This inspection took place on 11 July 2018 and was unannounced. St Mary’s Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and personal care for up to 60 people in one detached building that is adapted for the current use. The home provides support for people living with a range of complex needs, including people living with dementia. There were 58 people living at the home at the time of our inspection.

The service had a registered manager who was present throughout 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.

At the last inspection on 4 April 2016 the home was rated Good overall. At this inspection on 11 July 2018 we identified some areas that needed to improve.

People’s care plans were not always personalised to reflect what was important to people, their likes and dislikes, hobbies and interests. Staff knew people well and were providing care in a person-centred way but this was not reflected in people’s records. People told us they didn’t always have enough to do. Activities were organised but people’s individual interests were not always considered and this meant that some people felt activities organised were not relevant or meaningful for them. We have made a recommendation about providing meaningful activities for people.

People’s care records were not always maintained in good order and information was difficult to find. This was identified as an area of practice that needed to improve.

At the last inspection on 4 April 2016 we found inconsistent practice about the requirements of the Mental Capacity Act 2005. At this inspection on 11 July 2018 the provider had made improvements. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives told us they felt safe living at St Mary’s Care Home. One person said, “I feel safe because the staff care about me here.” Staff demonstrated a clear understanding of the responsibilities for safeguarding people. Risk assessments were clear and guided staff in how to support people to be safe whilst respecting their freedom. People were receiving their medicines safely and there were enough suitable staff to care for them safely.

People’s needs were assessed in a holistic way and in line with current legislation and good practice. Staff had received the training and support they needed to be effective in their roles. One person told us, “I think they are very well trained. They seem to know what they are doing.”

People were supported to access health care services when they needed to. Staff recognised changes in people’s health and made appropriate referrals. People told us they had enough to eat and drink and spoke highly of the food on offer. One person commented, “The food is excellent and the meals times are sociable.”

Staff were kind and caring and knew people well. People and their relatives spoke highly of the care. One person said, “The staff are fantastic, brilliant, really lovely. They’ll do anything for you.” People were supported to express their views and to be involved in planning their care and support. A staff member explained, “We see it as fundamental to ensure people remain as independent as they can be.” Staff encouraged and supported people to be as independent as possible. People and their relatives were supported to plan for care

We inspected St Mary's Care Home on the 5 April 2016. The home provided accommodation in rural East Sussex for sixty older people who required nursing or personal care. The majority of people lived with dementia but people with a learning disability, mental health and complex health needs also lived at the home. The Order of St. Augustine of the Mercy of Jesus provided care with nursing at four locations, three of the homes are based in spacious grounds in St Georges Park and the fourth home is nearby.

The home had a registered manager. A registered manager is a person who has registered with the 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 home is run.

Not all best interest decisions had been made involving people who knew the person well. We saw evidence that best interest decisions had been made in respect of, for example, the supervision of medicine but not all best interest decisions were decision specific. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and how DoLS is assessed and authorised in other settings such as supported living or people’s own homes. People can only be deprived of their liberty in order to receive care and treatment when this is in their best interest and legally authorized. Not all applications for DoLS were made. We have therefore identified this as an area that required improvement.

We found that further adaptions and adjustments could be made to ensure that people with living with dementia and those that had physical or sensory disabilities could orientate themselves around the building, fully access all areas and therefore retain their independence. There was a general lack of signs to indicate to people the function of a room or to help them to know if they were approaching a particular communal room, corridor or floor. The garden was locked to people. The registered manager told us that this was to prevent falls in the garden. However, we could not identify risk assessment for people that evaluated the risk of falls in the garden as a particular risk or other, less restrictive options had been considered. We have therefore identified this as an area that required improvement.

People at the home told us that they felt safe. There were safeguarding policies and procedures in place that were followed and staff were fully aware of their responsibilities in reporting safeguarding incidents. The provider had a whistleblowing policy in place and staff told us they knew how to use it if they needed to.

