This unannounced inspection took place on 24 October 2017. The service was last inspected on 4 October 2016 when we found two breaches of the Health and Social Care Act 2008 and associated regulations relating to Safe Care and Treatment and Good Governance. We also made recommendations in relation to the management of incidents and accidents and training. Following the inspection the provider sent us an action plan detailing how they would make improvements. At this comprehensive inspection we found the provider had taken action to address the breaches we had identified and improvements had been made.

Visitation of Our Lady Residential Care Home offers personal care for up to nine older people and is run by a Roman Catholic Polish Community. At the time of our inspection, five people were living at the service. The staff lived at the home and were a community of nuns from Poland.

There was a registered manager in post at the time of our 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.

People received their medicines safely. Staff received training in the administration of medicines and there were regular medicines audits.

People and staff told us they felt safe and there were systems and processes in place to protect people from the risk of harm.

There were enough staff on duty to care for people because staff lived at the service and were always available.

There were appropriate procedures in place for the safeguarding of people at risk of abuse and these were being followed.

There were systems in place for the management of incidents and accidents and appropriate action was taken to reduce the risk of reoccurrence.

People were supported by staff who were trained, supervised and appraised. The registered manager attended provider forums in order to keep abreast of developments within the social care sector.

People’s nutritional and healthcare needs had been assessed and were met.

The provider acted in accordance with the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and where they could, they had consented to their care and support. Where people lacked capacity, we saw that best interests decisions were made. Processes had been followed to ensure that, where needed, people were deprived of their liberty lawfully.

People and their relatives told us that the staff and registered manager were caring and communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. The staff team knew people well and delivered care that made people feel valued. The whole staff team promoted person centred values as the basis of the service and ensured these were followed at all times.

The whole staff team understood the importance of ensuring people’s emotional, spiritual and cultural needs were met as well as their physical needs.

Care plans were in place and people had their needs assessed and reviewed regularly. Care plans contained information that reflected the needs and wishes of the individual.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed.

People and relatives were given questionnaires to gain their feedback on the quality of the care provided.

People, relatives and professionals we spoke with thought the home was well-led. The staff told us they felt supported by the registered manager and there was a family atmosphere and a culture of openness and transparency within the service.

The provider and registered manager undertook regular safety audits and action was taken when issues were identified

The inspection took place on 4 October 2016 and was unannounced. The service was last inspected on 20 and 23 October 2015 when we found five breaches of the Health and Social Care Act 2008 and associated regulations relating to the management of medicines, the Mental Capacity Act 2005, supervision, appraisal and good governance. Following the inspection, the provider sent us an action plan detailing how they would make improvements. At this comprehensive inspection we found the provider had taken action to address the breaches we had identified and some improvements were made.

Visitation of Our Lady Residential Care Home offers personal care for up to nine older people. At the time of our inspection, five people were living at the service. The service is a care home for people predominantly from the Roman Catholic Polish Community. The staff lived at the home and were a community of nuns from Poland.

There was a registered manager in post at the time of our 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 provider had taken action to address some of the concerns identified at the inspection of 20 and 23 October 2015 and had put systems in place for the safe storage of received medicines. However, staff did not always follow the procedure for the recording and safe administration of medicines. This meant that people were still at risk of not receiving their medicines safely.

The registered manager did not undertake medicines audits and had not received training in the administration of medicines since 2014, therefore they failed to identify and rectify medicines errors.

Staff had received training identified by the provider as mandatory, however, some courses were not refreshed regularly.

The provider had made improvements and had acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support. Processes had been followed to ensure a person had been deprived of their liberty lawfully.

The provider had made improvements to the supervision of staff and regular one to one meetings were taking place. Staff appraisals were scheduled for the end of the year.

The risks to people’s safety were identified and managed appropriately and people were cared for safely.

There was a daily health and safety audit which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

All staff were nuns who were appointed by the Order’s Sister General in Poland, and had been working at the service for many years. All staff had a Disclosure and Barring Service (DBS) check carried out.

There were enough staff on duty to keep people safe and meet their needs in a timely manner.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

Staff treated people with kindness and dignity and took into account their human rights and diverse needs. People and relatives told us that people were safe and happy at the service.

People and staff lived together as a community. People were cared for in a relaxed and unrushed atmosphere. People were complimentary about the staff and indicated that the religious ethos of the home contributed to the good care and support they received.

