The inspection took place on 21 August 2018 and was unannounced. The provider registered with the Care Quality Commission (CQC) in April 2017. This was their first inspection.

St Mary’s Nursing 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.

St Mary’s Nursing Home provides accommodation for up to 56 people. The home consists of two separate units, one providing accommodation and personal care and the other providing nursing care. Some people receiving support at the home were living with dementia. The home is located in Doncaster near to the town centre. At the time of our inspection there were 40 people using the service. This included people who were staying at the home for a short period of respite care.

At the time of our inspection the service had a registered manager. 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.

Systems and processes were in place to safeguard people from the risk of abuse. Staff confirmed they had received training in this subject and told us what action they would take if they suspected abuse.

Risks associated with people’s care had been identified and actions had been considered to minimise them.

We observed staff interacting with people who used the service and found that there were enough staff available to meet people’s needs. However, we spoke with people who used the service, their relatives and staff and were told that sometimes there were not enough staff available to meet people’s needs in a timely way.

People received their medicines as prescribed, although we raised some concerns regarding the temperatures of the medicine store rooms and the recording of stock.

We conducted a tour of the building with the registered manager and found some concerns regarding fire safety and infection control. We brought these concerns to the attention of the registered manager who began to take action to address them.

We spoke with staff who felt they had the skills and knowledge to carry out the duties and responsibilities which were expected from them.

People received a healthy, balanced diet which met their needs and preferences. We observed lunch being served on both units and found people were offered a range of choices.

People had access to healthcare professionals who were contacted when people required their support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was compliant with the Mental Capacity Act 2005.

We observed staff interacting with people who used the service and found they were kind and caring in their nature. Staff ensured that people’s privacy and dignity were maintained. However, information relating to people’s care was not always treated confidentially.

People received personal care which met their needs. Care plans were detailed in a way they guided staff in how people preferred to receive their care.

The registered provider employed an activity co-ordinator who organised and delivered social activities.

The registered provider had a complaints procedure and people we spoke with felt able to raise concerns if they needed to.

The registered provider had systems in place to monitor the quality of the service. However, some audits had not been effective. Residents and relative’s meetings took place and people felt they had a voice.

We identified two breaches of regulation as the provider did not always ensure medic