St Raphael's Care Home is a 'care home'. People in care homes receive accommodation and nursing or 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. The home is a registered location of The Order of St Augustine of the Mercy of Jesus, a registered charity.

The home is run by Sisters who oversee the care home taking an active part in the day to day running and pastoral care of the residents. The home is set in its own grounds which provides residential and nursing care for a maximum of 58 people. The home specialises in providing care to older people who may have physical or sensory impairments and people who have dementia related conditions There were 53 people at the home at the time of the inspection.

At our last inspection we rated the service good. At this inspection we found that the service had remained good.

People felt safe at the service and staff and the registered manager were aware of their responsibilities for ensuring that people were kept safe. Risks were assessed and managed to keep people safe. Checks such as identity, professional registrations and criminal records checks were carried out on new staff as part of the recruitment process. People felt that staffing was suitable to meet their needs and was regularly assessed when people’s needs changed. Medicines were managed safely using an electronic system and staff were assessed to ensure they were competent to administer medicines to people.

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.

People had their needs assessed and care was planned taking account of their ability. People said they were involved in reviewing their care and relatives were invited to attend reviews. People’s relatives said “I’m always made aware of any changes”. Staff received training and support which allowed them to provide care to people in a safe way and developed their skills in areas relevant to the needs of people at the service such as in dementia and end of life care. Staff felt supported and able to develop their skills. Staff said they were able to ask for training and training was regularly reviewed.

Staff were observed treating people kindly and respecting their dignity and independence. People said that staff were kind and caring. Relative’s told us that they always observed staff being respectful to people which was observed during the inspection. Feedback received from people and their relatives was positive and they spoke highly of the service and staff. Staff communicated with people in a way that they understood and were patient with people. People told us they liked the staff and there was a nice and calm atmosphere within the home.

People's preferences and choices were reflected in their care plans. The service took account of people's individuality and supported them to maintain their individual interests and keep in contact with relatives via video calling. People said that they enjoyed the activities available and the home had introduced the use of virtual reality to enhance people’s sensory experiences. People knew how to raise concerns however said that they hadn’t needed to. The home received lots of compliments and positive feedback. The service was working towards an accreditation in the Gold Standards Framework for end of life care and people and their relatives were encouraged to express their wishes about how they would like to be cared for when they reached the end of their life.

People told us they liked the registered manager and staff and there was a positive friendly culture. Staff felt supported and their views were sought to drive improvements. There were governance structures in place for information to be shared and lessons learned to be fed back to services by

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Records showed that people had attended an event called ‘Listening week’ in November 2013 which offered “Residents and relatives and friends” the opportunity to make comments about the care and the service. The deputy manager advised that the team who gathered the comments had yet to make a written report. They said that they had been advised that the responses were positive and no recommendations had been made by the ‘Listening week’ team.

People we talked with were happy with the service they received. One person told us “It’s well organised. There’s a very good atmosphere.” We saw that recent written comments on the service had included “(This is) a special place where the residents and their families can feel at home”, and “(My relative) could not have had any better care”.

Staff we talked with told us that they were asked for their views. A member of staff said “The views of staff are listened to, at meetings and handover meetings.” We were told that a member of staff had suggested how one person’s care could be changed to support their nutritional needs, and that the new arrangements put in place had worked very well. Records of a recent staff meeting showed that a member of staff had suggested people would enjoy the opportunity to have hand massage. We observed on the day of the inspection that hand massage was offered to people. This showed that the provider listened to the views of staff in how the service was run.

We saw that the provider had arrangements in place to monitor the quality and safety of the service provided. Medication audits were regularly carried out and we saw records which showed that lessons to be learnt from the audits had been discussed with staff. We looked at an audit of care plans which the provider had carried out in January 2014. We saw that the audit had identified for one person that part of their care plan had not been completed, and the provider asked for this to be acted on. At inspection we found that the care plan was now complete. This meant that the provider had regularly audited the safety and quality of the service, and that action had been taken to make improvements in a timely manner.

There was evidence that learning from incidents had taken place and appropriate changes were implemented. We looked at the records for five incidents of falls. We saw that where people had had falls a written evaluation had been carried out to consider how the risk of falls could be reduced. Care plans seen provided guidance for staff on how the risk of falls should be minimised for the person.

There had been no complaints recorded since our previous inspection. The people who used the service told us that they had not had any concerns or complaints about the service. People told us that if they did have any concerns or complaints they felt they could approach the manager or deputy manager. One person told us “If I had any concerns I would talk to the deputy manager.” This meant that people felt they could use the complaints process as necessary.

Some people were not able to verbally tell us about their experiences. Therefore we used a number of different methods to help us to understand the experiences of people, including looking at records and observing care being delivered.

People who were able however told us they were happy with the care they received. Relatives visiting the home were also very complimentary about the care at the home.

We looked at the care people received and found that they were well cared for and consistently supported with their needs. We observed that people were supported in a sensitive and dignified way by the staff. We also saw that staff were respectful and positively engaged with individuals.

We looked at the care records and found that assessments and care plans were in place. We saw that they were regularly reviewed to make sure that people’s needs were met.

We also looked at staff support and training. We found the staff were well trained and there were good systems in place to ensure they were well supported in their work.

We found that people had good information and support to make decisions about their care or air their views about the home. We also found that good systems were in place to support people living at the home and the staff to raise concerns or complaints.

People living at St Raphael's Care Home told us they liked living there and felt safe.

People we spoke with told us they were involved in making decisions about the way they lived their lives and the care they received. They felt the staff always respected their privacy and dignity and that the staff helped them to remain as independent as possible. Staff knew the people living at the home well and had a good understanding of their care needs.

People told us that they had had a very nice lunch, they enjoyed the food and they were happy living at St Raphael's Care Home.

The inspection took place on 18 August 2015. St Raphael's Care Home was last inspected on 5 February 2014 and no concerns were identified.

St Raphael's Care Home is a care home with nursing for up to 58 older people that require support and personal care. People maybe living with conditions associated with advancing age, including dementia. The home is located in a rural part of West Sussex and is set in its own grounds. The service is provided by a Roman Catholic Organisation, The Order of St. Augustine of the Mercy of Jesus.

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.

Not everyone could tell us of their experiences, but those that could spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People had confidence in the staff to support them and we observed positive interactions throughout our inspection.

People were safe. Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. It’s nice here.”

Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) that applies to care homes. The registered manager had made appropriate applications, and was in the process of submitting further applications as people’s needs changed.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps were taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as end of life care and living with dementia. Staff had received one to one meetings with their manager, nurses received clinical supervision and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “The food is very good. They know my dislikes.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. Health care was accessible for people and appointments were made, as needed.

People could choose how to spend their day and they took part in activities in the home when they wanted to. They told us they enjoyed the activities, which included singing, puzzles and arts and crafts. People enjoyed the facilities that the home offered such as the extensive gardens in a rural location and its own peaceful chapel. Visits to local area were made in the home’s own minibus for those that wanted to go. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly relationships between people and staff. One person told us, “They treat you well here.” People told us the staff supported them to maintain their appearance and it was important to them.

People were encouraged to express their views. Completed written feedback and resident and relatives meetings showed people had high levels of satisfaction and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, I tell the staff.”

Staff were asked for their opinions on the service and whether they were happy in their work. Staff enjoyed their work. They felt supported within their roles and described a caring and ‘open door’ management approach. They described how management were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.