About the service:

• St Mary’s Care Home is a residential and nursing care home.

• The home accommodates up to 80 people in one adapted building, and is split into five different units.

• At the time of our inspection 72 people were living at the home.

People’s experience of using this service:

• The provider had made good improvements to the service since our focused inspection on 14 August 2018.

• People were safely protected from the potential risk of abuse, and staff were clear on how to identify and report concerns.

• Medicines were now well managed to ensure that people received them safely and in line with best practice.

• Quality assurance systems had improved to ensure that any improvements required were promptly identified and implemented.

• Sufficient risk assessments were in place to ensure that people were safely supported.

• People received support in order to meet their nutritional needs, with good access to other healthcare professionals.

• People’s capacity to consent had been assessed in line with legal requirements.

• People told us that staff were kind, compassionate and attentive to their needs.

• People were treated with dignity and respect.

• Activities were provided to ensure people received appropriate stimulation, and people were consulted on their views about their care.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

• More information is in our full report.

Rating at last inspection:

• At our last focused inspection, the service was rated “requires improvement”, where we inspected the key questions ‘Safe’ and ‘Well-led’ only. Our last report was published on 18 September 2018.

• Our last comprehensive inspection was published on 20 January 2018, where the home was rated ‘requires improvement” overall.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

We undertook an unannounced focused inspection of St Mary’s Care Home on 14 August 2018.

This inspection was prompted by a whistle-blower notification that people were at risk of ill-treatment. The concern also highlighted issues with manual handling practices and the prevention and control of infection. We also checked that improvements to meet legal requirements planned by the provider under ‘Safe’ and ‘Well-led’ after our 13 December 2017 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe.

No risks, concerns or significant improvement were identified in the remaining key questions,effective, caring and responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At our last inspection we found that the provider did not operate effective staff recruitment and quality monitoring systems. We found recorded evidence was not always available in staff's files to show the provider had obtained two professional or character references for all new staff. Although we saw systems had been established to monitor and review the quality and safety of the service people living at the care home received, the provider had failed to pick up most of the issues we identified during that inspection, specifically in relation to staff recruitment. Staff were not clear on how to manage behaviours that could be considered challenging, and appropriate guidance was not in people’s care plans to guide staff on how best to support people.

St Mary’s Care 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 Mary’s Care Home accommodates up to 80 people in one adapted building. The home was split into five different units. At the time of our inspection 76 people were living at the home.

At this inspection of 14 August 2018 we found a breach of regulations in relation to safeguarding people from abuse and improper treatment. People were not always protected from the risk of ill-treatment. During the inspection one person disclosed an allegation of abuse, and another told us that staff did not always treat them well. You can see the action we have told the provider to take about this breach at the back of the full version of this report.

At this inspection of 14 August 2018 we found that the administration of medicines required improvements. Regular stock balance checks were not always taken and recorded, staff did not always sign people's medicines administration records (MAR) to show that people’s medicines had been given. We spoke to the provider about these identified issues, and will check on their progress at our next inspection.

We also reviewed areas in need of improvement from our last inspection of 13 December 2017 in relation to staff recruitment records, the provider’s quality assurance systems and guidance for behaviour that could be considered challenging. Some improvements were still required in the provider’s audits, in that they needed to be prompt in taking action to address any identified issues. We will check on their progress with this at our next comprehensive inspection.

Staff recruitment records now included copies of two appropriate references, as well as staff employment histories and appropriate vetting checks. People’s risk assessments were comprehensive and included guidance for staff on how to manage behaviours that may be considered challenging in order to de-escalate and support people in line with their preferences.

Infection prevention and control was appropriately monitored across the home, with suitable personal protect

People living in St Mary’s Care Home receive accommodation and nursing or personal care as 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

The care home can accommodate up to 82 people across five separate units, each of which have separate adapted facilities. The two units known as Rose and Lavender wings specialise in providing care to older people living with advanced dementia. The three other units, known as Orchid, Jasmine and Daffodil wings specialise in supporting older people with personal care needs. At the time of our inspection 78 people resided at the care home.

At the last comprehensive CQC inspection of this care home in September 2015 we rated the service ‘Good’ overall and for each of the five key questions. We carried out a focused inspection in June 2016 in response to concerns we received about there being a lack of competent staff working in the care home to meet people needs. We found there were enough suitably trained staff on duty at the time of that inspection. At this inspection we have changed the care home’s overall rating and for the three key questions is the service Safe, Effective and Well-led? to ‘Requires Improvement’.

