About the service:

St Anslem’s nursing home is a care home that was providing personal or nursing care to 26 adults who have mental health needs and may be living with dementia.

People’s experience of using this service:

• People indicated and told us they felt safe living at the service, however, not all areas of the service were consistently safe.

• Staff administered people’s medicines, but these were not managed safely, putting people at risk of not receiving their medicines as prescribed.

• People were supported by sufficient numbers of staff who knew them well and their choices and preferences, however, staff had not been recruited safely.

• People were living in an environment that smelt of urine and the carpets were worn and stained.

• Environmental checks and risk assessments were not consistently recorded or updated, to make sure that the environment was safe for people.

• Checks and audits on the quality of the service had not been consistently completed and were not effective in identifying the shortfalls identified at this inspection.

• When accidents and incidents occurred, action was taken to reduce the risk of them happening again and these actions had been effective. However, they had not been analysed to identify patterns and trends.

• Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to manage behaviour and keep people safe.

• Staff and the registered manager understood their responsibility to protect people from abuse.

• People’s needs were assessed creating a detailed care plan, which was reviewed regularly. Where possible people were involved in planning their care.

• People were encouraged to make decisions about their daily lives and supported to live their lives with the least restrictions possible.

• People benefited from access to healthcare professionals and staff followed their guidance to keep people as healthy as possible.

• People knew how to complain, their concerns were investigated and used to develop their care plans.

• We observed people being treated with kindness and respect. People were supported to be as independent as possible.

• People benefited from an open and relaxed atmosphere in the service. They appeared to be comfortable in the company of the registered manager, who knew and understood their needs.

Rating at last inspection:

Good (report published 25 October 2016).

Why we inspected:

This was a planned inspection planned on the rating of the last inspection. We found that the service no longer met the characteristics of Good. The domains of safe and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 13 September 2016 and was unannounced.

St Anselm’s Nursing Home is an Edwardian style property situated in Walmer, near Deal. The service provides accommodation, support and nursing care for up to 26 people with a variety of mental health and physical health needs. At the time of inspection there were 25 people living at the service.

A registered manager was in post. 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. St Anselm’s is owned by a partnership of four people, two of whom work on a daily basis at the service. The remaining two partners visit regularly.

At the last inspection in July 2015, the service was rated ‘Requires Improvement’, there was a breach in the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider had not consistently notified CQC of the outcomes of Deprivation of Liberty Safeguards (DoLS) applications made to the local authority. We asked the provider to make improvements. The provider sent CQC a plan of actions to address the shortfall. The provider had submitted DoLS applications to the relevant authority. The provider had notified CQC when DoLS applications had been authorised. At this inspection the actions had been completed and the breache had been met.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Some people had an authorised DoLS in place and these were regularly reviewed.

People told us they felt safe living at St Anselm’s Nursing Home. Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

The provider had a recruitment policy and processes in place to make sure that staff were of good character. Staff completed regular training and had one to one meetings to discuss their personal development. There were consistent numbers of staff deployed to meet people’s needs.

People enjoyed a choice of healthy food and told us they had enough to eat and drink. People’s mental and physical health was monitored and staff took prompt action if they noticed any changes or a decline in health. Staff worked closely with health professionals and followed and guidance given to them to ensure people received safe and effective care.

People said they were happy living at the service and that their privacy and dignity were respected. Staff spoke and engaged with people in a caring and compassionate way. People were involved in the planning or their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them. People’s choices regarding their end of life care was recorded and regularly reviewed.

People told us they had no complaints about the service and that they would speak with staff if they were concerned about anything. There was a complaints system and people knew how to complain. People’s friends and family could visit when they wanted and there were no restrictions on the time of day.

There w

The inspection was carried out by one inspector over one day. We spoke with two people who use the service, two visitors, five members of staff, and the manager. We also looked at nine care plans and records related to the management of the service. We used the evidence to answer five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe. People told us that they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of the inspection, one person was subject to Deprivation of Liberty Safeguards authorisation.

The provider had taken action to address the areas of non-compliance found at the last inspection of July 2013, when people were not protected from the risks associated with medicines.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and their representatives were involved in the writing of their care plans. People said that they had been involved in writing their care plans and that care plans reflected their current needs.

Is the service caring?

The service was caring. People told us, "I love it here. It's my home". A visitor told us, "They (staff) are so caring".

People who use at the service and their families were asked to complete a satisfaction survey by the provider. Results from surveys were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive. The home worked with other agencies and services to make sure people received care that met their needs.

People knew how to make a complaint if they were unhappy. Complaints were managed in a satisfactory and timely manner.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service was well-led. The service operated a quality assurance system which identified and addressed shortcomings.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

As part of this inspection we looked at the medicine administration records for 15 out of 25 people. We saw there were not appropriate arrangements in place for recording the administration of medicines. We found omissions in the records made when medicines were given to people and there was no indication whether the medicines were given or not.

We saw some medicines were not administered to people as they had been prescribed. For example one person who had been prescribed a strong painkiller every three days, had on two occasions, had four days between doses. Records showed that the person had received this medication correctly following these two events.

People were able to demonstrate through speech, facial expressions and gestures that they were satisfied with the care and support they received. One person said ''It is very nice here''.

The staff told us that consent for care and support was obtained from people using the service or their representatives during discussions about the care and support the person needed. We saw signatures confirming people's agreement within the care plans.

Friends, relatives and visiting professionals told us that the staff at St Anselms were kind, considerate and helpful to the people who used the service.

We saw that there was enough equipment to help people with their daily lives. The equipment was serviced and checked regularly to ensure it was fit for use. The staff were able to demonstrate knowledge about the equipment and what to do when problems with the equipment occurred.

There were effective recruitment and selection processes in place. The service had systems in place for the recruitment and management of staff. Staff working at the service had had the necessary recruitment checks.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These checks included asking relatives for their views about the new staffs performance.

People were treated with kindness, consideration and respect. One person said, "I hope they do not make me leave, I love it here." We saw that staff spoke with people in a polite and informal way. People were supported to do what they wanted to.

A carer said, "I am very happy with the care (my relative) receives. The staff are really, really kind in their manner and I always have complete confidence that (my relative) is okay here. It's got a nice homely atmosphere."People looked happy and relaxed.

People promptly received the help they needed including being assisted to use the bathroom. When the call bell rang from people's rooms it was answered quickly.

People’s relatives told us that they thought the service was “Excellent”. They said that they had seen improvements in their relatives since they had been at the service. We were advised of one particular person who had come to the home with a life expectancy of a few months: this person had been living at the home for three years.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'I get on okay with the staff who are fine with me and helpful. A carer (relative) said, 'We think that the staff are kindness itself and they do everything they can for the residents'.

This inspection took place on 29 and 30 July 2015 and was unannounced.

St Anselm’s Nursing Home is situated in Walmer, near Deal. The service provides accommodation, support and nursing care for up to 26 people with a variety of mental and physical health needs. This includes people living with all types of dementia, personality disorders, such as paranoid schizophrenia and bipolar, and Parkinson’s disease. At the time of inspection there were 26 people living at the home.

A registered manager was in post. 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. St Anselm’s is owned by a partnership of four people, two of whom work on a daily basis at the service. The remaining two partners visit regularly.

People told us they felt safe living at the service. Staff understood the importance of keeping people safe. Risks to people’s safety were identified and managed appropriately. People received their medicines safely and were protected against the risks associated with the unsafe use and management of medicines. Staff knew how to protect people from the risk of abuse.

Accidents and incidents were recorded and analysed to reduce the risks of further events. People had a personal emergency evacuation plan (PEEP) in place so staff knew how to evacuate each person if they needed to.

Recruitment processes were in place to check that staff were of good character. People were supported by sufficient numbers of staff with the right mix of skills, knowledge and experience. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles.

People were confident in the support they received from staff. People and their relatives said they thought the staff were trained to be able to meet their needs or the needs of their loved ones. People were provided with a choice of healthy food and drinks which ensured that their nutritional needs were met. People’s physical and mental health was monitored and people were supported to see healthcare professionals.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Some applications to the supervisory body had been made in line with the guidance.  There were other urgent applications which had been made but since expired and not been renewed so people were being restricted without the restriction being authorised as lawful. DoLS checklists had been completed for people and were regularly reviewed but some of these checklists had not been dated.

People and their relatives were happy with the standard of care at the service. People were involved with the planning of their care. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Staff were kind, caring and compassionate and knew people well. People were encouraged to stay as independent as possible.

People were supported to keep occupied and there was a range of meaningful social and educational activities available, on a one to one and a group basis, to reduce the risk of social isolation.

The registered manager and nursing director coached and mentored staff through regular one to one supervision. The registered manager and nursing director worked with the staff each day to maintain oversight of the service. People and their relatives told us that the service was well run. Staff said that the service was well led, had an open culture and that they felt supported in their roles. Staff were clear what was expected of them and their roles and responsibilities.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted most notifications to CQC in an appropriate and timely manner in line with CQC guidelines. However, they had not consistently notified CQC of Deprivation of Liberty Safeguards (DoLS) applications made to the local authority and their outcomes.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.