This comprehensive inspection was carried out on 18 and 19 February 2019 and was unannounced. We last inspected St Stephen’s Care Home on 19 July 2016.

St Stephen’s Care Home (St Stephen’s) is a ‘care home’ providing care and accommodation for up to 40 older people. The premises are on one level and divided into two units, one of which provides support to people living with dementia. At the time of our inspection there were 37 people living at the home.

At the last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

People continued to receive a safe service and were protected from harm and abuse. Medicines were managed and administered safely. Accidents and incidents were recorded and management had oversight to identify developing patterns to mitigate the risk of recurrence. Although we received contrasting feedback about staffing levels, during the inspection we observed that there were sufficient staff to meet people’s needs. Safety checks were carried out to ensure St Stephen’s was a safe place to live. Measures were in place to control and prevent the spread of infection.

People continued to receive an effective service. People’s needs were assessed before they came to live at St Stephen’s. Staff received a wide range of health and social care related training. Regular staff supervision and appraisal took place. Staff competency was checked. Food was served in line with people’s dietary needs. 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 continued to receive a caring service. People’s privacy, dignity and independence were promoted and they were treated fairly and without discrimination. People’s individual communication needs were considered. We observed kind, caring and patient staff practice.

People continued to receive a responsive service. The service was homely and person-centred. People’s preferences and needs were recorded in a personalised care plan. A new system of care planning had been introduced including a more robust process for review. There was a policy and procedure in place to manage and respond to complaints. People’s future wishes for end of life care were considered and the service followed the ‘Six Steps’ programme to ensure high quality care at this stage of life.

People continued to receive a service that was well-led. There was a well-developed performance framework to assess the safety and quality of the service. Measures were in place to continuously improve the service. There was a registered manager in post who was due to leave however a new manager had been recruited. The regional manager would be responsible for overseeing their induction to facilitate a smooth transition.

We have made a recommendation that the registered provider reviews access to records to ensure that they are available in the absence of the registered manager.

Further information is in the detailed findings below

This inspection was carried out on the 19 July 2016 and was unannounced. We last inspected St Stephens Care Home in April 2014 and identified no breaches in the regulations we looked at.

St Stephen's is a nursing home providing care and accommodation for up to 40 older people in Elworth near Sandbach, Cheshire. The home provides care to older people who are physically frail and people living with conditions such as dementia. Nursing and care staff are provided 24 hours a day.

The home is divided into two units. One unit provides nursing care and the second unit provides care for people who are living with dementia. Each unit has two lounges, a dining room and a kitchenette area. All bedrooms are situated on the ground floor.

The home has a manager who is registered with the Care Quality Commission. 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 time of the inspection there were 36 people who lived at the home.

At this inspection carried out in July 2016, people told us they were happy living at St Stephens Care Home. We were told, “I don’t want for anything here. They’re nice to you here, they talk to you and look after you.” And, “I’m happy here, they look after you right.” People described staff as, “good.” And, “lovely.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Our observations showed people had positive interactions with staff who worked at the home. We observed people smiling and accepting help and comfort from staff that supported them. We saw a positive relationship between staff and people who lived at the home.

There were systems to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out. Care records documented the measures required to reduce risk. Staff were knowledgeable of the measures and we observed these were followed these to ensure people’s safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner. We found medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home.

We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. Staff told us they told us they could access training as required and professional journals were available to enable staff to maintain their knowledge and skills.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns which restricted people’s liberty to the registered manager.

We found people were offered a variety of foods. They told us they liked the meals at St Stephens Care Home. Feedback included, “Lovely lunches and the teas are good as well.” And, “Food’s good enough.”

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. Documentation we viewed confirmed people who lived at the home were supported to seek further medical advice if this was required.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. We observed people receiving assistance in accordance with their p

There are two wings to St Stephen's. One wing provides general nursing and personal care to frail and elderly people (21 beds), where residents have multiple physical nursing care needs. The other wing provides nursing and personal care to older people with mental health conditions and this particularly includes dementia (19 beds). There were 40 people living in the home on the day of the inspection. A relative commented “Mum has received exemplary care”.

Overall we saw that care was delivered with sensitivity and compassion after a structured assessment and using a written care plan.

We saw that people were cared for and supported by staff who interacted positively with people. In going about their duties staff took the opportunity to speak with people about a topic that the person was clearly interested in.

We saw that staff were respectful and knew individuals well. However, we also noted that staff were busy. From our examination of records, meeting with people and their relatives we noted that staff were not routinely able to engage people in structured and stimulating activities.

During our inspection we spoke with people who lived in the home, five relatives, two healthcare professionals and a visitor to the home.

People who lived in the home told us the home “was fantastic” and that staff were “more like members of the family”. One person told us that they “had no regrets about coming to live in the home”.

The relatives and healthcare professional told us that during their visits to the home they had seen staff treat people with respect and maintain their dignity.

One relative told us they had “absolutely no concerns about the manner (their family member) was been cared for”. Relatives told us they were kept fully informed and updated about their family member. They also told us they had been involved in reviews and other meetings and had seen their care plans.

The relatives told us they were regularly visitors to the home and had “never seen or heard staff treat anybody other then with kindness”. Two relatives told us “it was the most difficult decision we had to make to move (their family member) into a home” but “because the staff are so kind and caring” they can “walk away knowing their family member was in good hands”. Relatives told us they “can go home knowing their family member is safe and well looked after”.

People we spoke with during our inspection told us they were asked for their views about the quality of the service offered by the home. They told us the management and staff “were very approachable” and they were “more then confident” that any worries, concerns or complaints would be listened to and acted upon. One relative told us that “on the rare occasions” when they had questioned certain aspects of their family members care the senior staff on the units had “sorted things out and had kept them informed”.