About the service:

St. Mary's House is a privately-run home for up to 24 people over the age of 65, including people living with dementia. The home provides accommodation and personal care with any nursing services being provided by external health services.

People’s experience of using this service:

• At this inspection the service did not meet the characteristics of Good in all areas. In the areas of Safe and Well-Led the service met the characteristics of Requires Improvement. More information can be found in the full report.

• People did not always receive safe care and support. We found one medicine which was prescribed for an individual being administered generally to others.

• We found some staff records which did not contain sufficient evidence that staff had been thoroughly checked and vetted via the recruitment process.

• We found that there was a risk to people who lived on the top floor of the home of falling down stairs.

• There was no policy for the management of controlled drugs and controlled drugs were not covered in the "Administration of medication Procedure".

• There was no separate lockable fridge for medicines and records of daily temperatures were not taken.

• The service was not consistently well led. The registered provider carried out quality assurance checks however they were not effective in identifying areas for improvement.

• The registered provider had not reviewed or developed the service regarding management and quality assurance despite this being an area for action at the previous inspection in 2016.

• Elsewhere, people received effective care from staff who knew them and understood their needs.

• People and their relatives told us that they felt safe and well cared for in the home. People were complimentary about the quality of meals and how staff respected their dignity and privacy.

• We found where people lacked capacity that the appropriate authorisations were in place and being reviewed by the local authority.

• People accessed health care when needed and there were records in relation to hydration, nutrition, pressure area care monitoring and healthcare.

• People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff.

• The provider had a complaint process which people and relatives were aware of, although the home had an open-door policy which welcomed informal discussions and conversations whenever needed.

Rating at last inspection

At our last inspection of 5 and 6 September 2016 the service was rated “Good”.

Why we inspected:

• 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 intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 5 and 6 September 2016 and was unannounced. At our previous inspection in December 2013 we found the provider was meeting the regulations we inspected.

St. Mary’s House is a care home providing personal care for up to 24 older people, including people with dementia. At the time of our inspection there were 22 people living in the home.

There was an established registered manager who had worked in the service for many years. 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 and their relatives told us they felt safe and well cared for. Staff respected and understood people's need for privacy and promoted their independence. People were supported to maintain their hobbies and interests at home and in their local community.

At the time of our inspection most people living at St. Mary’s House had capacity to make decisions about their care. Their rights were protected because the registered manager and staff understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This is legislation that protects people who are not able to consent to their care and support, and ensures people are not unlawfully restricted of their freedom or liberty.

People's needs were assessed and reviewed to ensure they received all the support they needed. The care plan records included important information on how each person liked to live their life. People were fully involved in reviewing and providing feedback on the care and support they received, and relatives and family members were encouraged to contribute to the care planning of people.

Staff knew people well and knew when people were unhappy and how to respond to them. People and their relatives were encouraged to share their views about the care provided in the home. People knew how to complain and make suggestions, and were confident their views would be acted upon by staff and the registered manager.

People were supported to keep healthy and their nutritional needs and preferences were met. Any changes to their health or wellbeing or accidents and incidents were responded to quickly. Referrals were made to other professionals as necessary to help keep them safe and well.

St. Mary’s House was safely maintained and people lived in a home that met their assessed needs. Individual bedrooms were furnished to comfortable standards, were personalised and were homely. The standards of hygiene and cleanliness were good.

Staff understood how to protect people from harm and provide safe care. Staff knew how to recognise and respond to abuse correctly and had received safeguarding training. The service encouraged people to take positive risks whilst promoting their independence. Where risks were identified, there was guidance on the ways to keep people safe in their home and in the local community. Medicines were managed safely and people had their medicines at the times they needed them.

Staffing levels met the present care needs of the people that lived at the service. Staff received a structured induction and essential training to support them in their role. This was followed by on-going refresher training to update and develop their knowledge and skills. Staff also undertook training specific to the needs of people they supported. The provider recruited staff safely which helped ensure that people were protected from unsuitable workers.

The registered manager was also the registered provider and had been in charge at the service for a long time. She knew people and staff well and had good oversight of everything that happened at the service. The registered manager had values for the service, which were known and shared by the staff

People we spoke with told us that they felt able to speak with staff about all aspects of their care and that staff took time to explain what was taking place whenever care was provided, for example when assisting them to move throughout the home or when receiving medicines or food and drink. One person told us "The staff are so lovely. They are always there to help when you need them".

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three care records and found that they contained details of people's personal wishes, assessments of health and social care needs, care plans, records of medicines and daily care notes.

We saw evidence that the home had clear procedures for reporting any concerns about possible abuse and that they followed the local authority's safeguarding policy. We saw that staff had police checks carried out as part of the recruitment process, as well as having to provide other basic details and references. All staff received mandatory training in safeguarding vulnerable adults and reporting allegations of abuse..

Medicines were being managed appropriately in the home. The latest audit by the local pharmacist carried out in June 2013 found that the home's procedures and recording were in "excellent order".

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place.

Monitoring of the care provided at the home was done daily as the owner worked at the home and took time to speak with people and their visitors throughout the day. Staff were clear about their roles and duties due to well-laid out policies and procedures in the home.

We spoke to several people living at the home, including visitors. Feedback was positive, particularly in relation to staff attitude, meals and flexibility of receiving visitors.

Meals were described as "excellent", with one person commenting that it was "lovely to be able to have your breakfast in bed". people described staff as friendly and helpful, with one comment being "they can't do enough for you".

People who lived in the home commented that they felt it was comfortable, with one person saying that the gardens "were lovely".

Everyone spoken to commented that they would feel comfortable raising issues with the manager or staff and that social events in the home, as well as the trips out made it a friendly place to live.

The people who live at the home told us that they were happy there. They said that they were well cared for and the staff were kind and polite. They told us that they knew who to speak to if they were unhappy about anything. One person said, ‘the home is very warm and welcoming’.

Visitors we spoke to told us that they were pleased with the care of people at the home. They said that they thought everybody was treated as an individual and their needs were met.

One member of staff told us, ‘there is something about this place, the staff and the residents – it makes you look forward to coming to work each day’. Another member of staff said, ‘St Mary’s is a friendly family establishment which provides a high standard of care to older people’.