People’s nutritional and healthcare needs had been assessed and were met.

Assessments were carried out before support began to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly.

There was a complaints procedure in place and people and their relatives knew how to make a comp

We previously inspected Visitation of Our Lady Residential Care Home on 31 July 2012 and found the provider was not meeting the essential standards in respect of records management. People's records were not reviewed and kept up to date which might result in people's needs not being met. On our inspection of 14 June 2013 the provider had made improvements in the area that had been identified. We saw people's care plans were reviewed monthly and the care plan was amended to reflect any changes in people's needs.

We spoke with two people who use the service who said they were comfortable at the home and the staff were kind and supportive. We toured the home and found the home was clean and well maintained. Care was being provided in a homely and comfortable environment. Staff were receiving annual mandatory training to ensure they had the skills and knowledge to carry out their work effectively. People or/and their relatives were asked for their views on the home and people had completed questionnaires in 2012 giving their views on the home.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional. On the day of the inspection there were eight people using the service.

People confirmed they were happy living at the home and the staff treated them with dignity and respect. People said their privacy was maintained when they received help with care needs. People sharing double rooms confirmed they were happy with this arrangement. People told us their religious needs were met and they could participate in a variety of activities to meet their interests. Comments included “the Sisters are kind and gentle”, “I can see that they care about us and that is very important” and “we can do everything that is good for us – complete freedom.” The Polish culture was evident and enjoyed by all those living at the home.

People told us they enjoyed the food and if they did not like something they could choose an alternative. One person said they could always ask for a drink or snack and was “free to have what I like”. Another said “the food is Polish and mostly I enjoy it. If I don’t like a meal a choice is given. Supper time is lovely, you receive a selection of meat, cheeses and a real variety of food.”

When we asked people about abuse they said that the staff “wouldn’t know how to ill treat anyone”, and that the staff were extremely supportive of each other. People said they felt safe but if ever they had any concerns they would talk to the manager.

The inspection took place on 20 and 23 October 2015 and was unannounced. The service was last inspected on 14 June 2013 and at the time was found to be meeting the regulations we looked at.

There was a registered manager at the service at the time of our inspection. 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.

The service provided residential care for up to nine elderly people. Five people were living at the service at the time of our inspection. Visitation of Our Lady Residential Care home is a home for people predominantly from the Roman Catholic Polish Community. The staff lived at the home and were a community of nuns from Poland.

Medicines management was unsafe. Medicines were not stored securely, administered safely and records did not ensure that a clear audit trail was provided. The manager did not have systems in place to monitor the management of medicines. This resulted in people being at risk of not having their medicines properly administered.

People’s capacity to make decisions about their care and treatment had not always been assessed. The staff did not understand the legal processes required when relatives consented on behalf of people. Processes had not been followed to ensure a person had been deprived of their liberty lawfully.

Staff supervision had taken place in the past but was no longer carried out regularly. Staff did not receive an annual appraisal, therefore, there was a risk that staff may not have been adequately supported, and this may have had a negative impact upon the quality of care being provided.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The care plans contained assessments of people’s needs and information on how care was to be provided. The care plans contained information about people’s daily routines and preferences. Visits by health care professionals such as their general practitioner were recorded.

Care plans were reviewed and updated monthly and the reviews were signed by people. Individual risk assessments were carried out with regard to moving and handling and any other risks presenting in the environment, so that people were cared for safely.

There was a daily health and safety audit which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

All staff were nuns who were appointed by the Order’s Sister General in Poland, and had been working at the service for many years. We saw that all staff had a Disclosure and Barring Service (DBS) check carried out.

There were sufficient staff on duty to meet people’s needs in a timely manner.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care. Relatives confirmed this.

There was a complaints process in place and people told us they knew who to complain to if they had a problem. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

People said they liked living there. One person said “life is marvellous here”. People were complimentary about the approach of the staff. They indicated that the religious ethos of the home was instrumental in the good care and support they received.

We observed the staff and people living together as a community. We saw people being cared for in a calm and patient manner. There was a relaxed, unrushed atmosphere which facilitated general discussion and good communication between staff and people.

Daily events and activities were recorded in a diary for all people rather than in their individual care records.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines, the Mental Capacity Act 2005, supervision, appraisal and good governance. You can see what action we told the provider to take at the back of the full version of this report.