The inspection took place on 12 and 18 July 2018. The first day was unannounced.

At the last inspection in April 2017 we rated the key questions of Effective and Well Led as Requires Improvement. Following that inspection, we asked the provider to complete an action plan to improve the environment. We also asked them to tell us what they would do and by when to improve the key questions, Effective and Well-Led to at least Good.

During this inspection in July 2018, we found the provider had invested in the environment. Changes to the flooring, bathrooms, bedrooms and communal areas had made the environment more hygienic and dementia friendly. Governance processes had also significantly improved. These included robust audits to check the service was providing quality care in all areas and there was greater involvement with the local community, for example with schools and local forums.

St Anne’s Residential Care Home (known as St Anne’s), 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.

St Anne’s provides care and accommodation for up to 23 people. On the day of the inspection 17 people were using the service. St Anne’s provides care for people who are elderly and frail, some people may have mental health and / or physical needs.

A registered manager was employed to manage the service locally. 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 registered manager was supported by the provider and a manager to run St Anne’s.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The recruitment process of new staff was robust. People and staff were matched carefully and people could meet staff before they started receiving care from them.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “The staff make the place safe in my opinion because they are always on hand” and, “No concerns, my husband will be safe and happy. I was asked lots of questions about how he likes to be cared for.”

Staff used their knowledge of people to help ensure their diverse needs were met. Staff were aware of people’s communication needs and styles and their likes and dislikes.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff understood consent and when to follow the necessary legal processes to ensure people’s human rights were respected.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff were clear they were working in people’s home. Staff told us care was personalised and based around people’s own routines and wishes. Social engagement opportunities and activities kept people stimulated.

Alternative methods of communication were used, family and advocates were utilised to help staff understand people’s needs when verbal communication was not easy for them. There were pictorial formats of menus and activities, for example, to help p

The inspection took place on 19 and 20 March 2017 and was unannounced on the first day.

St Anne’s Residential Care Home (known as St Anne’s), provides care and accommodation for up to 23 people. On the day of the inspection 17 people were using the service. St Anne’s provides care for people who are elderly and frail and may have mild mental health and / or physical care needs. Five beds were “discharge to assess” (DTA) beds. These were for people transitioning from hospital to home and who required a short stay (up to 6 weeks) to support their recovery.

The service had 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 environment was mostly free from obstacles to enable people to move freely around the home and equipment was well maintained. However, we found the home was not well maintained in all areas. Some carpets looked extremely worn and were very stained and threadbare, some people’s rooms were in a poor state of repair with wall paper falling off and broken flooring. Staff told us this had been raised with the provider and registered manager repeatedly. The provider and registered manager shared with us the maintenance which had been undertaken in the past year but the service remained in need of updating to meet the needs of people with dementia.

There were effective quality assurance systems in place but staff feedback was not always acted upon especially in relation to the environment. Incidents were appropriately recorded and analysed from trends. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service. Inspection feedback was listened too to further enhance quality of care.

On the day of the inspection staff within the service were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People were comfortable with staff and we observed positive interactions between people and staff. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People, or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

Staff exhibited a kind and compassionate attitude towards people. Good relationships had been developed and practice was focused on the person and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People’s independence was encouraged and people were free to make choices regarding their care and positive risks. People were promoted to live full and active lives and enjoyed friendships within the service.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, district nurses and social workers.

People we observed were safe and they told us they felt safe and well-cared for by staff.

All staff had undertaken training on safeguarding vulnerable adults from abuse. They displayed good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully invest

We saw staff respectfully asking people their preferences and taking time to explain choices to them. We spoke with staff about their understanding of gaining consent. One member of staff said “I ask people if they want to get up. If they say no I will go away and go back later and ask again. If people say no again I will ask if they want to stay in bed or would they like a cup of tea. I try to find out what people want by asking in different ways”.

One person said “When I first came here I was scared stiff. People helped me to settle by encouraging me to help; they checked if I liked my room. I was treated like part of the family and then felt settled. If I had any concerns I would tell my daughter who would speak to staff and they would make changes. They are very helpful”.

We asked people about the food they received. One person told us “We have wonderful food, it really is good. We definitely get a choice; if something is on the menu we don’t like we can have something different. We are asked everyday what we would like and we pick out what we want”.

We observed medication being given during our visit. Time was taken to explain to people that were confused why it was necessary to take the tablets offered. We saw that the identified procedures were followed.

We conducted an unannounced visit to St. Anne’s Residential Care home on 9th July 2012 as part of a programme of scheduled inspections.

We met the majority of people who used the service. One told us, “Care here has been first class”. Where people were unable to communicate with us about their experience of being at the home we spent time observing what it was like for them.

We looked closely at the care of three people, two having a diagnosis of dementia. This involved meeting them, looking at records and asking staff about their care. The provider and registered manager also provided information and we spoke with a health care professional with knowledge of the home.

We saw that the staff had a good understanding of people’s individual needs and they were kind and respectful. They took time to work at people’s own pace. They gave us examples of how they had worked to give people a better quality of life. For example, one person had been supplied with a portable oxygen cylinder to enable them to be more independent and move around the home as they choose, with support. Many people talked about visiting family members and two people went out independently to local shops.

