The inspection took place on 1 and 3 August 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

This was the first time we had inspected the service since it was registered on 14 September 2017.

St Marks Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Marks Nursing Home provides personal and nursing care and support for up to 35 people who require support with personal care, some of whom are living with dementia. At the time of the inspection there were 33 people living there.

The service had a registered manager in place. 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 told us they felt safe living at the service and receiving support from staff. Staff understood the principles of how to safeguard people from abuse and had received up to date training. The registered manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

People’s medicines were administered in accordance with best practice and managed in a safe way.

People told us there were enough staff to meet people’s needs, although there was a general feeling more staff would be of benefit. Staff were recruited in a safe way with all necessary checks carried out prior to their employment. The service had a low turnover of staff with existing staff members working in the home for a number of years.

New staff received a comprehensive induction which included shadowing more experienced staff on shifts and observations by the registered manager. Staff received regular training, supervisions and annual appraisals to support them in their roles. They also received specialised training, specific to 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. Staff had received training in Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People who were unable to make decisions for themselves, had decisions made in their ‘best interests’.

People were supported with their nutritional needs and to access a range of health professionals. Information of healthcare intervention was included in care records.

People spoke highly of all staff and felt the service was caring. Staff treated people with dignity and respect and promoted their independence when supporting them with daily tasks.

People had access to independent advocacy services if they wished to receive support. Advocates help to ensure that people’s views and preferences are heard. Information related to advocacy services was on display in the home.

People’s physical, mental and social needs were assessed prior to them moving into the home. Care plans were personalised, detailed and reviewed regularly and included people’s personal preferences.

There was a range of activities available for people to enjoy in the home. People were also supported, where necessary, to access activities in the local community including going shopping and for pub lunches.

People knew how to raise concerns if they were unhappy with the service. All complaints received were investigated and subsequent action taken.

There were audit systems in place to monitor the quality and safety of the service. Any trends and lessons learnt were also recorded and acted upon. Fi