This inspection took place on 1 March 2017 and was unannounced.

St Martins provides care and accommodation to a maximum of 16 older people. The home is located in Coventry in the West Midlands. On the day of our inspection there were 14 people who lived at the home. The home provides care and support to older people and people who live with dementia.

The service was last inspected on 23 May 2016 when we found the provider was not meeting the required standards. We identified a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not ensure there were sufficient number of suitably qualified, competent and skilled staff to meet people’s care and welfare needs. Staffing levels also impacted on the availability of staff to provide the support people needed to take part in interests and hobbies that met their individual needs and wishes.

We gave the home an overall rating of requires improvement and asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us an action plan which detailed the actions they were taking to improve the service. The provider told us these actions would be completed by 24 May 2016.

At this inspection on 1 March 2017 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken and there was no longer a breach in Regulations of the Health and Social Care Act 2008.

Staffing levels had been improved. There were enough staff on duty to respond to people’s needs and to keep people safe and protected from risk. Increased staffing also meant during quieter periods of the day, staff were able to support people with activities that met their individual needs and interests. The registered manager and director of the service were addressing this through a joint project with a health care professional.

The service had a registered manager who had been in post since September 2016. This is a requirement of the provider’s registration. 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 provider had developed systems to gather feedback from people and relatives and used the feedback received to improve the service provided. Audits to monitor the quality and safety of the service were being regularly completed and were effective.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed.

The provider conducted pre-employment checks, prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff told us they were not able to work until these checks had been completed. Staff completed training the provider considered essential to meet people’s needs safely and effectively.

The registered manager understood their responsibility to comply with the relevant requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Improvements had been made in the completion of mental capacity assessments which were detailed and decision specific. Care workers gained people’s consent before they provided personal care and knew how to support people to make decisions.

People told us they felt safe living at St Martins and staff understood how to protect people from abuse. Risks related to the delivery of care and support for people who lived at the home had been identified and staff understood how these should be managed.

Staff respected and promoted people’s privacy and dignity.

This inspection took place on 23 May 2016. The inspection was unannounced.

St Martins provides accommodation with personal care for up to 16 people. The home is located in Coventry in the West Midlands. There were 14 people who lived at the home at the time of our visit. Eleven people who lived at the home were living with dementia.

A requirement of the provider’s registration is that they have a registered manager. 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 was a registered manager in post. We refer to the registered manager as the manager in the body of this report.

The service was last inspected on 30 November 2015 when we found the provider was not meeting the required standards. We identified one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The provider sent us an action plan telling us the improvements they were going to make. The provider told us these improvements would be completed by 19 February 2016.

At this inspection we looked to see if improvements had been made. Improvements had been made in how people’s capacity was determined. Mental capacity assessments had been completed and the local authority had approved DoLS applications for nine people who lived at the home. The provider had taken sufficient action in response to the breach of regulations.

However, further improvements were still required. Some mental capacity assessments were not decision specific. Records of best interest meetings, and to show family members had the legal authority to make decisions on behalf of people who lacked capacity to make decision for themselves, were not always completed. The provider recognised further improvements were still required and was taking steps to address these.

There were not enough staff on duty to respond to people’s needs and to keep people safe and protected from risk. Staffing levels also impacted on the availability of staff to provide the support people needed to take part in interests and hobbies that met their individual needs and wishes.

Most care records we reviewed were up to date and described people’s routines and how they preferred their care and support to be provided. Staff had a good knowledge of the people they were caring for.

People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, quality questionnaires had been developed for future use. The deputy manager and provider spoke to people, staff and visitors to gain their views about the service provided during their visits to the home.

The provider had procedures to check the quality of care people received, and to identify where areas needed to be improved. However, these systems were not always effective. This was because audits were not always detailed and some areas requiring improvement had not been identified.

People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

People and their relatives told us staff were caring and kind. People were treated as individuals whose preferences and choices were respected. Staff treated people with dignity, and supported people to maintain their privacy and independence.

Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report incidents to the manager.

This inspection took place on 30 November 2015. The inspection was unannounced.

St Martins is a care home providing personal care and accommodation for a maximum of 16 older people. The home is located in Coventry in the West Midlands. There were 14 people living at home at the time of our visit. Half the people at the home were living with dementia.

A requirement of the provider’s registration is that they have a registered manager. 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. St Martins had a registered manager who was on leave at the time of our visit. However, we spoke with the ‘floor manager’ and one of the directors. As part of our inspection process we spoke with the registered manager on their return from leave to gain clarification about information we had gathered during our visit. We refer to the registered manager as the manager in the body of this report.

