This comprehensive inspection took place on 7, 8 and 11 June 2018 and was unannounced. At the last inspection in January 2016 the service was rated ‘Good’. However, at this inspection we found that the provider was not meeting all the regulations that we inspected.

St Catherines House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Catherines House accommodates 16 people in one adapted building. At the time of this inspection there were 15 people living at the home.

There was a registered manager in post at the time of this inspection. 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.

The provider and registered manager carried out several audits and checks to monitor the quality of the service. However, we found that these audits failed to identify any of the issues that we identified as part of this inspection. Where issues were found, there was no record or action plan in place stating how the issues were to be addressed or resolved and by when.

Certain aspects of medicines management and administration was not safe. We found numerous omissions in recording, issues with the storage of controlled drugs, lack of ‘as and when required’ medicine protocols and incomplete paperwork confirming the safe and appropriate administration of covert medicines.

We found issues relating to the health and safety of people in relation to the fabric and condition of the home. Radiator covers were broken and not securely fixed to the wall, wardrobes were not stable and were leaning to one side and not safely secured to the wall. Although the provider addressed these issues during the inspection, the provider’s lack of awareness of these issues placed people at risk of harm.

Infection control processes were not in place to prevent cross contamination. Red bags were not available to care staff in order to safely clean soiled clothing and linen.

Staffing levels were not sufficient to safely meet people’s needs. Throughout the three days of the inspection we observed numerous times where the main lounge was left unattended. This was because care staff had to either support people who remained in their bedrooms or where other daily tasks such as laundry, cooking or cleaning had to be undertaken.

Care plans did not always contain appropriate documentation confirming people's consent to care. Where people had been assessed as lacking capacity we saw documents confirming they had signed consent to the care and support that they received. Where people had capacity, they had not been asked to consent to their care.

People ate well. People and relatives confirmed that they and their relative enjoyed the food that was presented to them. However, people were not always offered a choice of meal. Menus were not displayed and alternative meal options were not always available. Drinks were available to people throughout the day, however, we did not always see the availability of snacks including fresh fruit and biscuits for people.

The home monitored every person’s food and fluid intake to ensure people were eating and drinking sufficiently. However, the charts were just a formal record of what the person had eaten or drank. Amounts of fluid intake were not recorded and totalled to determine whether a person’s fluid intake was sufficient over a 24-hour period.

People’s individual needs were not always met by the adaptation, design and decoration of the home. The home had not been decorated and designed in a way which supported people living with dementia.

People and rel

This inspection took place on 12 January 2016 and was unannounced. When we last visited the home on the 27 June 2014 we found the service was meeting all the regulations we looked at.

St Catherine's House provides accommodation and care to a maximum of 16 older people some of who may have dementia. There were 14 people using the service on the day of the inspection.

The home 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.

Staff knew what to do if people could not make decisions about their care needs. People were involved in decisions about their care and how their needs would be met. Risk to people was identified and how the risks could be prevented. Medicines were managed safely.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported. The registered Manager and staff had received training on safeguarding adults, the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. These safeguards are there to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People received individualised support that met their needs. The service had systems in place to ensure that people were protected from risks associated with their support, and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified. Care plans were developed with people who used the service to identify how they wished to be supported.

People using the service, relatives and staff said the registered manager was approachable and supportive. Systems were in place to monitor the quality of the service and people and relatives felt confident to express any concerns, so these could be addressed.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were being cared for in an environment that was clean, hygienic and tidy. The records we read showed the home was cleaned daily. People told us they felt safe in the home. One person said, “I feel safe here, I would speak to someone if I didn’t.” We saw the service had effective infection control procedures. Equipment in the home included fire hydrants and a stair lift. The equipment had been well maintained and serviced on an annual basis under maintenance agreements.

The staff records we read showed appropriate checks had been made to ensure staff were suitable to work in care. Staff had received appropriate training to keep people safe. Training included health and safety, infection control and manual handing training. Staff were able to explain how this training kept the people who used the service safe.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing, first aid trained staff and a call alarm people could use to call for assistance.

The CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us they were happy with the care they received and felt their identified needs were being met. One of the health and social care professional we spoke with told us the service had met the needs they identified when they referred people to the service. They told us the service provided was, “second to none.“ We observed staff’s interaction with people and saw they were attentive to their needs.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, “All the staff here are lovely.” We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw people’s care plans had been regularly updated and people were given the opportunity to change their mind about what they wanted to do. People we spoke with told us the service was responsive to them when they changed their minds about what they wanted.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw people were regularly asked what they thought about the service and the manager took action to resolve any issues. We saw senior management of the home regularly receive quality reports and acted upon them. People told us the management had consulted with them before implementing changes to service the home provided and their views had been taken into consideration.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with people. People said that they received the care and support they needed. A typical comment was, "I feel cared for here.” People said that they had received visits from their dentist, optician and chiropodist. One person told us, "they call my doctor when I need to see him."

People told us that staff knew how to meet their needs. We saw that staff understood people’s needs. One person said, "staff understand my needs and do a good job." People told us that staff listened to them and responded to the requests. Staff responded to any suggestions they made about the service. People told us that there had been meetings where they could discuss their views of the home.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

We used the short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We also spoke to a three relatives of people use the service.

The four people spoken with told us that staff involved them in decisions about care and treatment. One person said he was, “Very happy” with the way staff treated him.

People were provided with assistance at lunchtime in a sensitive and respectful manner. People told us that they liked their meals. A person said, “The food is nice.” We asked about the variety of food a person said, “I can choose what I want to eat." We observed at lunchtime that enough staff were available to help people to eat and drink.

People confirmed that they trusted staff and felt safe. A person said, “I am safe here.” People's personal records including their care plans were accurate, and were kept securely.

People told us that they felt that they were treated with respect by staff. One person when asked about this said, "They do listen to me. Staff spend time with me and have a chat.” People told us that staff understood their needs and gave them the care they wanted. A person when asked about the care they receive said, "I am well looked after here. They ask you how you want things to be done." People are listened too, and can choose how they are cared for.

People told us that staff asked them how they wanted their needs to be met. A person told us when asked about this, "Staff give me the help I need." This meant that changes to their care were explained to them.

People spoken to felt that the home met their needs. They told us they were happy with how the home had treated them. One person told us that they had found the home to be, "A lovely place to live." This showed us that the home was meeting peoples’ needs. They are given the support they need.

People spoken to told us that they liked the food. A person said when asked about a variety of meals available to them, “I can choose from the menu. If this is not what I want I can ask for something else." People were offered a choice of what they would like to eat.

A person told us, "I can ask to see my general practitioner if I need to.” The home works with other professional to make sure that people get the care and support they need.

People told us that they could discuss their concerns with the staff. A person commented that, “I can talk to staff if I am worried about anything.” People know how to raise concerns about issues that affect their well-being.

People told us that the home was kept clean. A person when asked about this said, "The home is clean and tidy." People are protected from the risk of infection.

We found that staff checked before giving medicines to people. This made sure that they received the correct medication. A person told us when asked about their medication, “I know what I am taking. The staff always ask me if I want my painkillers." People know what medication they have been prescribed.

People were able to access all parts of the home safely. They were provided with a safe and accessible place to live. We saw that people had personal items such as photographs and ornaments in their rooms. These reflected their personal interests and cultural backgrounds. However, the carpet on the stairs and hallway had dirty marks on it. It looked worn. We spoke with the registered manager and she explained that this carpet should be replaced. An improvement action has been made to make sure that the home maintains compliance with this outcome.

We observed the staff knew how to care for people. They were happy with the way staff treated them. A person when asked about the staff said, “The staff are always helpful and kind.” Another person told us when asked about this, "The staff always come and help when you ask them.” Enough staff are available to meet the needs of people. People know that they can get the care and support they need. A person told us when asked about how staff treated them said, "The staff are supportive and kind." People feel that staff know how to meet their needs.

People told us that they felt that staff listened to them and responded to any suggestions they made about the home. They knew how to make a complaint. One person confirmed that, "I know what to do if I want to make a complaint." A person told us when asked about this, "You can talk to staff about anything that might be worrying you." People are able to raise concerns about the home. They know that staff can be trusted to listen to them, and take their concerns seriously.