Saint Lawrence Residential Care Home is registered to provide care for up to 23 older people some of whom may be living with dementia. It is situated near the town centre and close to local amenities. It consists of a large residential house and provides care over two floors accessed by a passenger lift. There is a large communal lounge with a dining area, a conservatory and a secure garden area. There are 17 bedrooms in total; 11 are for single occupancy and the remaining six are for either single or shared use. Sixteen rooms have en-suites and the remaining one has a sink. Additionally, there are three bathrooms in the home with bath and shower facilities.

The inspection took place on 14 and 20 December 2017 and was unannounced. At the time of our inspection, 12 people were using the service.

At the last inspection on 12 and 16 December 2016, the service was rated Requires Improvement due to issues raised at a previous inspection. We saw improvements had been made and sustained.

A condition of the provider’s registration was for the service to be managed by a registered manager. There was a manager who was responsible for the day-to-day running of the service and we saw they had submitted their paperwork for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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 told us they felt safe living at the service and we saw staff were trained in safeguarding and protecting vulnerable people. There were few accidents and incidents, and individual risk assessments were in place.

Staffing levels were sufficient for the number of people currently using the service and their dependency levels were assessed. This helped the provider ensure there were sufficient staff to meet people’s individual needs.

Staff were recruited safely and received an induction which was linked to the Care Certificate. Staff knowledge and training were good and they received regular supervisions, however these were not always fully documented. Competency assessments were completed to check staff used the skills they had learnt in practice.

The service was safe, clean and tidy and staff were trained in infection control. Personal, protective equipment (PPE) such as gloves and aprons was used and stored safely. Appropriate safety certificates were in place, however the fire extinguishers had exceeded their service requirement date. During our inspection, the manager arranged for this to be completed. Afterwards we received assurances these had been done and were sent a copy of an updated audit to ensure these would not be missed in future. Fire safety plans were sufficient although evacuations needed further recording. People had personal emergency evacuation plans (PEEPs) in place so staff were aware of their individual needs in an emergency situation.

The environment was being updated and we spoke with the manager about ensuring the decoration followed best practice guidance for being dementia friendly. People’s bedrooms were personalised and they were involved in colour choices in their rooms.

The manager and staff had good knowledge of mental capacity legislation and consulted and involved relevant parties when people lacked capacity to make their own decisions. 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 did support this practice.

People’s health and nutritional needs were met. People received their medicines as prescribed, and were referred to healthcare professionals in a timely manner. People could also access community services independently if they wished. The food was nutritious and healthy

Saint Lawrence Residential Care Home is registered to provide care for up to 23 older people, some of whom may be living with dementia related conditions. The home is situated near the town centre of Scunthorpe and is close to local amenities. The building consists of a large residential house with a purpose built extension, providing care over two floors, which are accessible by a lift. There is a large communal lounge with a dining area and a conservatory and small garden. At the time of our inspection there were 16 people living in the service.

We undertook this unannounced inspection over two days, on the 12 and 16 December 2016. The service was last inspected on June 2015, when we identified a breach of Regulation 15 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because there were concerns from the fire service in relation to the maintenance and upkeep of the building and the operation of the governance systems did not enable the quality of the service to be effectively monitored. Other improvements were also required to ensure people received effective care that was responsively delivered.

During this inspection we found improvements had been made in all domains and that action had been taken to address the breaches of the above regulations. We have changed the rating in two of the key domains that were previously rated as Requires Improvement to Good. We have not changed the rating in the safe and well-led domain, because we need to ensure the service is able to develop and sustain the improvements that have been made.

We found there was no registered manager in post. A new acting manager had been appointed to this role 12 weeks prior to our inspection visit, following the departure of the previous acting manager. There is a legal requirement for services to have a registered manager in place and we asked them to submit an application for this post within the next month. 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.