People were not always supported in line with the principles the Mental Capacity Act 2005 (MCA), People were able to make some everyday decisions themselves, which helped them to maintain their independence. However, not everyone at the home was able to make decisions about how they spent their time, and the activities they might enjoy.

People and their relatives felt the manager and floor manager were approachable. Staff said they were supported by the management team. We found the arrangements made by the provider for management cover for the home during the manager’s absence were not fully effective.

People and their relatives told us they felt safe with staff, and staff treated them well. Staff knew how to safeguard people from abuse, and were clear about their responsibilities to report these incidents to the manager. The provider had effective recruitment procedures that helped protect people, because staff were recruited that were of good character to work with people in the home.

There were enough staff at St Martin’s to support people safely, though staffing levels did not always enable people to have the support they needed to take part in interests and hobbies that met their individual needs and wishes. People who lived at the home were encouraged to maintain links with friends and family who could visit the home at any time.

Risk to people’s health and welfare were assessed and care plans gave staff instruction on how to reduce identified risks. However, risks to people’s health and safety were not always minimised as staff did not consistently follow the advice of nutritional health professionals.

People were supported to attend health care appointments with health care professionals when they needed to, and received healthcare that supported them to maintain their wellbeing. There were processes in place to ensure people received their prescribed medicines in a safe manner.

Overall, care records were up to date and described people’s routines and how they preferred their care and support to be provided by staff. Staff had a good knowledge of the people they were caring for. People and their relatives thought staff were caring and responsive to people’s needs.

Staff had received the training they needed to support them to meet the needs of people they cared for. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence. People were given privacy when they needed it.

People and a relative told us they knew how to make a complaint if they needed to. People were not always supported to develop the service they received by providing feedback about how the home was run. The manager did not gather feedback from people or their relatives through meetings or quality assurance questionnaires. However, the fl

Two inspectors visited St Martins to follow up concerns we found when we carried out an inspection on 15 April 2014. We completed this inspection to see whether the necessary changes had been made to ensure people received care from a service which was safe, caring, effective, responsive and well led.

We spoke with the director of the service, four staff, four people who lived at the home and two relatives. We also spent time sitting with people in the lounge and dining room observing the care they received. The manager was not available on the day of our visit.

We looked at the records of four people who lived at the home, three staff, and quality assurance records.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

At our last inspection in April 2014 we found the service in breach of the Health and Social Care Act regulations 2008.

Previously we found the service did not comply with the regulations relating to consent to care and treatment, care and welfare of people, staffing, assessing and monitoring quality, and records.

During this visit we found staff had received training to help them understand the mental capacity act and deprivation of liberty safeguards. People had given consent to care and treatment, and people's mental capacity had been assessed to determine their cognitive abilities to make decisions for themselves. This meant the provider was now compliant with the regulation relating to consent to treatment.

We saw care records gave clear and up to date information about the care needs of each individual and staff we spoke with worked to the updated care plans. People or their relatives had been involved with care planning. People and their relatives told us they were happy with the care provided at St Martins. This meant the service was now compliant with the regulation relating to care and welfare.

We looked at staff records which demonstrated all staff had undertaken the necessary recruitment checks prior to working at the home. Staff had attended training considered essential to support people safely and effectively. This meant the service was now compliant with the regulation relating to staffing.

We looked at records, spoke with staff and people about the way the service monitored and assessed its quality of care. We saw there were regular checks on the care provided to people and there were now systems in place to assess the quality of care. This meant the service was now compliant with the regulation relating to assessing and monitoring the quality of service provision.

We were able to find the information required in the records requested. Records were up to date and sufficiently detailed to support staff to meet people's needs. Records were kept safely and securely. This meant the service was now compliant with the regulation relating to records.

When we visited St Martins in November 2013, we found improvements were needed in two areas. These were ‘consent to care and treatment’ and ‘records’. During this inspection we found insufficient improvements had been made. We also found some additional areas requiring improvement.

We spoke with seven people and two relatives of people who used the service to find out what their experiences of the service were like. We also spoke with the manager (who was at the home for a short period of the day), care staff and the deputy manager. The evidence we collected helped us to answer five key questions, these being: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations, our discussions with people, staff and relatives and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

All people we spoke with told us they felt safe living at St Martins. We saw people were treated with kindness and respect but there were some instances where their privacy and dignity was compromised.

