St Anthony’s residential home provides care for primarily older people, some of whom have a form of dementia. The service can accommodate up to a maximum of 16 people. On the day of the inspection 14 people were living at the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

We carried out this inspection on 4 and 6 April 2017. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection on 19 October 2015. In October 2015 the service did not have robust recruitment processes. There were two new members of staff, who were providing personal care for people, without the appropriate pre-employment checks in place.

At this inspection we found improvements had been made to the recruitment processes and robust systems were now in place. Recruitment files we looked at contained all the relevant recruitment checks to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks.

Before the inspection concerns were raised with us that some staff were rude and shouted at people living in the service. There were also concerns raised about the staffing level at night and the inappropriate use of continence pads due to insufficient numbers of night staff on duty. At this inspection we did not find any evidence to substantiate these concerns.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people and relatives included, “It’s lovely here”, “I am very happy living here”, “Can’t fault it” and “No complaints.”

Due to people’s health needs some people were unable to tell us verbally about their views of the care and support they received. However, we observed people were relaxed and at ease with staff, and when they needed help or support they turned to staff without hesitation.

On the day of our inspection there was a calm, relaxed and friendly atmosphere in the service. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Comments from people and relatives included, “Staff are very good, all you have to do is ask and they will help”, “They [staff] have been very good to me”, “Staff are very attentive to Mum’s needs” and “Staff talk to me fine.”

People were able to take part in a range of activities of their choice. Where people stayed in their rooms, either through their choice or because they were cared for in bed, staff spent one-to-one time with them. This helped to prevent them from becoming socially isolated and promoted their emotional well-being. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

Staff knew how to recognise and report the signs of abuse. Staff received appropriate training and supervision. New employees completed a thorough induction and had the opportunity to attain a Diploma in Health and Social Care. However, the induction was not in line with the care certificate, which is an industry recognised induction that replaced the Common Induction Standards in April 2015. The provider assured us that all staff, who were new to the care industry, would complete the care certificate.

People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointm

St Anthony’s residential home provides care for primarily older people, some of whom have a form of dementia. The service can accommodate up to a maximum of 16 people. On the day of the inspection 12 people were living at the service. Some of the people at the time of our inspection had physical health needs and some mental frailty due to a diagnosis of dementia.

We carried out this unannounced inspection of St Anthony’s on the 19 October 2015. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and that their care needs were supported appropriately.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The registered manager was not present on this inspection but we met with the registered provider and senior carer

Recruitment records identified that people had commenced employment without appropriate recruitment checks being made. Disclosure and Barring check (DBS) to confirm if they were safe to work with vulnerable people were not in pace, nor were sufficient references. We therefore found that the registered person was not following recruitment procedures to ensure that people were suitable and safe to work in a care environment.

We found that care records were kept up to date and accurately reflected the persons care needs. The registered provider acknowledged that not all records in relation to the day to day running of the service were kept up to date. For example fire records, whilst they had occurred, were not recorded, nor were staff supervision records. The provider showed that he was currently reviewing the services policies and procedures. The provider reassured us that records in respect of the day to day management of the service would be kept up to date.

People felt safe living in the service, commenting “I feel safe here, very safe.” One person commented “This is my home now and I’m happy here.” Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People told us they were completely satisfied with the care provided and the manner in which it was given. People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the persons wishes and preferences. This gave staff a very good understanding of the person and how they could care for them.

People chose how to spend their day and a wide range of activities were provided. Activities were provided by the service individually and in a group format, such as for arts and crafts and through outside entertainers coming into the service. People told us their visitors were always made welcome and were able to visit at any time.

Staff were observed by their line managers to ensure they could carry out certain tasks, for example personal care or medicines, competently. We saw a matrix which showed when these sessions had occurred. We did not see records of the findings of these observations.

Staff said they attended appropriate training and future courses were displayed on the staff noticeboard. The registered provider acknowledged that staff needed to attend some updated training, for example the mental capacity act and deprivation of liberties.

The registered provider and senior carer had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to ensure decisions were made in the person’s best interests.

People told us they received their medicines on time. People’s care plans identified the person’s care and health needs in depth and how the person wished to be supported by the service. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all the staff.

People were complimentary about the staff, stating they were “lovely,” “It’s quiet here just how I like it” and “I worked in care, never thought I’d be in care, they are friendly it’s ok in here.” A health care professional told us staff were “competent and professional.” We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a really good knowledge of the people they supported. Peoples' privacy, dignity and independence were respected by staff. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. People said that staff respond to their calls for assistance promptly, which we observed. Staff felt there were sufficient staff on duty.

We saw the service’s complaints procedure which provided people with information on how to make a complaint. People told us they had no concerns at the time of the inspection and if they had any issues they felt able to address them with the management team.

The provider and registered manager promoted a culture that was well led and centred on people’s needs. People told us how they were involved in decisions about their care and how the service was run.

There was a management structure in the service which provided clear lines of responsibility and accountability. There was a clear ethos at the home which was understood by all the staff. It was very important to all the staff and management at the service that people who lived there were supported to be as independent as possible and to live their life as they chose.

We found a Breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the end of the full version of the report.

We carried out the unannounced visit as part of our planned schedule of inspections. St Anthony's is registered for sixteen people but at the time of the visit ten people were accommodated.

We made contact with all ten people but due to the ages, health and frailty of four people we could only communicate with six people who shared with us their experience of what life was like at the home. People made comments such as "I am very comfortable living here". One person said "the staff are very kind and I am well cared for and very comfortable".

We spoke with two relatives who visited the home at least once a week. One relative said they "the staff are brilliant and I have no concerns whatsoever". Another relative said "it has taken me time to get used to my relative living in the home but I am very satisfied with the care". Both relatives said the providers and staff were excellent and they were very satisfied with the care and attention their family member received.

We saw staffing ratios which evidenced that people were protected because there were sufficient numbers of staff on duty to fully meet their needs.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We spoke to one visitor who told us they were pleased their relative lived at St.Anthonys Care Home. We spoke to four people who used the service and spent time observing people and staff during the day. We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

During our observations we saw staff help two people to mobilise. We also saw staff conversed with people when they were laying up tables for lunch. We saw people talked to each other at lunch.

We witnessed staff interactions with people which were generally positive. People told us staff answered call bells promptly. One person said the staff were “polite and friendly”. Another person said, ”I am very happy here, no complaints”. People told us the food was good and they were offered choices. We were told visitors were welcome. One person said “I can go to bed when I want, if I wanted to go out someone would take me”.

We heard care workers ask people what they would like to do and they gave them ideas if people could not make a choice.

We found staff were recruited in an appropriate way.

We observed a new member of staff complete an initial induction process which lasted over two hours.

A number of people were observed during the visit this gave us information about the care and support they need and staff interactions with them.

People were not spoken with directly as they were being assisted with personal care or getting ready for their lunch.