We rated the service ‘Requires Improvement’ because the provider did not operate effective staff recruitment and quality monitoring systems. We found recorded evidence was not always available in staff’s files to show the provider had obtained two professional or character references for all new staff. This meant the provider had not done enough to satisfy themselves of the suitability of staff working at the care home. Furthermore, although we saw systems had been established to monitor and review the quality and safety of the service people living at the care home received, the provider had failed to pick up most of the issues we identified during this inspection, specifically in relation to staff recruitment and the support they received from management.

These failings represent two breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We have also made a recommendation about the home’s environment and design not being as dementia ‘friendly’ as it could be. Although we saw there were some signs displayed throughout the care home to help people identify toilets and bathrooms, most bedroom doors lacked any visual cues in order to make the room more recognisable to people. We also saw communal areas had all been painted in identical neutral colours. This lack of visual stimulation might lead to people living with dementia becoming disorientated.

The service had a newly registered manager who had been in post since August 2017. This is the third registered manager the service has had in the last seven years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People and their relatives told us they were happy with the standard of care provided at the home. We saw staff looked after people in a way which was kind and caring. Staff had built up caring and friendly relationships with people and their relatives. Our discussions with people living in the home, their relatives and community health care professionals supported this.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe. The premises and equ

We carried out an unannounced comprehensive inspection of this service on 22 September 2015. The service met all the regulations inspected at that time. We rated the service as good.

We undertook a focused inspection on 9 June 2016 due to concerns we had received about the service in May 2016. There were concerns that people were not receiving safe care and treatment due to staffing levels at the service. This report only covers our findings in relation to these concerns.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Mary’s Care Home’ on our website at www.cqc.org.uk.

St Mary’s Care Home provides accommodation for persons who require nursing and personal care for up to 82 people. On the day of the inspection, 78 people were using the service.

There was a registered manager 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.

During this focussed inspection, we saw the action the registered manager had taken to mitigate the effects of staff shortages due to staff leaving the service. The registered manager had recruited nursing and care staff to ensure there was sufficient staff to provide safe care to people. The provider had not successfully recruited a replacement for the deputy manager and recruitment was underway. Staff had the right skills and knowledge to provide people with safe care and treatment. People received the support and care they required although some people might have experienced delays. The provider had appointed an operations manager to provide management oversight at the service and to support the registered manager. The registered manager had taken appropriate action to address the concerns and develop the service.

This unannounced inspection took place on 22 September 2015. The last inspection of St Mary’s Care Home took place on 4 March 2015. The service met all the regulations we inspected at that time.

St Mary’s Care Home provides accommodation for persons who require nursing and personal care for up to 82 people. On the day of the inspection, 68 people were using the service.

The service had a registered manager 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 were kept safe at the service. Staff understood how to take action to protect people from neglect and abuse. Healthcare professionals told us people received safe and effective care and support. Medicines were kept securely and administered safely to people as prescribed.

People were treated with kindness and respect. People had sufficient food and drink and received support from staff with their eating and drinking when required. Staff followed healthcare professional’s advice in supporting people with their nutritional needs.

The registered manager ensured risks to people’s health and their well-being were assessed. Staff had up to date information about people’s needs and sufficient guidance to manage the identified risks. People were supported to pursue their hobbies and interests.

People were supported by experienced and skilled staff. The registered manager showed leadership and expertise to manage the service. Staff received appropriate training and the necessary support to enhance their work. People were involved in the planning of their care and consented to the support they received. Staff knew people well, understood their needs and respected their views on how they wanted to be supported. People’s privacy and dignity were respected.

The registered manager carried out regular audits on the management of the service and used feedback to make improvements. People and their relatives were asked their views about the service and the care and support they received and their opinions were considered. The registered manager recorded and monitored incidents and accidents and ensured staff took appropriate action to minimise recurrence.

People had access to healthcare services when needed. People were effectively supported by staff to maintain their health and wellbeing. The service had received an award for its care and support to people nearing the end of their lives. The registered manager worked in partnership with other healthcare professionals and ensured people’s needs were met appropriately.

