About the service:

• St Paul’s Convent is a care home that provides nursing and personal care for up to 26 ‘sisters’, some of whom require nursing care. People living at this service are referred to as 'Sister's' as they have all previously lived at the convent and are part of a community of Catholic religious women who endeavour to live the Gospel way of life.

There were 14 Sister's living at the home at the time of the inspection, as the registered provider was refurbishing some parts of the home, and had reduced the number of Sister's it would care for.

People’s experience of using this service:

• The sisters continued to receive safe care and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support the sisters safely. The sisters received their medicines as it was prescribed. Staff followed infection control guidance and had access to personal protective equipment. Staff noted accidents and incidents and monitored trends to reduce the amount of accidents.

• The effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent as the provider had not always followed the principles of the Mental Capacity Act (2005). The sisters’ nutritional needs were met and they accessed health care when needed. Staff were supported and had the skills and knowledge to meet the sister’s needs.

• The sisters continued to receive care from staff who were kind and caring. Staff supported and encouraged them to be involved in how decisions were made about their support. Staff were caring, compassionate and kind. Staff respected the sister’s privacy, dignity and independence.

• The sisters continued to receive responsive care. Their support needs were assessed and planned with their involvement to ensure they received the support they needed. The sisters support was individualised and reviewed. The sisters were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaints process which the sisters were aware of to share any concerns.

• The service continued to be well managed. The environment was welcoming, warm, comfortable and clean. There were some areas with temporary restricted access due to on-going refurbishment of the service. The registered manager was known and made themselves available. Spot checks and audits were taking place to ensure the quality of the service was maintained.

Rating at last inspection:

• Rated Good (Report published July 2016).

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on the 07 June 2016. The service was last inspected in July 2014 and was meeting all the regulations. Saint Paul's Convent provides accommodation for a maximum of 26 retired nuns, some of whom require nursing care. The nuns living at this service are referred to as 'Sister's'. There were 24 Sister's living at the home at the time of the inspection, as the registered provider has commenced work to refurbish some parts of the home, and had reduced the number of Sister's it would care for.

The service has a registered manager who was present throughout the inspection. 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.

The Sister's told us they felt safe living at the service. Staff were aware of how to recognise possible signs of abuse and the need to report any concerns. We saw there were enough staff available to meet individual requests for support in a timely manner.

Medicines were given safely and there were systems in place to monitor medication administration.

Staff had a good understanding of the Mental Capacity Act (2005) and could explain how they put this into practice when supporting the Sister's. Staff received sufficient training to provide care based on people’s individual needs.

The Sister's had their healthcare needs met and received support to maintain their nutritional and hydration needs. The Sister's were treated with dignity and respect and their independence was promoted.

The Sister's told us they were happy with the care provided and that staff were kind and caring and knew people well. The Sister's were involved in planning their own care, and we received feedback that the care provided met people's individual preferences. Staff that we spoke with were enthusiastic about their role and could describe how each Sister preferred to be supported.

There was opportunity for people to join in activities. The service had resources for activities at the home and also engaged with the wider community to provide external activities for people. The Sister's had opportunity each day to express their faith, both individually and corporately.

The Sister's were aware of how to raise concerns and were confident that any concerns raised would be dealt with in a timely manner.

The Sister's, health professionals and staff were happy with how the service was managed. The registered manager had ensured that the quality of the service was monitored and sought feedback. Staff felt supported in their role and felt able to make suggestions for improvements to the service.

The inspection was carried out by one inspector. At the time of our inspection there were 27 people who were using the service. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people who used the service, five staff who were supporting them and from looking at records. This evidence helped us answer the five questions detailed below.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and staff. There were risk management plans in place for people and health and safety. The premises were well maintained and repairs made where necessary so that they remained safe for use. We found that staffing numbers ensured people received appropriate care when they wanted it. Staff had received training for their respective roles to promote their competency for delivering safe care and treatments for people who used the service.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. We found that one application had been submitted to a registered assessor through the appropriate channel. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people and or their relatives or an advocate being involved with the development of care plans. We found regular nutritional assessments of people had been carried out. Appropriate systems were in place to ensure people were supported in having a balanced diet that met their needs. A process for monitoring people who failed to eat or drink enough was in place. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff encouraged and supported people in leading interesting and enriched lifestyles. The people we spoke with all said they received the standard of care that matched their needs.

Is the service caring?

The people we spoke with were positive about the way they were cared for and supported. A person told us: "Staff know what I need and they assist me automatically." Another person said: “They (staff) are really helpful and do exactly what you want.” People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. We observed staff making arrangements to assist people with their preferred activities when they had made a decision about what they wanted to do. The home was supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

Staff respected people’s confidentiality and asked for permission before sharing personal information with other organisations. When people who lived in the home made suggestions for changes these were actioned as far as practically possible. We found evidence that people were able to make choices about their care, activities and day trips. One person said: “They (staff) don’t put pressure on us to do things.” Records’ confirmed people’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes. We found evidence that staff sought professional advice when they had identified concerns about people’s health and safety. Staff followed the guidance provided by healthcare professionals to ensure that people received appropriate care and support.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. There were clear processes in place for dealing with complaints. Regular audits had been carried out that enabled staff to make changes that could be of benefit for the people who used the service. Staff told us they were clear about their roles and responsibilities, the ethos of the service and the quality assurance processes. A nurse told us: “We work well, I have a great team here.” There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something.

We met most of the 33 people residing at St Paul's Convent, during our inspection. Their comments included "You couldn't beat it. I think it is fantastic here" and "The carers are all very good to me. You can't deny that."

We found that people had all been supported to undertake personal care to a very high standard, including people being cared for in bed. We found that people had been involved in writing their care plans and when required were supported to access health care facilities at local clinics or hospitals.

People told us they were very satisfied with the food provided. We observed staff provide patient, sensitive support to people when they needed help to eat. We were concerned that records did not show people being cared for in bed were always getting enough to drink.

The provider had systems in place to ensure that people were protected from the risk of abuse. We found this was a subject raised with people and staff on a regular basis to ensure people felt confident and had opportunity to speak out if necessary. We found some improvements were required to the record keeping of people's personal monies.

People had opportunity to administer their own medicines or to receive staff support. People were getting the correct medicine at the correct time.

We found that the systems in place to manage and audit the home were not as effective as is required. This was not ensuring the home was always a safe place to live or work.

There were thirty five people living at the home at the time of our visit. We spoke with some of these people and the staff that were supporting them. We spoke with a health professional that was visiting the home. She told us “Care is good. If something isn’t right communication is good, and they put it right for everyone. There are no issues here.”

People told us that they were happy living at the home and that they were satisfied with how their care needs were being met. People told us “I had a health problem and straight away the staff phoned the doctor to come and see me;” and “I have regular baths, have my hair done and get my nails cut.”

People told us that they had opportunities to express their views about what it was like to live at the home and that they were able to make choices about how they spent their time. A person that was living at the home told us “Sometimes I say I don’t want my tea in the dining room and it is fine. It is all about my choices.”

People told us that staff were available at the times that they needed them and that staff supported them in an understanding manner. People told us “The staff are very helpful. If I use my call bell they come immediately.”

People we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to. A person that was living at the home told us “I would talk to one of the nurses if I wasn’t happy about something. I could open up to any of them and they would help me. I have no problems.”

During our review, we requested information about the quality of the service provided at the home from local authority staff involved in monitoring the home. At the time of writing this report, we had not received any feedback from them.