St Mary's Convent & Nursing Home is a care home providing accommodation for up to 60 people who require personal care and support. At the time of the inspection there were 57 people using the service. The service was divided into three areas. The two areas on the ground floor were for people who required nursing care and the third area on the first floor provided residential care.

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 and associated Regulations about how the service is run.

At the last inspection on the 5 and 6 May 2015, the service was rated Good.

This inspection took place on 20 and 21 April 2017 and we found the service remained Good.

Staff understood how to respond to safeguarding concerns and we saw risk assessments and risk management plans to protect people using the service from the risk of harm. There were a number of checks to ensure a safe environment. Safe recruitment procedures were followed and there were enough staff to meet people’s needs.

Medicines were administered safely, but we saw one instance where a care worker administered the medicine and a nurse signed for it. We recommended that the provider develop systems in line with the Royal Pharmaceutical Society guidance on the management of medicines in care homes to ensure the proper and safe management of medicines at all times.

Staff were supported through training and supervision to have the necessary skills to meet people’s needs. The service was very person centred. Staff, professionals and relatives all specifically noted the level of individual care each person received.

The service worked within the Mental Capacity Act (2005) so people were supported in the least restrictive way and had choices.

Nutritional needs were identified and monitored. People enjoyed their meals and had access to food and drink whenever they wanted to.

People’s day to day healthcare needs were met and healthcare professionals confirmed, in their experience, staff had the skills to care for people using the service. End of life care provided by the service was excellent.

We observed staff were kind and caring and knew of people’s preferences. Staff took time to listen and engage positively with people. People’s privacy and dignity were respected.

People and their relatives were involved in care planning and reviews were held regularly. Care needs were assessed and care plans included guidance for staff on how to support people in their preferred way. The service had a number of activities for people to attend and we observed those taking part were interested in the activity they were involved in.

The service had a complaints procedure and addressed complaints appropriately. Everyone we spoke with was satisfied with the service and no one had made a complaint.

The service was well run and the feedback we received indicated the management team were approachable and acted on information received.

The service had systems to monitor the quality of the service delivered including the environment and how the needs of the people using the service were being met.

The service met all the fundamental standards because it continued to provide a high standard of care to people using the service by a competently trained and skilled staff team providing person centred care in a kind and caring manner that involved the person using the service.

Further information is in the detailed findings below.

St Mary’s Convent and Nursing Home is a care home providing accommodation for up to 59 older people who require nursing, personal care and support. When we visited, 57 people were living in the home. The home had a registered manager in post. People living in the home and their relatives commented positively on her “caring nature” and told us she promoted high standards of care.

People we spoke with told us they were happy with the care and support they received. One person said “I am very happy here. We get excellent care. When I want them I call them and they come. Sometimes two or three of them. The sisters are ‘just there’ and I have two daughters who live nearby and visit regularly.” A second person told us “I can’t say enough. I would give them all a medal. Every one of them. They go that one step farther. I don’t call them helpers, they are friends.” A relative also told us “The carers are really caring. My [relative] is prone to fits and they ring me at home whenever she has had one, just to let me know, even though everything is alright.”

We saw most people had the support they needed at lunch time and they were encouraged to make choices about what they ate and drank. However, some people who needed help with eating were not supported in a respectful and dignified way.

The care staff we spoke with demonstrated a good knowledge of people’s care needs. However, the care plans we looked at did not include clear guidance for staff on the care people needed. This meant staff did not have the information they needed to care for and support people in the ways they preferred in a respectful, safe, caring and dignified way.

There was a need to make sure staff understood and followed the provider’s procedure for safeguarding people using the service. Incidents that should have been reported to the local authority safeguarding adults team and the Care Quality Commission were not identified as safeguarding concerns by the home.

We saw all communal parts of the home and some people’s bedrooms, with their permission. We saw the home was clean, hygienic and well maintained.

The problems we found breached health and social care regulations and the action we have asked the provider to take can be found at the back of this report.

