This inspection took place on 28 July 2017 and was unannounced.

St Brendans Residential Home is registered to provide care and support to 26 older people living with dementia. At the time of our inspection there were 24 people using the service.

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 felt safe at the home and with the way staff provided them care and support. Risk assessments were in place to help staff understand how people could be protected from risk of harm. Staff were knowledgeable about safeguarding procedures and where and when to report their concerns internally or externally to local safeguarding authorities.

People told us there were enough staff to meet their needs in a timely way. There were robust recruitment procedures in place to ensure that staff were recruited safely to work in the service. People’s medicines were stored and administered safely.

Staff received a full programme of training and induction that enabled them to carry out their roles effectively. Training was regularly refreshed and updated as required. The manager regularly supervised staff and they received regular performance reviews.

Staff understood the Mental Capacity Act 2005 (MCA) and how this applied in practice. Deprivation of Liberty Safeguards (DoLS) authorisations that were in place were appropriate to keep people safe. People’s healthcare needs were identified and met, and they had access to health services as required.

People told us they received enough food and drinks and they had plenty of choices offered to them. Staff were knowledgeable about people`s likes and dislikes and delivered care and support accordingly.

The environment had been improved since our last inspection and people were consulted and involved in the decision making around the decorations around the home. There were plans to further improve the environment to help ensure it fully met the needs of the people living with dementia.

Staff demonstrated a caring attitude towards people and respected their privacy and dignity. People were given opportunities to discuss issues through residents meetings and surveys. The service had received many compliments about the care provided to people.

Care plans were detailed about people’s needs and also their likes and dislikes. These were still under development to ensure that the personalised care and support people received was accurately reflected in their care plans.

People told us that they enjoyed the activities at the home. The registered manager told us they were in the process of recruiting an activity coordinator to broaden the type of activities currently provided.

People, their relatives and staff were positive about the manager of the service. The visions and values of the service were clear and staff understood their job roles and responsibilities. The registered manager and the provider carried out regular audits in the home to assess the quality of the service provided and for identifying improvements that needed to be made in a variety of areas. Staff had the chance to contribute to the running and development of the service through team meetings.

This inspection took place on 15 March 2016 and was unannounced.

St Brendans Residential Home provides care and support to older people living with dementia. At the time of our inspection there were 24 people using the service.

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 felt they were safe living in the service. There were risk assessments in place which detailed the ways in which people could be protected from risk of harm. Staff knew how to report any signs of abuse and which agencies to contact if they had any concerns about people’s safety. Equipment was regularly checked to ensure that it was appropriate for use, and staff were trained to move people safely. There were robust recruitment procedures in place to ensure that staff were recruited safely to work in the service. Staffing levels were appropriate to meet people’s needs. People’s medicines were stored and administered safely.

Staff received a full programme of training and induction that enabled them to carry out their roles effectively. Training was regularly refreshed and updated as required. The manager regularly supervised staff and they received performance reviews and refreshers on their knowledge. Staff understood the Mental Capacity Act 2005 (MCA) and how this applied in practice. Deprivation of Liberty Safeguards (DoLS) authorisations that were in place were appropriate to keep people safe. People’s healthcare needs were identified and met, and they had access to health services as required. People had enough to eat and drink and there were varied menus in place with snacks throughout the day.

The design and decoration of the service was not always suitable for people living with dementia. There was little evidence of personalisation, and some elements of the environment could be confusing or disorientating. We have made a recommendation about creating a dementia-friendly environment for people.

Staff demonstrated a caring attitude towards people and respected their privacy and dignity. People were given opportunities to discuss issues through residents meetings and surveys. The service had received many compliments about the care provided to people.

Care plans detailed people’s needs and support they needed throughout the day, but they were not always person-centred. Some information was included about people’s background and social history, but it was not always clear how this was used to help people enjoy full and active lives. People’s activity programs were basic and limited, and people told us they did not have opportunities to go out or keep busy throughout the day. We have made a recommendation about following current guidance on activities for people living with dementia. There was a complaints system in place which handled and resolved people’s grievances efficiently.

People, their relatives and staff were positive about the manager of the service. The visions and values of the service were clear and staff understood their job roles and responsibilities. There was a robust system in place for identifying improvements that needed to be made in a variety of areas. Staff had the chance to contribute to the running and development of the service through team meetings.

When we visited St Brendans Residential Home on 9 April 2013, we spoke with people using the service about their experiences in the home, and observed care practices.

We observed positive engagement between staff and people who used the service, and noted that people's consent was sought before care and support was delivered. People were encouraged and supported to make their own decisions, and where people lacked the capacity to make decisions for themselves, appropriate processes had been followed to ensure best interest decisions were made on their behalf. For some people this process was in progress at the time of this inspection.

People had care plans and risk assessments in place so that care could be delivered safely and with continuity. Robust medication systems ensured that people received their prescribed medication on time and in a way they suited their needs.

Although people we spoke with told us they were happy with the staff that supported them, we found the recruitment systems were insufficient to ensure that the staff employed were suitable to work in this environment.

There was information displayed relating to the complaints procedure, so that people who used the service and visitors to the home knew how to raise any concerns with the provider.

When we visited St Brendans Residential Home on 11 October 2012, we found that people were very satisfied with the care and support they received. They told us they felt safe and the staff were friendly and supportive. One person said "I've been here a few years now, it's great. I love a curry, and I get one nearly every week".

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. There was a relaxed atmosphere in the home, and the staff were friendly and polite in their approach to people and interacted confidently with them.

We noted that people were encouraged to express their views and were involved in planning their care and making decisions about their support and treatment, and how they spent their time. One person said. "I'm very happy here, it's my home now. I go out each week with my friend and I love my music. As long as I have that I'm fine". They also talked about the range of activities and entertainment that was available to them. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.

We visited this service on 24 January 2012 and wrote a report showing that the service had made improvements in five outcomes. At the time we also noted that improvements had been made relating to two further outcomes, which are now reported on here. Therefore, this report should be read in conjunction with the report published in February 2012.

We spoke to people during our visit on 24 January 2012 but their comments did not relate to the two outcomes reported on in this report. During our visit we observed that people living at this home, and the staff, had good, professional, respectful relationships with the manager.

We carried out an inspection of St Brendans Residential Home on 24 April 2014 and found that they were meeting all the regulations that we inspected.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

We found that the home was meeting all areas.

If you wish to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer 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?

This is a summary of what we found

Is the service safe?

People had been cared for in an environment that was safe. The provider carried out routine safety checks on the premises. There were enough staff on duty to meet the needs of the people living at the home and a senior member of staff was available to provide support. Staff we spoke to told us that the home was 'alright' and people were 'settled'. Staff told us that the training available was 'brilliant' and there was a 'good level of care provided' to people using the service. We observed that people at the service were happy and had their personal care needs met. We observed that staff interacted well with people and provided them with encouragement and support.

Is the service effective?

On entering the home we observed that some people had chosen to sit in the communal lounge whilst others were finishing of their breakfast or had remained in their rooms. We noted whilst being shown around the home that people were happy and interacting well with staff. Staff told us that they were able to spend time with people and 'just chat', and people we spoke to also told us that they enjoyed the company of the staff and the manager. One person we spoke to told us that staff 'are very good'. From reviewing the care documents and observing staff with people we saw that they had a good understanding of the people’s care and support needs.

Is the service caring?

People were supported by kind and caring staff. We saw that staff worked at a pace that suited the people using the service. Staff took interest in peoples conversations. We observed staff assisting a person into a wheelchair, we saw that staff communicated with the person and told them what they were doing so the person was aware at all times. Staff were softly spoken and referred to the person as 'darling' whilst listening to their conversation and taking interest in what they had to say. Staff told us that they provided people with person centred care.

Is the service responsive?

Care plans were regularly reviewed and updated according to the person’s needs. Each care document provided staff with clear information about the person and the care they required. Staff were aware of people’s needs and preferences and acted in accordance with their wishes.

Is the service well-led?

Staff told us that they would not change anything about the home. They said that the manager was 'supportive' and the home was 'well managed'. Staff told us that the management was 'approachable and they 'listen to problems and helped as much as they can'. When we spoke with people using the service we were told that the manager was 'the nicest person you could ever meet' and that all staff were 'very nice'.