This inspection took place on 29 October 2018 and was unannounced.

At the last inspection in 2017 we rated the service as requires improvement. At this inspection we found that improvements had been made, although some improvements were still required to ensure that systems for monitoring and improving the quality of the services provided were robust and encouraged continuous improvements.

St Quentin Senior Living, Residential & Nursing Homes 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 Quentin Senior Living accommodates up to 51 people in two separate buildings. At the time of the inspection, the service supported 48 people. Each building had its own manager.

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. The registered manager worked across both buildings.

Some improvements were required to ensure that systems in place to monitor the quality of services were effective in identifying areas for improvement and ensuring that action was taken. Some people and relatives did not feel engaged and involved in the service and able to approach the management team with any concerns, whilst others did feel the management were approachable and responsive.

People were protected from the risk of harm and staff were trained to recognise the signs of abuse. People’s risks were assessed and managed to help keep them safe. There were enough suitably skilled staff to meet people’s needs. People were protected from the risk of infection and they received their medicines as prescribed. There were systems in place to learn when things went wrong.

People’s needs were suitably assessed before they moved to the service and care plans were developed in line with best practice guidance. Staff were trained and suitably skilled. People had their nutritional needs met and there were systems in place to ensure people received consistent care and support. People were supported to have healthier lifestyles by having timely access to healthcare services and professionals.

People had their consent sought in line with the principles of the Mental Capacity Act 2005. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People received support that was delivered in a caring and compassionate way and people were treated with dignity and respect. People, where possible were consulted about how their care was provided and were given choices in their day to day lives. People’s communication needs were met.

Staff knew people well including their likes, dislikes and preferences. People had access to activities. There was a complaints procedure available to people and their relatives and people were supported at the end of their life to have a dignified and comfortable death.

Staff felt the management team were approachable and supportive. People and relatives’ feedback was requested via questionnaires but improvements were required to ensure that action taken in response to feedback was shared with people and their relatives.

The service worked in partnership with other organisations to improve outcomes for people. They participated in partnership working with other agencies to help improve the services provided.

This inspection took place on 5 April 2017 and was unannounced. At our last inspection in January 2016 the service was rated as Good.

St Quentin Senior Living, Residential & Nursing Homes provides support and care for up to 51 people, some of whom may be living with dementia. At the time of this inspection 46 people used the service.

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.

People’s medicines were not consistently managed safely. People were at risk of not receiving their prescribed topical creams in a safe or effective way.

There was not always sufficient staff available to meet people's individual support or nursing needs.

People's risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans. People were safeguarded from the risk of abuse as staff and the management knew what to do if they suspected or identified abusive situations.

The principles of The Mental Capacity Act (MCA) 2005 were being followed as the provider was ensuring that people were consenting to or when they lacked mental capacity, were being supported to consent to their care.

People were supported with their nutritional needs and monitoring was in place to ensure people ate and drank sufficient amounts.

Advice was sought from health and social care professionals when people were unwell. This advice was documented and followed by staff to maintain and support people’s physical and emotional wellbeing.

Staff had been recruited using safe recruitment procedures to ensure they were of good character and fit to work with people who used the service.

People were treated with dignity and respect and their right to privacy was upheld. People chose whether or not to participate in the daily activities arranged.

The provider had a complaints procedure and people knew how and who to complain to.

The provider had systems in place to assess, monitor and improve the quality of care.

People and staff told us that the registered manager and the senior management team were approachable and staff felt supported to carry out their role.

This inspection took place over two days, 14 and 15 January 2016, and was unannounced.

Fifty one people can be accommodated within the two units at the same location. One building provided accommodation and care within a residential setting for 20 people. The other building provided nursing care and accommodation for up to 31 people. At the time of this inspection 47 people used the service, 20 people in the residential unit and 27 people in the nursing care unit.

At our previous inspection in July 2014 we judged the service as Requiring Improvement overall and in each of the five key questions. We issued four requirement actions in relation to assessing the risks to people, consent and medication, staff training and the quality assurance processes. At this inspection we found improvements had been made in all areas.

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’. The registered manager is the registered provider for this service. 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. In this report we will refer to the registered provider as the registered manager.

Staff were aware of the actions they needed to take if they had concerns regarding people’s safety. Risks to people’s health and wellbeing were identified, recorded, reviewed and managed. Procedures were in place that ensured concerns about people’s safety were appropriately reported to the registered manager and local safeguarding team.

There were enough suitably qualified staff available to maintain people’s safety and meet their individual needs. Staff received regular training and supervision that provided them with the knowledge and skills to meet people’s needs. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed.

People were supported to make important decisions about their care and treatment. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

People told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Health care professionals were contacted when additional support and help was required to ensure people’s health care needs were met.

People were treated with kindness, compassion and respect, and staff generally promoted people’s independence and right to privacy.

