This inspection site visit took place on 5 and 6 July 2018 and was unannounced.

St Anne’s Residential Care Home is registered to provide accommodation for persons who require nursing or personal care, for a maximum of 19 people. At the time of the inspection 17 people were living at St Anne’s Residential Care Home, some of whom were living with dementia. The adapted building also accommodates a convent. There is a shared lounge and dining room as well as an activity lounge, chapel and kitchenette facilities. Accommodation is over two floors which are serviced by a lift.

St Anne’s Residential Care Home is a ‘care home’. 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.

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.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, staff were not always clear about who was able to give consent and documentation that recorded people's understanding of specific decisions did not reflect the person's views or those who knew them well.

Although there was a quality assurance system in place at the service, this had not supported the identification of all areas of inconsistency in documentation we found during the inspection.

Medicines were ordered, received and stored safely. There was a lack of documentation around “as required” medicines, and we have made a recommendation about this.

People told us they felt safe. There were robust systems in place to manage falls, accidents, incidents and safeguarding concerns. There was sufficient staff available to meet people’s needs and plans in place in case of emergency.

The service worked well with other organisation to promote people’s health and wellbeing. The provider sought, and responded to, the views of people, their relatives, staff and other professionals.

People were treated with kindness, respect and compassion with their independence promoted. Staff knew people and their interests well and had developed good relationships.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on the 20 January 2016 and was unannounced.

St Annes Residential Care Home provides care and support for up to 19 older people. On the day of our inspection 16 people were using the service. The home is a large detached property spread over two floors with a well maintained garden and patio area.

The home had a registered manager. 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.

There were clear lines of accountability. The home had good leadership and direction from the management team. Staff felt fully supported by management to undertake their roles. Staff were given regular training updates, supervision and development opportunities. One member of staff told us “There’s training all year round and it’s very good. I’ve done dementia training which was useful”. However the provider did not have over sight of the quality of care being given or formal supervision arrangements in place for the registered manager. We identified this as an area of practice that needs improvement.

The experiences of people were very positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. One person told us “This is a lovely safe place to live, I could not wish for more”. We observed people at lunchtime and through the day and found people to be in a positive mood with caring and supportive staff interactions.

Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff on duty at all times to meet people’s needs. When the registered manager employed new staff at the home they followed safe recruitment practices.

The home considered peoples capacity in line with the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed. Staff observed the principles of consent in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Arrangements were in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed. People had sufficient to eat and drink throughout the day.

Staff supported people to eat and they were given time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable leisure and social activities in line with their individual interests and hobbies.

Resident and staff meetings regularly took place which provided an opportunity for staff and people to feedback on the quality of the service. Staff and people told us the registered manager took action in response to feedback received. Feedback was sought by the registered manager via surveys which were sent to people at the home. People and relatives we spoke with were aware how to make a complaint and all felt they would have no problem raising any issues. One person told us “If I had any concern I would speak with the manager but there are no problems here”.

We met with four people and two relatives. People told us that they liked living at the home and that they felt the staff were very caring. One person said “the manager is very good. As I become in need of more help they change things to make it easier for me to remain as independent as possible, which is what I want”. A relative explained that they knew how to complain but they had no reason to. They said "it's a lovely home, the staff are patient and considerate".

People told us about their life at the home and the activities they participated in. We looked at a sample of records. We found that events had been properly and timely recorded and had been responded to appropriately. This gave us a good insight into how the home was run and provided us with evidence that the home met people's needs and expectations.

We talked with the manager and three members of staff. Staff told us that they felt people were well looked after and experienced a good quality of life. Staff also told us that they enjoyed looking after people and felt well supported in their roles with access to appropriate training and guidance from their manager. We found that the home had systems in place for monitoring the quality of care and support the home offered.

We spoke privately with six of the seventeen people who lived at the home and met the other eleven in communal areas. We also spoke with five relatives and two visiting professionals. Our observations and discussions with people indicated that they were happy and had positive relationships with the staff who supported them. People told us that they liked their bedrooms and had been able to furnish them with their own personal belongings. People talked to us about how they liked to spend their time and said that they had freedom and control over their lives. We observed people participating in meaningful activities and noticed that they were consulted with throughout the day.

The home employed dedicated maintenance and housekeeping staff and the home was found to be clean and well maintained at the time of our inspection. We spoke with five members of staff including the registered manager. We found staff to be knowledgeable about the needs of the people they supported and committed to their roles. Staff told us that they felt well supported by the management team and said that St Annes Residential Care Home was a nice place to work.

We found that the home had effective systems in place to train staff. We looked at a range of records maintained by the home, including the care plans for four people. We found that all records viewed were well maintained with evidence of having been regularly updated.