The inspection was completed on 14 and 18 October 2016 and there were 26 people living at the service when we inspected.

St Martins Residential Home provides accommodation and personal care for up to 26 older people and people living with dementia.

A registered manager was 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.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staffs were appropriately supported and received regular formal supervision and an annual appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and although people’s comments about the quality of meals provided were variable, steps had been taken to address the issues identified. People who used the service and their relatives were involved in making decisions about their care and support.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. Staff’s understanding of the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards required minor improvement, however the management teams understanding ensured that appropriate applications to the Local Authority had been made.

Care plans accurately reflected people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

St Martin’s Residential Home provides accommodation and personal care for up to 26 people. Some people have dementia or dementia related needs.

The unannounced inspection was completed on 25 November 2014 and there were 24 people living in the service when we inspected.

A registered manager was 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 person’s’. Registered person’s 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 last inspection on 22 July 2014 found that the provider was compliant with all areas viewed.

People and their relatives told us the service was a safe place to live. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and other’s safety.

Staff understood the different types of abuse and knew how and who to report any concerns to.

We found that the deployment of staff was not always appropriate to meet people’s needs.

We found that risks to people’s health and wellbeing were assessed but had not always been reviewed and updated to reflect the most up-to-date information.

We found that the management of medicines did not ensure people’s safety and wellbeing.

Staff told us that they felt supported and valued. They said that they received regular training opportunities. We found that staff received a robust induction, supervision and appraisal.

Comments about the quality of the meals provided were positive and people were supported to have adequate nutrition and hydration.

People told us that their healthcare needs were well managed and we found that the service engaged proactively with health and social care professionals.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

Not all people had been involved in the development of their care plan. We found that people’s care plans were not fully reflective of their care needs as some of the information was not up-to-date.

People and their relatives told us that if they had any concerns they would discuss these with staff on duty. People told us that they were confident that their complaints or concerns were listened to, taken seriously and acted upon.

We found that an effective system was in place to regularly assess and monitor the quality of the service provided. The registered manager was able to demonstrate how they measured and analysed the care provided to people who used the service and how this ensured that the service was operating safely. However, the provider’s quality assurance system had not picked up any of the concerns or areas for improvement that we found.

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

We spoke with five of the 31 people who used the service at the time of our inspection. We also spoke with three visiting relatives and five staff members. We looked at five people's care records. We also looked at staff records, health and safety checks, staff and resident meeting minutes and records of checks that the provider’s representative completed to monitor the quality of the service.

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 a summary of what we found;

Is the service safe?

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to recognise the signs of abuse, how to respond when they suspected abuse had taken place and to ensure people’s human rights were respected.

We found that care records were complete, accurate and fit for purpose. This meant that care was planned for the individual to limit the risks to their safety and well-being.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

Is the service effective?

Staff used their knowledge of individual people’s needs and personalities to provide them with care that effectively met their needs. One person’s record showed the triggers that led to their becoming upset and agitated. It told staff individual ways to help the person into activities or songs that they liked that were effective in helping the person feel calm and reassured.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. All the people we spoke with commented very positively about the staff and the calm, caring and friendly support they offered to people who used the service.

One person said, “Staff are so kind and caring, they sit and chat with people and are always helpful. They give [person] time and attention." Another person said, "Staff work extremely hard and are always very caring. They are very good at managing and supporting people who get upset or agitated, they are really very patient."

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. We saw that people's views and choices were listened to and respected.

Visitors told us that visiting times were flexible and that they could arrange to eat with the person who used the service.

We saw that staff tailored their approaches to people in a way that responded to how they were at that particular time. A visitor said, "[Person's] capacity varies but they will always ask [person] first, for example, whether [person] would like to have their mail."

Is the service well-led?

The service had a registered manager in post who provided consistent leadership of the service. The provider had systems and staff in place to support the manager to lead the service. Staff had clearly defined roles and responsibilities so that all aspects of the service were effectively managed.

As part of our inspection, we spoke with three of the 25 people who used the service. We also spoke with one person's relative and three staff members. We looked at eight people's care records. We also looked at the provider's arrangements for obtaining, and acting in accordance with, the consent to care and treatment for people who used the service. In addition we looked at medication practices and procedures, the provider's arrangements to safeguard people from abuse, cleanliness and infection control procedures at the service, staffing levels and; the provider's arrangements to monitor the quality of the service provided.

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 a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the majority of staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service was safe, clean and hygienic. This meant that arrangements were in place to maintain appropriate standards of cleanliness and hygiene.

We found that improvements were required to ensure that people who used the service were protected against the risks associated with the unsafe use and management of medicines. 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 management of medicines.

We looked at staffing levels at the service. This showed that although the numbers of staff at night had been increased, the staff rosters showed that staffing levels told to us by the manager had not always been maintained and the deployment of staff within the service was not adequate. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to there being sufficient numbers of staff at the service.

Is the service effective?

Our observations and discussions with the manager demonstrated that people who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

We found that improvements were required to ensure that all of a person's care needs were recorded within their care file and that information also included how risks were to be proactively managed. 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 carrying out of an assessment of the needs of the people who use the service.

Records showed that not all staff had received Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] training. Not all staff spoken with were able to demonstrate a good understanding and awareness of MCA and DoLS. We found that not all people who used the service had had their capacity to make day-to-day decisions formally assessed and improvements were required. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having suitable arrangements in place for the consent to care and treatment and; in line with the Mental Capacity Act 2005.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

People told us that they knew how to make a complaint if they were unhappy and/or had any concerns. We saw that where people had raised concerns appropriate action had been taken to address them.

Is the service well-led?

The provider was able to demonstrate that some systems were in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive. However, whilst the provider did have some systems in place to monitor the quality of the service provided, it was apparent from our inspection that the absence of robust quality monitoring maybe a contributory factor to the failure of the provider to identify non-compliance or any risk of non-compliance sooner.

As part of this inspection process we spoke with the operations manager, newly appointed manager and two people who used the service.

People's health and personal care needs were assessed and there were detailed care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. People told us that they liked living at St Martins Residential Home and that they found the staff to be kind and caring. Comments included, "It's not the same as living in your own home and that would be my preference, however I have no complaints at the moment. The staff are very nice and they to their best to assist and accommodate."

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. There was also evidence to show that appropriate arrangements were in place for staff to receive regular supervision and an annual appraisal. We found that staff employed at the service had received training in core and specialist subject areas.

We directly observed care within the service so as to help us determine what it was like for people living at St Martin's Care Home. We found that staff interactions with people who use the service were positive and staff had a good understanding of peoples care needs.

We spoke with three people who used the service. They told us that they were happy living at St Martin's Residential Home and found the care and support to be appropriate and to meet their needs. One relative spoken with told us that they were very happy with the care and support provided for their member of family. They told us "The care is excellent."

It was apparent from our findings at this inspection relating to outcome four (care and welfare of people who use services), outcome 12 (requirements relating to workers), outcome 14 (supporting workers) and outcome 16 (assessing and monitoring the quality of service provision) that the absence of robust quality monitoring by the provider has been a contributory factor to the failure of the service to identify non-compliance, or any risk of non-compliance sooner. There was no evidence to show that the provider had effectively monitored the management team's performance and level of compliance with meeting regulatory requirements.