We observed people being supported to make decisions about their lives and be as independent as possible. We saw that people’s care records described their needs and how those needs were to be met. A staff member told us how a recent new admission’s plan was discussed with a person who had just moved into the home. Those records we saw confirmed what we had been told.

People’s emotional and physical needs were supported. We observed one person becoming distressed and saw how staff provided reassurance and support to move to a quiet area. This support continued until the person settled. The home had been under some safeguarding reviews recently and we were informed by the provider and registered manager that all reviews were now closed. A health care professional confirmed that these reviews were closed and that management of the home had been proactive in working closely with the safeguarding teams for the best outcomes for people living in the home.

People were safeguarded from abuse through the arrangements at the home to protect them, such as staff training. Skilled and knowledgeable staff were provided in sufficient numbers and the quality of the service people received was being regularly reviewed. Some of the newly employed staff came with many years experience in working with people with complex care needs.

Some of the people living in St Anne’s Care Home have limited communication and were unable to communicate with us. However, we did meet with all of the 15 people living in the home and observed the interaction between them and the staff working in the home. Information about peoples’ experiences in the home was given to us by a visiting professional, a visitor to the home and staff of the home.

During our visit we observed people enjoying their meals, going about their everyday routines and relating well with the staff supporting them.

We saw staff treating people with dignity and respect at all times, communicating clearly and sensitively with people, and responding promptly to the differing needs of people in the room. ‘The staff are kind to me’, we were told by one person in the lounge.

Most of the people who live at St Anne’s come down from their room for meals, a few wish to remain in their own rooms. People who needed help to eat their meal were given that help sensitively and discretely. We saw that people were given alternative food according to their dietary needs.

We spoke to three health and social care professionals about St Anne’s and all spoke positively about the home. One said, ‘They have been brilliant’, with another saying, ‘People living here are always looked after well’.

This inspection took place on 2 and 3 January 2015 and was unannounced. St Anne’s Residential Care Home provides personal care and support for up to 23 people. On the first day of our inspection there were 18 people living at the home, one person was in hospital. St Anne’s provides care for older people with mild mental health needs including people living with dementia. Some people at the home required nursing intervention and this was provided by the local district nursing team.

St Anne’s had 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.

Throughout the inspection there was a calm, friendly and homely atmosphere. People were relaxed and happy. People, their relatives and all health care professionals spoke highly about the care and support St Anne’s provided. People felt supported by knowledgeable, skilled staff who effectively met their needs. One person stated; “Most of them are wonderful and knowledgeable”; “I feel like they do the best they can”; “Sometimes the staff are busy. Most staff are very, very good.” Relatives commented, “There’s never anyone out of view of staff. They are always around, watching…nobody is left to their own devices.”

Information we requested was supplied promptly. Care records were comprehensive and personalised. People’s communication methods and preferences were taken into account and respected. People’s risks were considered, well-managed and regularly reviewed to keep people safe. One relative told us “Mum is safe, I don’t even have to think about that.” Where possible, people had choice and control over their lives and were supported to engage in activities within the home and outside where possible.

Staff put people at the heart of their work. Staff were kind, compassionate and gentle in their interactions with people. Strong relationships had been developed and practice was personalised and not task led. The service had an open door policy, relatives and friends were welcome and people were supported to maintain relationships with people who mattered to them. Staff were supported with an induction and on-going training programme to develop their skills and competency was assessed.

Staff understood their role with regard to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made and advice sought to help safeguard people and respect their human rights. Staff had undertaken safeguarding training and they displayed a good knowledge on how to report concerns and were able to describe the action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated. People told us they felt safe. One person said “I feel safe and am well looked after.”

People knew how to raise concerns and make complaints. People told us they had not needed to make a complaint but the management team were visible and approachable and would deal with any concerns promptly. We saw complaints which had been made had been recorded and investigated in accordance with the home’s policy. Learning from incidents was used to drive improvements.

People, relatives and staff described the management as very supportive and approachable. Staff talked positively about their jobs and took pride in their work. One staff member said, about management, “Always around, good atmosphere”. The registered manager explained their role to us “Supporting staff, keeping up with legislation – filtering the information down; an overview of the whole system; risk assessing and minimising the risk to people – ensuring service users are confident they can come to us”.

The service had an open and transparent culture. The registered manager had set values which were respected and adhered to by staff. Staff felt listened to and were encouraged to share any concerns they had so issues were promptly dealt with. The staff worked closely with external agencies such as the local authority to raise issues and seek advice promptly when required.

People’s opinions were sought formally and informally. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Incidents, accidents and safeguarding concerns were investigated and, where there were areas for improvement, these were shared for learning.

Staff recruitment files showed appropriate checks had been undertaken before staff began work. . The registered manager assessed the competency of staff in areas of their care work such as administering medicines, using the stair lifts and monitoring infection control practices. Any concerning issues were promptly followed up and action taken where necessary.

Staff had undertaken infection control training and there were policies and procedures within the home for staff to refer to when required.