This comprehensive inspection took place on 11 December 2018 and was unannounced.

St Marys is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

St Marys is registered to accommodate up to 29 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit, 26 people were living in the home. Ten of the people living in the home were living with a diagnosis of dementia.

A registered manager worked in the home. 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 of St Marys, we rated the home overall as Requires Improvement. This was because people had not always received care that was safe, effective or responsive to their needs. Systems in place to monitor the quality of care had not been robust. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection we found that improvements had been made in some areas but that there were shortfalls in others. This resulted in three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2018. The overall rating for the home therefore remains as requires improvement.

Risks associated with hot surfaces, hot water and fire had not all been identified or managed well. This placed people at risk of avoidable harm. Robust recruitment processes were not in place to ensure that staff working in the home were of good character. Furthermore, the systems in place had not been effective at assessing, monitoring and mitigating risks to people’s safety. In response to our findings, the provider told us they would immediately act to rectify these shortfalls. You can see what action we told the provider to take at the back of the full version of the report.

Other risks to people’s safety such as not eating or drinking enough, falling and developing pressure ulcers had been managed well. The home was clean and tidy and the equipment that people used had been serviced when required to make sure it was safe to use.

People received care from staff who were kind, caring, polite and compassionate. People were treated with dignity and respect and their care needs and preferences were being met. They had a say in how their care was to be delivered and were listened to and their opinions respected. They were supported to have maximum choice and control of their lives.

There were some activities available to people to improve their wellbeing. These were limited but the provider was working to improve and tailor these to people’s own interests and hobbies.

The food that people received was of good quality and home cooked. There was a choice of food and drink available and people received enough to meet their needs.

Staff had received sufficient training and supervision to provide them with the skills to keep people safe and to meet their needs. People received support to maintain their health although people were not routinely reminded when they were due a dental appointment.

There were enough staff working in the home to support people when they required this. Some improvements had been made to the environment since our last inspection and these were ongoing. Further improvements are needed to ensure the home has been fully adapted to meet people’s needs.

The provider and regi

St Mary’s Residential Care Home is a residential care home that provides accommodation, care and support for up to 29 older people, some of whom live with dementia. It is registered to provide accommodation for persons who require nursing or personal care but nursing care is not provided. At the time of our inspection there were 19 people living in the home.

People in care homes receive accommodation and 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 Residential Care Home accommodates people across two floors. People are accommodated in single rooms, and there are communal toilet and bathroom facilities for people to use. This was the first comprehensive inspection carried out for this organisation.

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.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Care plans did not always contain enough guidance for staff to mitigate risks to people. There were some risks associated with people’s environment which had not previously been identified by the provider.

People’s food and fluids intake was not always monitored and recorded appropriately. People were not always referred for a review for their swallowing, and care plans did not always have enough detail about people’s diets.

Mental capacity assessments had not been carried out for people with variable or limited mental capacity in order to ensure that decisions were made in people’s best interests. Staff sought consent from people wherever possible, before delivering care.

Care records were not always written in a person-centred manner, and did not always contain full information about people’s health and care needs, their preferences and their histories.

Improvements were needed in the overall governance systems in the home, to ensure they assessed, monitored and improved the quality of the service provided. There were plans in place for improvements to be made.

Staff had received some training relevant to their role, such as manual handling, but further training was needed in areas such as mental capacity and dementia.

There were plans in place to address the above concerns, as the provider was working with the registered manager and a consultant on a service improvement plan.

There were enough staff to keep people safe and meet their needs. They knew how to report any concerns they had, and there were safe recruitment systems in place. People received their medicines as they were prescribed, and people felt safe living in the home.

People told us they enjoyed the meals in the home and people were supported to engage in activities in the home.

People had access to healthcare and staff supported them to see the doctor or occupational therapist if they needed. Staff provided compassionate care to people and respected their privacy, dignity and independence. People had choices of where to spend their time and were supported to eat a healthy balanced diet.

The registered manager was available to people, and people felt listened to. The registered manager demonstrated team work and staff were positive about their roles.