Staff knew people’s likes and dislikes but were not always fully aware of people’s health care needs. This was because they did not have access to up-to-date care plans and risk assessments. This meant people were put at risk of not receiving safe and appropriate care.

Information being recorded regarding accidents and incidents was not being used to help prevent further risks of these happening.

Recruitment records were not sufficiently robust. Where information was omitted, it was not clear this had been followed up to make sure staff were safe to work with vulnerable people.

We could not be confident people always received heir medicines as prescribed.

We were told there was no policy and procedure related to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff did not have an understanding of these to be able to apply the principles of them. This meant people who lacked capacity may not be appropriately supported when decisions about their care and treatment needed to be made.

Is the service effective?

We saw healthcare professionals were involved in people’s care to support staff in meeting people’s needs.

Staff we spoke with told us they did not have access to key information about people’s care needs. They told us they were supporting people based on their previous knowledge of their needs. This meant people may not always receive effective care.

There had been action taken to develop consent forms to help staff provide support in accordance with people’s wishes. These were not available for all people in the home. Those that had been completed, had not been placed on people’s care files so that staff were aware of them.

We saw some staff had completed mandatory training but some of the training was overdue. We found staff had not attended training linked to the healthcare needs of people living at St Martins to help them support people’s needs appropriately.

Is the service caring?

We saw people were supported by kind and caring staff. People and relatives spoken with told us, “On the whole, they are very good.” “It’s very good. If I wanted any help I would just ask them.” “Very friendly.”

A relative told us how one member of staff had stayed beyond their working hours to complete a care assessment to allow the admission of their relative to the home. They felt the member of staff was “wonderful.”

We saw care staff were patient with people and did not rush them when assisting them with care.

Is the service responsive?

Staff asked health professionals to visit people when they had concerns about their health. Staff completed daily records where they identified any concerns relating to a person’s care.

We saw charts were in place to monitor people’s health although these were not always completed consistently. We saw information of concern on people's charts was not always acted upon. For example, those people who had taken insufficient fluids or had fallen frequently. This meant we could not be confident the service was always responsive to people’s needs.

Is the service well led?

We found the service had not been effective in carrying out the required improvements following our last inspection. Although action had been taken to progress improvements, they had not been fully implemented. During this inspection we found additional areas in need of improvement.

We found people’s experiences of care were positive at St Martins but the service did not have a fully effective quality monitoring system in place. This was because there were aspects of care and services in need of improvement that had not been identified by the service. We found there were no effective audit processes in place to identify where improvements may be needed.

The manager told us there had been a recent meeting organised with people living at the home and their relatives to gain people’s view of the service. We saw the notes of this meeting which confirmed people had been given an opportunity to share their views. Due to this meeting being recent, it was too soon to check suggestions made had been acted upon.

At the time of our visit St Martins was providing care and support to 16 people. We spoke with six people and one visitor to the service. They were mostly positive in their comments about the care provided. They told us: “On the whole they are pretty good.” “I could not fault them in any way.”

We found choices and options available to people were not always well communicated. We also found it was difficult to determine from records if people were able to consent to care.

People told us they were satisfied with the meals provided. They told us: “For what it is, it’s very good.” “The food is nice.” We saw the service had sought advice from health professionals where this was required in relation to meeting people’s nutritional needs.

Staff told us they had access to all of the required training to carry out their role. We observed staff to be friendly in their approach towards people.

People were positive about the staff supporting them. They told us: “Pretty good…generally all right.” “They are alright ….. they are very good.”

People we spoke with told us if they had a concern they would speak with staff or the manager. We saw an appropriate procedure was in place for any complaints to be investigated.

We found records within the service were not always clear to make sure people received consistent and appropriate care.

On the day of our visit there were 15 people living at St Martins. We spoke with six people and three visitors about their experiences of the home. We also observed what daily life was like for people living there. People we spoke with about the care provided told us: “It’s smashing.” “I think it’s great.”

We saw people had plans of care in place detailing their care needs and how these were to be met by staff. We observed staff being friendly and supportive towards people. During the day we saw staff engaging people in social activities. Some people chose to sleep or watch television and some chose to stay in their room. People were complimentary of the staff. They told us: “They are very good, I can’t fault them at all.” “Fantastic.”

People were provided with a choice of meals and they told us they enjoyed them. A visitor told us: “The food is tremendous, they always get an alternative.”

There were quality monitoring processes in place to make sure people were happy with the care and services they were receiving. The results of a quality questionnaire completed by people showed a high level of satisfaction. People told us if they were not happy about anything they would talk with the provider who was regularly available in the home.