what they did with their time. People had a choice of meals and opportunity to engage in a diverse range of suitable social activities. Entertainment was provided and social events organised to which their families and friends had been invited. People had also enjoyed various outings throughout the year. A person living at the home said, “We went out for a meal recently to a restaurant in Richmond Park. It was very nice and I had a lovely time”.

Visitors confirmed they were welcome to visit at any time and could see people in private if they wished.

Is the service caring?

A person using the service told us, "Staff are kind". People were dressed in clean clothing and good attention had been given to their personal appearance and hygiene. Staff were knowledgeable about people's preferences and needs. They were attentive to people with high levels of engagement. We saw staffs' interactions with people and their approach was friendly, cheerful, caring and respectful.

Is the service responsive?

People and those acting on their behalf had been informed of the procedure for making a complaint or expressing a concern. Comments from relatives included, “I am very happy with the home, the quality of care is usually good. The manager is accessible and encourages feedback. The manager took immediate action on the few occasions I have had a concerns”. Another relative stated, “I have attended meetings to review the care needs of my relative. I was able to openly express my views about the service and the standard of care and my feedback was listened to and taken seriously”. These systems enabled issues and concerns to be discussed and acted upon.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Systems were in place for analysing incidents, complaints and safeguarding alerts. Learning from these events had been constructively used, promoting continuous service improvement and developments.

Is the service well-led?

The environment was clean, hygienic and well- maintained. A range of audits had taken place to ensure people benefited from quality care and appropriate management of risks, ensuring their health, welfare and safety.

Systems enabled staff to learn from events such as accidents, incidents, practice shortfalls, complaints and concerns. This minimised risks to people and promoted continuous service improvements.

The home manager named in the report is no longer in post. A new manager took up post in March this year and was going through the registration process at the time of the visit. The provider’s representative visits the home most days. The home manager and the staff team was supported by the provider's operations director who regularly visited the home, monitoring quality and compliance.

On the day that we visited there were 37 people living at St Judes. All of them had a degree of dementia or short term memory loss. However, some of them were able to talk with us and they told us that they were very happy living there. They told us that the staff were “very kind”, and “very helpful”. Visitors told us that they always felt welcome in the home and that staff kept them informed about any changes in their relative’s health.

People told us that they were free to spend their days as they wanted to, joining in with activities or occupying themselves. There were activities arranged for those who wished to participate. Those people who were mobile were free to walk around the home as they wished and out into the garden.

We saw that care was planned and delivered in line with people’s individual care needs. Families were involved in discussions about how people liked to be supported. Regular reviews made sure any changes were identified and addressed.

A training programme was in place for staff to help them meet the needs of the people that they were supporting.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of foods and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was lead by a CQC inspector joined by an Expert by Experience,

people who have experience of using services and who can provide that perspective.

We spoke with several people who use the service, to ask them about what it was like to live in the home.

During our visit we also used the Short Observational Tool for Inspections (SOFI). SOFI is a specific way of observing people who may not be able to communicate with us.

The inspector also spoke with the trained nurse in charge of the home at the time and six care staff.

In addition, we looked at a sample of records kept by the home as evidence of how peoples care needs are being met.

At the time that we visited there were 36 people living in the home. We spoke with the majority of them although many of them found it difficult to communicate with us or contribute towards the inspection process. However, through our SOFI observation we saw that most of them showed signs of positive wellbeing and there were some examples of good interaction between them and the staff.

Comments from people included “I’m well looked after here”, “the staff are alright here, very kind”, and “the foods good”, and “we get lovely meals here”. One person we spoke with was particularly impressed with the mashed potato, telling us “we get real mashed potato here, not like that stuff they give you in hospital.

Most of the people who live in this home have dementia or mental health problems. However, several of them were able to chat with us when we visited. They all told us that they were happy and comfortable living in this home. They said that staff ask them about how they want to spend their days, what time they want to get up in the mornings, about the clothes they want to wear and the meals they would prefer to eat.

Others told us how well they were looked after in the home telling us “its lovely living here” “I really like this lady “(the activities person) she’s wonderful” “its alright here, they treat you really well” and “very nice people look after you, they’re all here to help you”.

Several people told us that the food was very good”we had fish and chips today, its Friday, with tomato ketchup” “and “they do a nice salad with beetroot”.

One person was particularly impressed with the laundry telling us how her clothes came back all washed and ironed.

This inspection took place on 13 and 14 May 2015. The first day of the inspection was unannounced and we informed the registered manager that we would be returning on the second day to complete our inspection.

At the last inspection, on 23 September 2014, we found the service was meeting all the essential standards we looked at.

St Jude’s is a care home that provides accommodation, nursing and personal care for up to 40 older people. There were 38 people residing at the home when we visited. Approximately three-quarters of the people using the service were living with dementia.

Accommodation was arranged over two floors. All the bedrooms had en-suite toilet and washing facilities, of which 36 were single occupancy and two shared. Communal space located on the ground floor included three separate lounges, two dining areas, a hairdressing salon and a wheelchair accessible garden. The home had two passenger lifts and a stair-lift chair that ensured people could move freely between floors.

There was a registered manager in post. 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 were safe at St Jude’s. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these to keep people safe from harm or injury. The service also managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies, such as fire.

People told us they felt happy at St Jude’s. They also told us staff looked after them in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this.

People’s rights to privacy and dignity were respected. When people were nearing the end of their life they received compassionate and supportive care.

St Jude’s was a comfortable place to live. We saw people could move freely around the care home and rear garden. The building was well maintained and safe.

There was a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

People were supported to maintain social relationships with people who were important to them, such as their relatives. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome.

People were encouraged to participate in meaningful social, leisure and recreational activities that interested them. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.

Staff routinely monitored the health and welfare of people using the service. Where any issues had been found appropriate medical advice and care was promptly sought from the relevant healthcare professionals.

People received their medicines as prescribed and staff knew how to manage medicines safely.

Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wished to be supported. Where people's needs changed, the service responded by reviewing the care provided.

Sufficient numbers of staff were deployed throughout the home to meet people’s needs. Staff were suitably trained, well supported and knowledgeable about the individual needs and preferences of people they cared for. The registered manager ensured staffs’ knowledge and skills were kept up to date. The service also ensured staff were suitable to work with people using the service by carrying out employment and security checks before they could start work at the care home.

The registered manager understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The registered manager encouraged an open and transparent culture. The views of people using the service, their relatives, professional representatives and staff working at the care home were routinely sought by the provider, which they used to improve St Jude’s.

People and their relatives felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The service had a clear management structure in place. We saw the registered manager and senior nurses led by example. The registered manager demonstrated a good understanding of their role and responsibilities, and staff told us they were supportive and fair.

There were effective systems in place to monitor the safety and quality of the service provided at the care home. The registered manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken.