This unannounced comprehensive inspection took place on 22 May 2017. The last inspection took place on 17 and 18 November 2014. St Anne’s was meeting the requirements of the legislation at this time and was given an overall rating of Good. The key question 'Caring' was rated as Outstanding.

St Anne’s is a care home which offers care and support for up to 33 predominantly older people. At the time of the inspection there were 32 people living at the service. Some of these people were living with dementia. The service uses a detached building over two floors. There is a passenger lift and a stair lift to assist people to move around the service.

A culture of safety was embedded within the staff team, and staff were vigilant in spotting potential risks and addressing them. Staff responded quickly to any changes in people’s needs. People's safety and well-being was promoted because staff developed positive and meaningful relationships with people and spent time with them. The atmosphere in the service was calm and organised.

Any accidents or incidents that took place were recorded by staff. The reports were audited by the registered manager to identify any patterns or trends. Action was taken to address specific concerns and the service worked closely with external healthcare professionals to help reduce the risk of re-occurrence.

People who lived at the service were consulted about recruitment decisions. People were given the opportunity to meet prospective new staff at the time they were interviewed. It was important to the staff and manager that people living at the service met potential new staff to ask them if they felt they would ‘fit in’. The service had developed a ‘care apprentice’ role to help encourage young people 17 – 21 years old to join the care industry and address the recruitment challenge in the care industry.

People received their medicines safely and on time. Staff who administered medicines were trained and assessed to make sure they had the required skills and spoke knowledgeably about people's medicines. People were given the opportunity to self administer their own medicines.

Healthcare professionals told us the service was exceptionally effective in supporting people’s needs. Comments included, “I rate them very highly indeed, they are the best service in the area easily. We place people there to avoid them being admitted to hospital. They liaise well with the GP, are very proactive and effective in the care they provide. People recover well and return home” and “They are striving for excellence in end of life care. They are keen that people regard St Anne’s as their home and will do their upmost to allow them to be cared for. They are one of the best homes I work with and all seem to genuinely care and strive for the best care.”

Staff worked in partnership with people, other professionals and continually developed their knowledge and skills. Staff were encouraged to have additional skills and knowledge to support their ‘champion’ roles in areas such as infection control, safeguarding, moving and handling, nutrition, falls, health and safety and medicines. The ‘six steps’ end of life care accreditation was being sought for St Anne’s and two care staff were attending a course at the local hospice. This would bring valuable skills to the service to support people’s care at the end of their lives.

The service was well maintained. People and staff had collaborated to re-design the corridors from a plain clinical look to a more attractive environment. Each section of the corridors had been themed involving people living at the service. For example, a Cornish theme had examples of ships, fishing, knots and the Cornish flag. Another section displayed film stars of the 40’s and 50’s with people being involved in choosing which film stars picture was hung outside their particular flat. This meant people were supported to remain as independent as possible when moving around their home. There were no malod

During out visit to St Anne’s Care Home we met with six people, spoke with staff on duty and reviewed four care records. We found people were involved in decisions about their care and treatment and staff understood the principles of the Mental Capacity Act (2005) which ensured people's human rights were respected.

Care and treatment was provided in accordance with people's needs. A holistic approach was evident in the care records which considered people's physical, mental health and social needs. Evidence of health and social care professionals’ involvement was apparent. Risks were assessed and updated if people's needs changed. People were able to participate in community activities as they wished.

One person told us “the staff are very kind”. Another said, “I like it here” and the staff are as good as gold.”

We saw that the home was clean and well maintained which reduced the risk of infection.

There was a system in place to manage complaints and the people living at St Anne’s care home and the staff were confident complaints would be taken seriously and investigated.

People who lived at St Anne’s – Saltash told us staff were kind and helpful. Everyone we spoke with said they were satisfied with the care they received. One person said “they are always cheerful and that cheers me up” and “they are always there when you need them”. We saw there were a range of activities available that included tea dances and band practice. One person told us “I can join in with things if I want to, there is plenty on offer”.

The people we spoke with were positive about how staff supported them. One person said “staff are very friendly and caring”. Another said "they [the staff] knock on my door, I feel my privacy is respected".

During our inspection, we spoke with two people who lived at St Anne’s - Saltash, who said that they enjoyed the food they received. People told us they were given a choice of meals every day.

We were shown that there was a robust system in place to obtain medicines from the pharmacy for people who lived in the home. This meant that people received the correct medication at the correct time.

We checked if St Anne’s - Saltash operated an effective recruitment procedure. This was to make sure the people Anchor Trust (the organisation that owns St Anne’s) employed were of good character, suitably qualified, skilled and experienced.

The care records seen were maintained and updated daily. This meant they were accurate and directed staff in how to provide care and support for people who sued the service.

People told us that staff were polite and always ready to help. One person said that the food was good and there was a choice of what to eat at meal times. Another said that he

was well cared for and that staff came to attend his needs when he rang the bell for

assisstance.

Three people told us that they were able to express their views about care and how it is delivered and provided.

One relative told us that she was involved in making choices for her mother.

This was an unannounced inspection, carried out over two days on 17 and 18 November 2014

St Anne's provides accommodation for up to 33 older people who require support in their later life or are living with dementia. There were 33 people living at the home when we visited.

The home is a modern purpose built property. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The home has 33 single bedrooms all with kitchenette and en-suite facilities.

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.

We last inspected St Anne’s in October 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

People were protected from avoidable harm and abuse that may breach their human rights. Staff understood how the mental capacity act and deprivation of liberty safeguards protected people to ensure their freedom was supported and respected. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. People’s medicines were managed well which meant they received them safely. Where able, people were empowered to take responsibility for their own medicines.

People were supported by sufficient numbers of staff who had the knowledge, skills and experience to carry out their role. The registered manager provided support, training and development opportunities for staff. Staff were aware of people’s individual nutritional needs and drinks were available at all times. People could access health care services and were empowered to be involved with external health care professionals. The registered manager had systems in place to ensure staff shared information about people’s health care. This encouraged effective communication, and meant staff were pro-active in meeting people’s needs.

People were supported by staff who promoted and showed positive and inclusive relationships. Staff were kind, caring, compassionate and tactile in their interactions with people. Staff were considerate and respectful which helped to ensure people’s privacy and dignity were promoted. People were encouraged to be actively involved in the running of the service. Their views were valued and used to facilitate change. The registered manager and provider welcomed feedback to enable learning and improvement. For example, complaints were considered positively, people were encouraged to attend residents’ meetings and participate in interviewing staff.

People received care which was personalised to their needs. Care plans and risk assessments did not always give clear direction to staff about how to meet a person’s needs. However, from our observations and conversations with staff it was clear they were knowledgeable about people. Care records demonstrated people were involved in creating their own care plans.

People were encouraged to continue their interests and take part in social activities. Staff recognised and understood people’s individuality and social engagements were tailored to suit.

People were able to request the support of an advocate to represent their views and wishes, and the registered manager attended meetings with the local advocacy service to help promote positive relationships.

The registered manager and provider promoted a positive culture that was open, inclusive and empowering to people, staff and visitors. The internal and overarching quality monitoring systems in place helped to ensure continuous improvement.