People’s needs were assessed and care plans provided staff with guidance about how individual needs were met. Plans we looked at placed the person at the centre of all planning and contained the necessary risk assessments to keep people safe. They were reviewed and amended to ensure they reflected people’s changing support needs.

Essential training was up to date for all staff. Staff received training specific to people’s care and treatment needs, including specific health conditions. One member of staff said, “We have lots of training and everything you can think of is included in the programme. The recent training about dementia was very interesting.” People told us they felt the staff were well trained and able to meet their needs. The relative of a person commented, “Staff appear to be skilled and well trained.”

People were very complimentary about the friendliness and professionalism of the staff. One person said, “The staff look after me very well indeed. This is why I’m doing so well at my age.” Staff interacted with people in a warm and friendly manner. A health care professional told us, “The Nurses/Health Care Assistants I observe are kind, gentle and very respectful towards the patients.”

People had acc

A single adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We spoke to staff about their understanding of safeguarding procedures. They had an awareness of the different types of abuse and what to do if they witnessed abuse.

Equipment was available and safe for people to use. We heard from a person who said, “[My relative] is quite tall and they use a walking aid. The home took it to pieces to adjust it to make it just right for [my relative] and made sure it was labelled so it’s solely for their use.”

Is the service effective?

People who used the service and their relatives told us that they were happy with the care provided and felt their needs had been met. Staff told us they understood people’s care needs and that they knew them well. We read the following feedback, ‘The staff have all been so gracious and friendly. It is a peaceful, safe, caring, loving and spiritually fulfilling.’

We observed how people were supported with their care needs with the aid of suitable equipment. We found that there was sufficient equipment in place to meet people's needs safely and in a timely way.

We saw that there were systems in place to support staff. These included regular handover meetings and team meetings.

People who used the service and their relatives commented on the training within the home. One person told us, “I was a manager myself so I have done the job and I consider the carers to be extremely well trained.”

Is the service caring?

We saw that staff communicated with people at a suitable relaxed and considerate pace. All of the people we spoke with told us they were happy at St Mary’s Care Home. A relative told us, “The staff are so kind and friendly. Every aspect of the home is excellent and I could not ask for more. [My relative] is in good hands here.”

Is the service responsive?

Care and nursing staff told us about each person’s care needs and support required. One member of staff told us, “People are well cared for here, we know their needs.”

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Quality and compliance audits were regularly conducted and included medication, accident and incidents, care plans and maintenance reviews.

We used a number of different methods to help us understand the experiences of people who used the service. The complex needs of many of the people who used the service meant they were not able to directly tell us their experiences. During our visit we were able to speak with two people who lived in the home, and we spoke with two relatives of people who lived in the home. We spoke with six members of staff, including the manager, and two volunteers. We looked at the records of six people. We also looked at the responses to a survey of people who lived in the home and their families and friends.

The people we spoke with were happy living at the home. One person said "Undoubtedly the care is very good", and another told us "It's a smart operation".

We spent time observing the care that people received, and saw that people's needs were met quickly by staff who understood their needs, and people were always treated with dignity and respect. People's care was assessed, planned and delivered effectively. People were protected from abuse and their human rights were upheld. Staff told us they received the training they needed. We saw that the quality of care was monitored and lessons were identified and shared.

There was no registered manager in post for this service at the time of our inspection. We have asked the service what action they will be taking to address this as it is a condition of their registration that one is registered with the CQC.

At our last inspection there was no Registered Manager at St Mary's. A new manager is now in place and several changes to the way care is being delivered have been put in place.

We looked at the care records relating to people's care and support and saw that people's wishes had been taken into account in planning their care, with the help of relatives if necessary. Risks to people's health had been assessed and managed and care was delivered in a way that promoted people's independence. People were cared for by staff who had undergone an effective recruitment procedure.

We spoke with seven people and six relatives about the care provided in the home. One person said "I can't fault them on asking my permission. They tell us everything". One relative said "It's absolutely excellent. It's like a five star hotel".

We spoke with six staff who had different levels of experience of working in the home but all said they were well supported with training. One member of staff told us "training is continuous".