The inspection took place on 27 March 2017 and was unannounced. This means the provider did not know we were coming. At the last inspection on 17 September 2015 we had asked the provider to make improvements to how medicines were managed. We received an action plan from the provider detailing how these improvements would be made and we found on this inspection that the legal requirements were met.

St Catherine's Care Home is a 45 bed care home that provides personal and nursing care to older people, including people with dementia. At the time of our inspection there were 42 people living at the home.

The service had a registered manager. 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 who used the service and relatives we spoke with consistently praised the skills of staff working in the home. One person living in the home told us, “I looked at a few homes before choosing this one and this was head and shoulders above the rest. Since moving in I have not been disappointed. The staff have been very supportive in helping me to settle.”

A relative summed up the views we consistently gained from all the relatives we spoke to by saying, “It was a huge comfort to us knowing (relative) was being cared for at this home and we will always be grateful for this and the way they were looked after in her final days, a rock of support every step of the way. This home makes a difference to people’s lives.”

People were supported with care and compassion and there was an ethos of care which was person-centred, valuing people as individuals. A relative told us, "I know my relative gets the very best care here. I'm 100% sure of that."

We found that this home was particularly effective in delivering quality care because of the emphasis it placed on building a really strong staff development programme. The provider valued their staff and saw them as an asset when delivering high quality care to people. Staff received extensive training and support to meet people's needs effectively.

Staff were well motivated and proud of the service. There was an emphasis on developing staff potential within a positive learning environment to create a high quality service. Staff had regular opportunities to reflect on their practice and to request any additional support or training. Staff were 'champions' in specialist areas and had received additional training and skills in their specific areas. Skills were then shared within the rest of the staff team to create more positive outcomes for people who used the service.

People were at the centre of care planning. People told us that they were made to feel in "control" from the time they first made the decision to move into the home. The staff knew the people they were supporting well and treated them in a respectful and friendly way. One person told us, “I get good support from all the staff, from the manager right through to the laundry staff and cooks.”

People were safe because risks had been identified and managed. All the staff in the home had completed training to give them the skills and knowledge to carry out their roles and to ensure people in the home were safe.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

People received on-going healthcare support from a range of both internal and external healthcare professionals and people’s health and nutrition were effectively monitored and responded to in line with nationally recognised practice. People were supported to eat a well-balanced diet and those who were at risk of malnutrition and/or dehydration had their food and fluid

The inspection took place on 4 and 6 May 2016 and was unannounced. This means the provider did not know we were coming. We last inspected St Catherine’s Care Home in February 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

St Catherine's Care Home is a 45 bed care home that provides personal and nursing care to older people, including people with dementia. At the time of our inspection there were 44 people living at the home.

The service had a registered manager. 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 found that clear processes were followed for reporting and responding to any safeguarding issues. The provider was open about their safeguarding procedures and trained staff in how to recognise and protect people from harm and abuse.

People and their relatives told us they felt the care provided at the home was safe. Risks had been assessed and measures were in place to ensure people’s personal safety. Steps were taken to provide care in a safe, comfortable and hygienic environment.

The risks associated with the safe use of medicines were not fully mitigated. Administration of medicines was not always accurately accounted for in records. Omissions in the application of topical medicines were evident and there had been an undue delay in one person receiving their medicines.

New staff were robustly recruited to check their suitability in working with vulnerable people. Enough staff of all grades were employed to ensure people received safe and consistent care. There was an appropriate skills mix and staff were given training and support which enabled them to care for people effectively.

People and their families were consulted about and asked to agree to their planned care. Where people were unable to give their consent, formal processes were followed to make decisions in their best interests.

People were given support to meet their health needs and access a range of health care services. A varied menu with choices of meals was offered and people told us they enjoyed the food. Nutritional risks were monitored and people were supported with eating and drinking where necessary.

Staff had a good understanding of people’s individual needs and preferences. They were caring in their approach and promoted people’s privacy and dignity. People were supported to express their views and make choices and decisions about their care and treatment.

Care needs were regularly assessed and recorded in personalised care plans. People’s care was kept under review, with their involvement, and adapted when their needs changed. People were able to engage in social activities and have their spiritual needs met.

The home had a defined management structure that provided staff with leadership and support. There was a continuous system for assessing and improving the quality of the service. Feedback about the service was actively sought and any complaints were properly responded to.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

We found action had been taken to improve the quality of people’s personal and health care records. The records now demonstrated that people’s care and treatment was properly planned and delivered.

People living at the home and a relative described being very happy with the care they received. Their comments included, “I’m more than satisfied, I can’t fault the care”, and, “They (staff) are all very good, I have no worries”.

We found people were cared for by staff who understood their needs and provided the care and treatment they required. However, action needed to be taken to bring personal records up to date and ensure they accurately reflected people’s planned care.

People were supported to meet their nutritional needs, including, where necessary, being given special diets and assisted with eating and drinking.

Care was provided by staff who were checked and vetted to make sure they were suitable to work with vulnerable people.

There were enough qualified, skilled and experienced staff to meet people’s needs. The provider had recently recruited additional nurses, a senior carer and housekeeping staff, to reflect changes in people’s dependency levels.

The expert by experience reported there, ‘appeared to be quite a number of staff on duty during our visit’ and that, ‘staff were kind and caring in their manner towards residents.’ They also reported one person, who was full of praise for the staff said, 'The lasses are lovely nothing’s a bother.’ Other people told the expert by experience that they too were happy with their care. The expert by experience told us that all the people they spoke to appeared clean and well cared for.

We found that people living at the home, and their representatives, were consulted about, and agreed to their care and treatment.

Care was planned to meet individual’s assessed needs and was delivered by enough skilled staff to ensure people’s safety and welfare. This included appropriate arrangements that made sure medication was given safely.

People and their relatives told us they received the care they needed and spoke highly of the commitment of staff. Their comments included, “The day to day care is meticulous”; “They are so very patient and tuned into people’s needs”; and, “All the staff are nice, very caring and friendly”.

There was a clear process for making complaints that people understood, and the service responded promptly to address any concerns.

We spoke with people regarding their care and treatment at the home. Everyone made positive comments and indicated they were pleased with the care they received. One person told us, “Since I came here, this is God helping me."

Relatives whom we approached were also complimentary about the home. One relative commented, “We couldn’t have asked for anywhere better. Any concerns are addressed immediately. Not that we have any big concerns…We are so lucky having St Catherine’s” and “What we like is the consistency. There isn’t a high turnover of staff which is such a bonus. We know them and they know us.”

Another relative told us, “It’s absolutely excellent. Their responsiveness has been incredible. It comes from the top, they’re an amazing team” and “Everything the staff does makes sense…I don’t worry about X being here and I’m a worrier.”

Other comments from relatives included, “The staff are kind, caring and professional. I have no complaints at all” and “they treat everybody as an individual.”

People we spoke with were complementary about the level of care and support they received. One person told us, "it's like heaven here" and "they say there’s always a reward in life and living here is my reward.” Another person said, “I’ve got no complaints whatsoever. I couldn’t be in a better place.” People told us they were encouraged to make decisions about their care and support. They said they were well looked after and felt safe at the home.