We carried out an unannounced comprehensive inspection of this service on 9 July 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to responding to medical emergencies.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Mary’s Care Home on our website at www.cqc.org.uk

At our previous inspection some staff were unsure of how to support people in a medical emergency. At this inspection we confirmed that effective action had been taken to address this. The registered manager had ensured staff received additional training which covered how to safely support and care for people during various medical emergencies.

Staff understood how to appropriately support people when they became unwell and how to ensure they promptly received the medical treatment they required.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

We undertook an unannounced inspection. St Mary’s Care Home provides accommodation for people requiring nursing and personal care. The service can accommodate up to 60 people. At the time of our inspection 55 people were using the service.

At our last inspection in November 2013 the service was meeting the regulations inspected.

The registered manager has been in post since 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People using the service told us they felt safe. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures.

Staffing levels were determined according to the needs and dependency levels of people who used the service. Staff had qualifications in health and social care, previous experience of working in care settings and received regular training. However, we found that some staff were not familiar with current guidance regarding cardio pulmonary resuscitation and what to do if someone was choking. This meant there was a breach of the relevant legal regulation and you can see what action we told the provider to take at the back of the full version of the report.

People’s needs were assessed and care plans were developed to identify what care and support people required. Staff liaised with other healthcare professionals to obtain specialist advice to ensure people received the care and treatment they needed.

Staff were patient and polite when supporting people who used the service. We observed staff supporting people to eat their meals in a gentle manner and at a pace dictated by the person eating. Staff supported people to maintain their dignity and were respectful of their right to privacy.

Activities were on offer at the service. However, people told us they would like more access to the local community.

Staff felt well supported by their managers and said the registered manager was open to suggestions from staff and visiting professionals on how to improve the service. We saw that appropriate action was taken in response to incidents and steps were taken to reduce the risk of incidents reoccurring.

There were processes to monitor the quality of the service and we saw from recent audits that the service was meeting their internal quality standards.

One person using the service told us, “I’m very thankful to be here.” Another person said, “The staff are very kind.”

There were procedures in place to identify whether people using the service had the capacity to make decisions about their care. Where people did have capacity they were involved in their care planning and identification of their support needs. The provider liaised with a person’s relative to discuss care needs if the person was unable to do this themselves.

Care plans were put in place with information about how to support a person to maintain their safety and welfare. The care planning process addressed people’s physical and mental health, their social needs, and their spirituality.

The provider liaised with other health and social care professionals to ensure people were provided with the care and treatment they required. The service liaised with specialists for advice and further support if they had concerns about a person’s health.

Staff felt well supported and there were supervision processes in place to regularly discuss their performance. Staff received a range of training and were able to attend additional training to ensure they had the skills and knowledge to support people using the service and aid career progression.

The manager regularly took time to speak with the people using the service, their relatives and the staff to obtain feedback about the service and identify areas for development. There were processes in place to manage and monitor complaints and incidents.

There were 30 people at St Mary's at the time of this inspection. We spoke with six people using the service and with two relatives of people using the service. Some people had limited verbal communication abilities and so we could not interview them to find out their views. However, we were able to observe their mood, behaviour and how staff interacted with them.

People, and relatives, told us that they were happy with the care provided at the home. "They look after me very well. They are very kind, like family".

We found that people were kept safe from harm and that they had adequate food and drink throughout the day.

We made an unannounced visit to the service on 29th June 2011. At this visit we found that the service was not meeting one of the essential outcomes and we had minor concerns about two other outcomes. The provider told us that they had made improvements and we visited the home on 24th November 2011 to check these improvements.

We did not speak with people who live at the home during this visit. However, we met some people and they appeared happy and well cared for. In June people told us that they thought the home was well run and the staff were caring.

The manager told us that some of the staff were taking part in a workshop to learn more about dementia care. We met the trainer and saw some of the information staff were learning about. The trainer told us that the staff were supporting people who live at the home and involving families to create books about their lives using photographs and stories that they wanted to share.

We met a number of people who live at the home, some of their relatives and visitors and with some of the staff working there. We also spoke with some external professionals who work with the people who live at the home. People told us that they thought the home was well run and that the staff were caring.

A relative told us, “I visit the home several days each week and on my visits I observe that staff are patient and understanding”, another relative said “I like the way staff work with people, we never hear raised voices and the atmosphere is always calm”. Relatives told us that staff were good at keeping them informed of any changes or concerns.