We undertook an unannounced inspection of St Andrews Residential Home on 10 May 2018.

St Andrew's is a care home located close to Oxford town centre. The home is registered to provide accommodation for up to 24 people who require care and support. 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. On the day of our visit 24 people were living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good overall.

Why the service is rated Good:

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.

The service continued to provide support in a caring way. Staff supported people with kindness and compassion and went the extra mile to provide support at a personal level. Staff knew people well and many referred to them as family. Staff respected people as individuals and treated them with dignity whilst providing a high level of emotional support. People and their relatives, were fully involved in decisions about their care needs and the support they required to meet those individual needs.

People were positive about the food and told us they enjoyed the meals. Where people had specific dietary needs, these were met.

There was a positive culture at the service that valued people, relatives and staff and promoted a caring ethos that put people at the forefront of everything they did.

People remained safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. Risk assessments were carried out and promoted positive risk taking, which enabled people to live their lives as they chose. People received their medicines safely and were protected from the risks of infection.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People had access to information about their care and staff supported people in their preferred method of communication.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care and support and promote a positive culture that was person-centred, open, inclusive and empowering which achieved good outcomes for people.

This inspection took place on the 2nd and 6th June 2016. It was an unannounced inspection.

St Andrew's is a care home located close to Oxford town centre. The home is registered to provide accommodation for up to 23 people who require care and support. On the day of our inspection 23 people were living at the home. The majority people were living with dementia.

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.

We were greeted warmly by the registered manager and staff at the service who seemed genuinely pleased to see us. The atmosphere was open and friendly.

People told us they felt safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed. However, accurate records of medicine stock were not always maintained. The registered manager took immediate action to resolve our concerns.

There were sufficient staff to meet people’s needs. Staffing levels were consistently maintained. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act (MCA) and all staff applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included Deprivation of Liberty Safeguards (DoLs).

The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care. However, systems used to monitor the quality of service did not identify our concerns relating to inaccurate medicine stock levels.

Staff spoke positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People and their relatives told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

There were 23 people residing at the home of the day of our visit. We spoke with five people who used the service, five members of staff and a visiting professional.

We found that care plans and assessments contained detailed information about people's preferences and choices. One person told us, “the manager came and saw me and my daughter and completed an assessment before I came here, they sorted everything out for me”. Another person told us was here on respite first, they gave me a preliminary chat so I knew exactly what I was coming to”.

We found that choices of food were offered and people were supported to eat and drink. One person told us “the food is always wholesome and good, we always have a choice of at least three vegetables”.

We found that equipment in the home was safe and suitable. Staff were observed using hoists in accordance with risk assessments and individual care plans.

We found people were supported by sufficient skilled and experienced staff. One person told us “the staff are ok and there is always enough of them, they sit and help me with my crossword sometimes”. A visiting professional told us “the staff here are really obliging, they are always warm and friendly”.

People we spoke with were happy with the service they received and knew how to complain if they had a concern .One person told us "they are so good, they sort any worries I have". Another person said “I have no worries or concerns living here, but I do know how to complain, there is a notice by the front door”.

People we spoke with told us that they liked the home and that the staff were “ nice and so helpful and friendly “. People told us that they felt safe and well cared for. People liked the food and could ask for things that were not on the menu. People we spoke with told us that there was enough to keep them occupied. Some people told us that staff took them into the town. We were told that they had been on recent outings in a hired coach. People could choose whether to join in activities or not. On the day of the visit people in the main lounge were enjoying a sing song with a member of staff and a relative. The meal served on the day of the visit was freshly prepared and appetising. Staff monitored peoples food intake and offered assistance where required. People told us that visitors were always made to feel welcome and that “ they are always offering tea and biscuits to relatives and friends “