People told us that staff arranged a range of social and leisure activities that met people’s hobbies and recreational preferences. These were arranged either on a one to one basis or in groups. People could choose whether they wished to participate or not and staff respected their choices.

Some people were aware of the complaints procedure and knew how and to whom they could raise their concerns.

The registered manager was aware of the requirements of their registration with us and notified us of significant events related to care provision. The registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. Our previous inspection took place in February 2014. The service had no breaches in regulations at the last inspection.

The service is divided into two buildings. One building provided accommodation and care to 20 people. The other building provided nursing care for up to 31 people. On the day of our inspection the service was full. 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

Records were not maintained to clearly record that people had been involved in decisions about their care, treatment and support. There was limited personal information about people for staff to be able to meet people’s individual preferences.

Improvements were needed in how the provider responded to people’s individual care and welfare needs. For example, staff basic training was up to date, but specialised training was not available to support staff to care for the individual needs of all the people who used the service effectively and safely.

The Deprivation of Liberty Safeguard (DoLS) procedure aims to ‘safeguard’ the liberty of the individual by ensuring that a rigorous and transparent procedure is followed prior to any deprivation of liberty. The registered manager demonstrated knowledge of the DoLS procedure but we could not see evidence that best interest meetings had taken place where people lacked capacity.

People who used the service and their relatives told us that they were happy with the care they received at St Quentin’s.

We saw that staff respected people’s privacy and dignity. We observed that staff interacted with people who used the service in a kind and caring manner.

The service had a recruitment process in place. All essential checks had been satisfactorily completed, in order to ensure that people were suitable to work at the care home.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During the inspection we spoke with seven people who used the service, four relatives, five staff who provided support and the registered manager. We did this to understand the experiences of people who lived at the home.

We found that the provider had systems in place to gain consent to care and treatment from people who use the service. People we spoke with told us that they consented to their care and treatment. Staff explained how they followed the principles of the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. One person told us, “I’m well looked after here. The staff are very pleasant and helpful”. Another person told us, “It’s very good I am well looked after”.

We viewed records that showed care was planned and delivered in line with people’s preferences. Staff we spoke with knew the needs of people who used the service and how they preferred care to be carried out.

We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment during our inspection and staff we spoke with understood the importance of infection control.

The provider had a recruitment system in place. We saw that staff had been checked to ensure that they were suitable to provide support to vulnerable people.

We saw that the provider had an effective complaints system in place. People we spoke with told us that they knew who to complain to if they needed to.

We found that people who used this service received good quality care and support in a homely environment which had been adapted to meet their needs.

The atmosphere of the home was friendly,informal, open and inclusive. People who used the service told us that they felt well cared for and that the staff were caring and attentive to their needs. A person said, "It's very good here, they look after us well." Another person said, "All the staff are lovely."

Staff delivered care and support according to people's preferences and wishes and people were supported to maintain their social and therapeutic needs and hobbies. Staff were supported to develop their skills and were suitably trained, supervised and appraised. Staff felt that the providers had a good staff training and development programme in place. A staff member told us, "The training and support is very good here."

The providers sought help and advice from other other relevant health care professionals to ensure that people's health care needs were monitored and met. Specialist advice was also obtained where people were in need of this so that people received best practice coordinated care, treatment and support.

People who used the service and their relatives were encouraged to participate in the development and review of care plans. Relatives told us that they felt informed and involved and able to talk to staff including raising concerns and suggestions regarding their relative's care and support.

We visited St Quentin Nursing home on 23 February 2012. On the day of our visit we spoke with six people who lived at St Quentin Nursing home as well as six relatives and four members of staff. We also spoke with the manager.

We saw the nursing home was clean and tidy. People appeared to be happy and relaxed. People we spoke with during our visit were overall happy with their care, people told us they were comfortable. People reported staff were caring and they could approach them with a concern. One person commented the care was "excellent".

People we spoke with said they were treated with dignity and respect. People told us there were activities they could be involved with such as flower arranging and games. People commented they had choice and did not have to take part. Two people we spoke with said they preferred sitting in their room watching the television and staff respected their decision.

People said they enjoyed their meals and they were offered choice, one person said "we get food we like". We saw meal times were organised and relaxed. People were supported into the dining room and assisted by staff. Staff ensured people were comfortable and had an adequate meal.

The relatives we spoke with were happy with the care received by their family members. Relatives said they felt involved and staff kept them informed of changes which occurred.

We saw staff attended to people in a caring, considerate manner and responded

appropriately to their needs. People's likes, dislikes and religious beliefs were known by staff and included in the delivery of care.

Staff we spoke with felt well trained and supported to provide good quality care.Staff understood what constituted abuse and said that they would be able to recognise and report poor practice. This demonstrated people were cared for by appropriately trained staff .

We found appropriate quality assurance systems in place. The service was improving as a result of findings and responding to feedback.