During our inspection we spoke with nine people who use the service and/or their representatives and a minimum of seven staff. People who use the service spoke positively about the support they received. They said the staff were caring and attentive to their needs. One person said “they are lovely, and just can’t do enough for me”. Other people commented that the staff were “terrific” and “always ready to help”. People also said they were able to spend their time as they wished, on their own, or in the company of other people.

We saw that the people who use the service and the staff had developed positive relationships with each other.

People or their representatives were involved in identifying where they needed support and how this was to be provided. This was reflected in the care plans which detailed how people’s needs were to be met by the staff.

People received support for their needs from the service and from external health and social care professionals. Within the home they were supported by sufficient levels of staff.

Staff received support and training to ensure they were competent in their work and the care and support they gave to people.

We did not speak with people using the service about this outcome area. The main aim of the inspection was to assess whether the provider had appropriate arrangements in place

to manage medicines so that people were protected against the associated risks.

People told us that staff always give them information and discuss their care with them. They said that staff were friendly and treated them with respect and they were particularly pleased with the management of the home which was very approachable and visible. We observed that staff communicated well with the people they were supporting and responded promptly to their requests when they needed something.

People told us that staff monitored their condition when they were not well and took action where required. They added that they or their relatives have seen their care records. They reported that staff kept them or their relatives informed of changes in their care and treatment. One person said “staff take my weight, my blood pressure and temperature every month and give me my medicines. Staff call the doctor if I am not well”. Another person said ”this place is out of this world, they would do anything for you”.

People said that all their needs were met in the home including their social and recreational needs. One person said “we do not sit and gaze at the walls”. Another said “I do not get bored here and there is always something to do”.

All people said that they made choices for each meal and that their choices were respected by staff. One person said that “the food is awfully good and you get fresh fruits, ice cream, yogurts”. Another person said “You put on weight very quickly in here” and a third added “I have to watch what I eat”.

People said that they trusted staff and management to make sure that they were safe. Some people said that they would speak with their relatives if they had any concerns. Others said that they could speak to any senior member of the management team who would listen to them and address their concern. One person said that “you can discuss the slightest thing with staff and you can go to any staff if you want to talk to them”.

This inspection took place on 5 and 6 May and was unannounced. At the last inspection on 4 April 2014 we found the service was not meeting the regulations relating to care and welfare, safeguarding, respect and involvement, notifications and records. At this inspection we found that improvements had been made in all of the required areas.

St Mary’s Convent and Nursing Home is a care home providing accommodation for up to 59 older people who require nursing, personal care and support. When we visited, 58 people were living in the home.

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.

People using the service told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. Staff had received safeguarding training. They understood how to recognise the signs of abuse and knew how to report their concerns if they had any.

People, their relatives and friends told us they were happy with their care. Staff working at the home understood the needs of people and we saw that care was provided with compassion and kindness. People felt included in their care, were listened to and supported to make decisions and choices which staff respected. Throughout the inspection, we observed that staff cared for people in a way that took into account their diversity, values and human rights.

Assessments carried out by the staff ensured that people’s needs were identified and met. Risks were assessed and reviewed to ensure people’s individual needs were being met safely.

Staffing levels were appropriate to keep people safe and meet their needs.

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff and volunteers began work.

People received their medicines as prescribed and medicines were managed safely.

CQC is required by law to monitor the implementation of the Mental Capacity Act (MCA) 2005 and the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and least restrictive way, when it is in their best interests and there is no other way to look after them. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have the capacity to consent to specific decisions the staff involved relatives and other professionals to ensure that decisions were made in the best interests of the person and their rights were respected.

Staff were well trained, skilled and supported to meet people’s needs. They understood their roles and responsibilities.

People took part in activities and outings of their choice. The activities programme was extensive and took into account people’s diverse needs.

There was a clear management structure at the service and people, staff and families told us that the management team were approachable, inclusive, and supportive. The home had an open and transparent culture, with clear vision and values.

The provider had effective systems in place to monitor the quality of the service so areas for improvement were identified and addressed.

The provider encouraged feedback from people, their relatives and friends, which they used to make improvements to the service.