This comprehensive inspection took place on 20 November 2018 and was unannounced.

Following our last inspection in April 2016 we rated the service ‘good’ overall. At this inspection, we found concerns in areas relating to safe premises, medicines management and record keeping. As a result, we rated the service ‘requires improvement’ overall.

St Teresa’s 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.

The home has been run by the Sisters Hospitallers of the Sacred Heart of Jesus for more than 85 years and provides residential care for 26 older people. The building has three floors and a basement and is fully accessible, with a ramp to the main entrance and a lift serving all floors. Most rooms have en-suite bathroom facilities. There were 24 people living at the home on the day we visited.

The service has 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.

People's needs were assessed before they moved into the service and further assessments were conducted once people were living in the home and feeling settled. This information was used to develop individual support plans. People and their relatives were involved in decisions about how care and support was provided.

Staff completed a range of risk assessments in relation to skin integrity, mobility, nutrition and continence. However, risk assessments were not always being reviewed on a regular basis and related contemporaneous monitoring records were not always in place.

Staff were not always following safe practice regarding the management of people's prescribed medicines. Staff competency in relation to safe medicines practice was not being regularly assessed.

The provider was in the process of carrying out maintenance works as recommended by the London Fire Brigade. Not all staff were aware of the correct fire evacuation procedures.

The provider had policies and procedures in place that ensured staff had guidance if they needed to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation to restrict a person's liberty in their best interests. However, applications were not always being reviewed and renewed when needed.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe and told us they would report any concerns they may have to the management team.

People felt the service was safe and homely. People liked their rooms and told us the home was clean, spacious and comfortable. Most of the relatives we spoke with provided positive feedback as to the way care was delivered to their family members and the way in which the home was managed.

Staff were mindful of people’s need for privacy, promoted their independence and encouraged people to do the things that were important to them.

People had enough to eat and drink although views about the meals served were not always positive.

There was an activities co-ordinator in post and a programme of activities on offer to ensure people were able to maintain their hobbies and interests.

Staff recruitment processes were followed ensuring people received care and support from staff who were suitable for employment at the service. Sufficient numbers of staff were deployed to the service to meet people's needs and staff felt supported in their roles.

Staff completed an induction and were required to attend training and supervision sessions throughout their employment. However, the training matrix showed that some mandatory training was now overdue.

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St Teresa's Care Home has been run by the Sisters Hospitallers of the Sacred Heart of Jesus for more than 85 years and provides residential care for 26 older people. All bedrooms are single rooms and the majority have an en-suite bath or shower. The building has three floors and a basement. The home is fully accessible, with a ramp to the main entrance and a lift serving all floors. There were 26 people living at the home at the time of inspection.

St Teresa’s Care Home was last inspected in April 2013 where we found that the provider was meeting the regulations checked.

The service had a manager in post who had completed the application and interview process to become the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received excellent care in a way that was personalised and responsive to their changing needs. Risks to people were managed in a proactive way which enabled them to live independent and fulfilling lives. Staff worked closely with community health professionals and therapists to maximise people's well-being.

People had confidence in the staff and the sisters who supported them and felt safe in their care. Staff treated people with kindness and took steps to promote their privacy and dignity at all times.

People had control over their lives and spent their time as they wished. The provider offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives.

People were provided with a variety of meals and kitchen staff catered for any specialist dietary needs or preferences. Mealtimes were viewed as a social occasion, but equally any choice to dine alone was fully respected.

Staff enjoyed working at the service and felt well supported in their roles. They had access to training which equipped them to deliver their roles effectively. Staff ahd supervision and appraisals. However, these sessions were not always taking place in line with the provider's policies and procedures.

The culture of the home was open and people felt confident to express their views and opinions. The manager and head carer provided clear leadership and direction to staff and were committed and passionate about the quality of care provided.

Quality assurance processes were in place and action plans to improve the service were prioritised and completed quickly. However we found that Do Not attempt Resuscitation (DNAR) orders in place were not always completed in full and that these records were not always consistent.

St Teresa's Care Home is run by the Sisters Hospitallers of the Sacred Heart of Jesus. It provides residential care for 26 older people.

All bedrooms are single rooms and the majority have an en-suite bath or shower. The building has three floors and a basement. It is fully accessible, with a ramp to the main entrance and a lift serving all floors.

On the day of our inspection 24 people were living at the home, and we met and spoke with all of them. People were happy with the care they got and praised the consistently "reliable service" they received at St Teresa’s Care Home.

We met with three visitors, who had come to see their relatives, they were positive about what they saw, and felt. We also received information from two community healthcare professionals involved in the support services provided to people. They complimented the service and said that they would recommend the care home.

Risks to individuals were managed appropriately so that people were protected and their freedom was supported and respected. Staff encouraged people's independence, but, when appropriate, supported and assisted them with tasks they needed help with.

Safeguarding procedures were robust which protected people from the risk of abuse, and there had been no safeguarding concerns raised at this home in the past four years. Staff understood how to safeguard the people in their care. People told us they trusted staff and felt safe using the service, staffing ratios were good, lounge and dining areas always had staff present and this helped ensure they were safely cared for.

The home ensured people had access to healthcare services and received on-going healthcare support. Staff were trained and knowledgeable on supporting people to manage health conditions, and they followed recommendations made by health professionals.

People reported that St Teresa’s promoted a caring environment, and people were treated with kindness, compassion and respect. Staff interaction with people they cared for was consistently good, and this promoted a sense of wellbeing for people. People told us their opinions mattered and this was reflected in how the service constantly looked at improving outcomes for people living in the home. Staff morale was good, and everyone employed at the home worked well together in the staff team.

The provider gave people appropriate information and support regarding their care. People gave their views and opinions about what they would like to eat, wear and do each day. Staff delivered personal care in privacy and treated people with respect and dignity.

Staff completed risk assessments for people in relation to falls, moving and handling and nutrition. People had individual care plans that were based on their risk assessments. Each person had a named keyworker and where possible, people had signed their care plans.

People told us that they were "satisfied" with the quality of care that they received. One person said that they were "duly impressed" and another said that the home was "well managed".

There was a policy in place on safeguarding vulnerable adults. This included the contact details of who to contact should there be concerns for a person's welfare. Most staff had attended safeguarding training knew how to recognise the signs of abuse.

Recruitment procedures for new staff included an application and interview process, pre-employment checks, including Disclosure and Barring Service (DBS) checks. People were complimentary about the care staff. One described staff as "kind and understanding" and other said “they are always professional”.

St Teresa’s had a policy for the maintenance of care records. Records were kept securely on a password protected computerised system, which staff could access from a variety of locations in the home.

We spoke with six people using the service. They told us that before they received any care or treatment they were asked for their consent by staff members. We were told that they received very good care from the staff and described it as "excellent". One person said she was "lucky to be here".

People using the service told us that they had key workers who co-ordinated their care and care plans that described their care. We noted that statements from the residents’ survey in December 2011 included, "the home is an example to other homes", "residents and staff are excellent and caring" and "my father was looked after so well that I cannot think of anything to complain about at all".

People using the service have their privacy and dignity respected at all times. They are consulted on various activities and are encouraged to express their views. People have their needs meet by the service and they have high praise about the care received. Consent is always sought before any care or treatment is provided. Staff listen to people using the service and if a concern was reported, it would be taken seriously by staff.