A range of health and safety checks of the building and equipment were carried out to ensure people were kept safe from potential harm. Contracts were in place to ensure equipment was satisfactorily maintained. Improvements were needed to ensure the water supply was delivered at consistent temperature levels, although the acting manager took action to address this shortfall. Improvements had been made in relation to the operation of the governance systems to enable the quality of the service to be effectively monitored. This included a programme of audits and analysis of incidents and accidents, to enable trends or patterns to be identified.

Recruitment checks were appropriately followed to ensure care staff were safe to work with people who used the service. Dependency levels of people were monitored and we were told about plans to deploy a further member of staff to ensure there were suitable numbers of staff available to meet people’s needs.

People’s medicines were administered in a safe way by care staff who had received training on this aspect of their role. Risks to people were monitored and action was taken to ensure these were safely managed. Safeguarding training had been provided to ensure care staff knew how to recognise and report potential signs of abuse. Care staff were familiar with their responsibilities for raising whistleblowing concerns and they said they were supported and listened to by the acting manager.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were

We looked at two care files which belonged to the people who used the service. We saw that on one record a signature was obtained to indicate consent was sought.

We saw there was a system in place to record when GPs made changes to people’s medicines regime. We saw records of discussions with a person’s GP and the medications administration record MAR record altered to comply with this new arrangement.

We saw that rooms were personalised for example, with family pictures, people’s own furniture and TV’s. This showed the service promoted people's independence and supported their daily living activities.

Staff were complimentary about the service and told us, “I like working here, it’s not just a job, it’s like we are family.”

A relative we spoke with commented, “Our relative didn’t really want to be in here but he has got to know the staff and we can’t believe how he’s bounced back.”

People told us they were happy with the care they received at the home. One person told us that when relatives asked if they wanted to move, they said they had made friends, that the staff were "wonderful" and that they felt "safe and content." We observed care during the early afternoon and saw that everybody in the lounge was given appropriate attention.

The care files reflected a system of assessing need, taking peoples' wishes into account, developing and using a personalised plan of care and monitoring of peoples' daily activities and condition. The premises were clean, tidy and there was evidence of systems in place to minimise the risk of spread of infection.

This inspection took place on 28 May and 2 June 2015 and was unannounced. The service was last inspected on 28 August 2013 when the service was found to be compliant with the regulations inspected.

Saint Lawrence Residential Care Home is registered to provide care for up to 23 older people, some of whom may be living with dementia related conditions. The home is situated near the town centre of Scunthorpe and is close to local amenities. The building consists of a large residential house with a purpose built extension, providing care over two floors, which are accessible by a lift. There is a large communal lounge with a dining area and a conservatory and small garden. At the time of this inspection there were 15 people using the service.

There was a registered manager in place. 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.

Whilst people who used the service told us they felt safe and trusted the staff, we found potential risks to their safety had not always been appropriately managed in a timely manner. We saw maintenance checks of the building were not regularly taking place, which meant the registered provider was not complying with regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we asked the registered provider to take at the end of this report.

Staff demonstrated an appropriate understanding of how to keep people safe from harm and we saw they had been employed following checks as part of their recruitment process, to ensure they did not pose a risk to people who used the service.

Whilst staff received a range of training opportunities, further work on this was required to ensure they had the right skills to carry out their roles. Staff confirmed they were listened to and supported by the registered manager, to enable them to meet people’s needs.

People told us staff were caring and kind and they were happy with the support they were provided. Whilst we saw there were limited opportunities for people to be involved in meaningful social activities due to current staff shortages, we saw evidence two staff were due to start work in the near future, subject to satisfactory checks for them being completed.

People told us they enjoyed their meals and we saw their dietary needs had been assessed to ensure they received appropriate nourishment and hydration.

Assessments of people’s health and social care needs had been carried out and individual plans of support developed from these, to enable staff to deliver care and ensure people’s wishes and feelings were respected. Health and community professionals were involved with people who used the service to ensure changes in their needs were acted on and followed up.

People who used the service were consulted about their wishes to help improve the service and were able to raise their concerns. Whilst the registered manager monitored the quality of the service provided, the system for this needed further development, as we saw that checks were not always followed up to enable the service to learn and improve. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we asked the registered provider to take at the end of this report.

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