This inspection took place on the 25 October 2017 and was unannounced.

St. Marys Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

St Marys Care Centre provides accommodation, nursing or personal care for a maximum of 60 people. The service provides support for older people and people who may have a physical disability. At the time of our inspection there were 59 people using the service.

We last carried out a comprehensive inspection of this service on 10 and 11 September 2015. The service was rated Good overall. At that inspection we identified a breach of regulation. We carried out a focused inspection on 20 January 2017 and found that the registered provider had achieved compliance with the breach we had identified.

At this inspection we found the service remained ‘Good’ overall with the responsive domain improving to ‘Outstanding.’

There was a registered manager employed by the service. 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 registered manager and staff team demonstrated commitment to providing the best possible responsive care and opportunities for people. Staff had an excellent understanding of how to ensure people’s preferences were met. People participated in a range of creative projects and activities that provided new experiences and the opportunity to develop new skills. Activities within the service were designed to promote stimulation, mobility and dexterity and to promote fundraising for the service for the benefit of all. The service fully understood and promoted the diversity of the people living at the service and as such was able to proactively support their needs.

People were at the heart of the service, which was organised to suit their individual needs. We saw examples of caring interactions between people and staff. One person said, " Yes, (staff are caring), extremely so.”

We received feedback via a letter from the relative of a person who had received care at the service, they told us, ‘I must stress that if it hadn’t been for the staff [Name] wouldn’t be with us today. The tender loving care [Name] received was absolutely marvellous.”

The mealtime we observed was relaxed and organised. People were supported to eat in a supportive and calm setting that provided opportunity to socialise as well as eat. The staff were attentive and provided the support people needed to be able to enjoy a meal. Food and the dining spaces were attractively presented and people were able to choose what they wanted to eat. Special dietary requirements were understood and provided for.

Staff had a good understanding of safeguarding and knew what steps to take if they believed someone was at risk of abuse or harm. Risks to people had been identified and were managed safely. Guidance was provided for staff about keeping people safe.

We found there were enough care staff, nurses and ancillary staff on each shift to safely meet people's needs. Recruitment systems were established and only suitable staff were employed to work at the service.

There were systems in place to ensure people’s medicines were safely managed. We found people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s plans of care were organised and had identified the care and support people required. We saw people who lived at the service had access to healthcare professionals and their

We carried out an announced comprehensive inspection of this service on 10 September 2015. At this inspection we identified a breach of regulation. This was because medication had not been recorded safely. We issued a requirement notice to the registered provider in respect of Regulation 12: Safe care and treatment, with regard to medicine management, as the breach was assessed as having a low impact on service users.

We carried out a focused inspection on 20 January 2017 to check whether the registered provider had achieved compliance with the breach we identified. This report covers our findings in relation to the requirement for medicine management. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Marys Care Centre on our website at www.cqc.org.uk.

St Marys Care Centre is a purpose-built care home situated in a residential area in Anlaby. The service supports people with long-term nursing care needs and can accommodate a maximum of 60 people. Accommodation is provided in spacious, en-suite rooms with four different room designs. People using the service are provided with a wide variety of communal spaces including lounges, a cinema room, a hairdressing salon, a physiotherapy room, a library and music room.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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.

During this focused inspection we found the staff had completed medicine management training in the last year. This ensured they had the skills and knowledge to safely manage and administer medicines to people using the service. Improvements were seen to the recording of medicines on the medication administration sheets.

The service used a risk based approach to people self-administering their medicines. Those people who had capacity and were able to do this safely were supported by the staff to achieve this goal. The risk assessments gave staff clear and precise information on how to reduce the risk of harm to people and there were detailed care plans for medicine management that reflected and recorded each person’s ability and support needs.

We saw these changes resulted in the registered provider meeting the breach of Regulation12 in respect of medicine management.

People’s capacity to make decisions was assessed and information about their care needs was gathered prior to them being admitted to the home.

People were supported through a care planning process to have their needs met; they told us they felt their needs were met in the home and that staff “Do their best.”

We observed that people received appropriate support with their nutritional needs and that staff support was polite and respectful

Staffing levels remained consistent throughout the week in order to meet people’s needs.

Quality assurance systems were in place which included seeking the views of people who lived in the home. Maintenance work and risk assessment were undertaken to help ensure peoples safety.

As part of our inspection we spoke with four people who used the service and looked at care records and associated documents. We also observed staff practice and saw that staff understood and respected people's rights and capacity to consent to care. People said “The care we receive is very good. We can talk to the staff about our care and treatment and they listen to our opinions and respect our wishes.”

Infection control systems within the service were looked at. These were monitored regularly by the manager. The clinical and communal areas were clean, tidy and there were systems in place to lower the risk of spread of infection. People told us “The home is immaculate, our bedrooms are cleaned daily and the staff keep everything spotless.”

People who used the service were all very happy with their care. They told us that they were given support when needed, but were also given the chance to be as independent as possible. We saw the service had an effective recruitment policy and procedure, which ensured staff working in the home had the right skills and qualifications to meet people’s needs.

We saw there was a complaints system in place, with information and complaints forms readily available to people who used the service. People told us they saw the provider and manager most days to talk to and they were confident of using the complaints system if they needed to.

People spoken with told us they were happy in their home, which they said was spotless, ”It’s a nice place – it never smells” and “this place is second to heaven”.

They told us the staff looked after them well and respected the privacy and dignity. They said they were able to banter and have a laugh and a joke with staff.

People said they could make decisions about their care and they saw a range of health and social care professionals for treatment and advice.

The meals were described as very nice, varied and well cooked. People also said they had the opportunity to meet the chef and make suggestions to the menu.

People knew how to complain and said they would have no hesitation in talking to the manager about any concerns.

This inspection took place on 10 and 11 September 2015 and was unannounced. The last inspection took place on 18 November 2013 and no actions were required.

St Marys Care Centre is a purpose-built care home situated in a residential area in Anlaby. The service supports people with long-term nursing care needs and can accommodate a maximum of 60 people. Accommodation is in single occupancy rooms with en-suite facilities. There is a large car park onsite for the use of visitors and staff.

The service comprises of two units within one large building. Riplingham unit supports people with residential care needs and Newland unit supports people who need nursing care.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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 recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

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

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards.