This inspection took place on 5 January 2018 and was unannounced. At our previous comprehensive inspection on 24 and 25 November 2016 the service was rated as Requires Improvement but met the legal requirements and regulations associated with the Health and Social Care Act 2008. This was because continued improvements to the service were required to ensure consistent and sustained good care and practice.

St Cecilia's Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing care and support to 29 people. The home had 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.

Risks to people were assessed, recorded and staff managed identified risks safely. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take if they had any concerns. There were systems in place to ensure people were protected from the risk of infection. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed to meet people’s needs.

There were processes in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals that enabled them to fulfil their roles effectively. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People told us staff treated them well and respected their privacy. People were involved in day to day decisions about their care and had care plans in place which reflected their individual needs and preferences. People were supported to maintain relationships with people that mattered to them. There was a range of activities available to meet people’s interests. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met and there were regular volunteers who supported activities within the home. There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered through meetings and satisfaction surveys. People, relatives and staff spoke positively of the management and the improvements that had been made.

The inspection took place on the 24 and 25 November 2016 and was unannounced. At our previous comprehensive inspection on 3 and 4 May 2016 we found breaches of legal requirements. We took enforcement action and served warning notices on the registered manager and provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always assessed, reviewed or managed appropriately. Staff were not appropriately supported and trained to deliver care and treatment safely. There were not adequate numbers of staff deployed to ensure people's needs were met and in a timely manner. We placed the provider in special measures and continued to monitor the service.

We undertook a focused inspection on the 21 September 2016 to check that the provider had met legal requirements. At the focused inspection we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notices we served. However some of the ratings for the service at that inspection remained unchanged as improvements were still required.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing support to 26 people. The home had a registered manager in post. However an acting manager was in place at the time of our 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.

At this inspection on 24 and 25 November 2016 we found continued improvements had been made and some were on going. Medicines were managed, administered and stored safely. Staffing levels within the home had improved since our last inspection; however the service was still recruiting to vacant posts at the time of this inspection. Improvements in assessing and reviewing risks to people using the service had been made, however further continued improvements were required. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place and accidents and incidents were recorded and acted on appropriately.

Staff received supervision and support on a regular basis and had received an appraisal of their performance. Staff training had improved, however we will continue to monitor the progress of staffs completed training. There were processes in place to ensure staff new to the home were inducted into the service appropriately. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. However some of these systems were newly implemented and so we will continue to monitor these to ensure continued good practice. People’s views about the service were sought

We carried out an unannounced inspection of this service on 3 and 4 May 2016 at which breaches of legal requirements were found. We took enforcement action and served warning notices on the registered manager and provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always assessed, reviewed or managed appropriately. Staff were not appropriately supported and trained to deliver care and treatment safely. There were not adequate numbers of staff deployed to ensure people’s needs were met and in a timely manner.

We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to those regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Cecilia's - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection there were 28 people living at the home.

At this focused inspection on the 21 September 2016 we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were complaint with the warning notices we served. However some of the ratings for the service at this inspection remain unchanged as improvements are still required which we will follow up at our next comprehensive inspection of the service.

At the last comprehensive inspection the service was placed into special measures by CQC. At this inspection we found that there was not enough improvement to take the service out of special measures at this time and we will check on other breaches and improvements required at the next comprehensive inspection of the service.

The inspection took place on the 3 and 4 May 2016 and was unannounced. At our previous inspection on 17 and 18 June 2015 we had found the service was breaching several legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included regulations about staffing levels and the support provided to staff. The provider sent us an action plan detailing the action they would take to meet these legal requirements. They told us this would be completed by the 30 September 2015. We carried out this inspection to check the action plan had been completed and to provide a new rating for the service.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing support to 29 people. The home had 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.

At this inspection on 3 and 4 May 2016 we found continued breaches in relation to staffing levels and the failing to provide staff with support, supervision and appraisals and a new breach of legal requirements in respect of the safe management of medicines. We served Warning Notice’s against the provider and the registered manager for some of the breaches found and will re-inspect the service to check they have complied with the notice. You can see information about action we have asked the provider to take at the back of the full version of this report.

There was not sufficient numbers of suitably qualified staff to meet people’s needs safely and in a timely manner. There had been no review of staffing levels and no increases in staffing levels following our last inspection on 17 and 18 June 2015. Medicines were not always managed safely. Risks to people’s physical and mental health needs were not always assessed and reviewed in line with the provider’s policy. People's care needs were not always reviewed in line with the provider’s policy and in response to their identified needs. Staff did not receive appropriate support, training, supervision and appraisal in line with the provider’s policy and to enable them to carry out the duties they were employed to perform. The provider did not have an effective system in place to regularly assess and monitor the quality of service people received or to address the improvements required as a result of our last inspection on 17 and 18 June 2015.

There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a social care environment. There were safeguarding adult’s policies and procedures in place and staff were aware of the potential types of abuse that could occur and the actions they should take. Accidents and incidents were recorded and acted on appropriately and there were suitable arrangements in place to deal with foreseeable emergencies. There were systems in place to monitor the safety of the premises and equipment used within the home.

There were systems in place to ensure staff new to the home were inducted into the service appropriately. The service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods to meet their needs and ensure well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff worked with people in a friendly and respectful manner and care plans contained guidance for staff o

People that we spoke with told us they were happy living at St Cecilia’s and felt that a good quality of care was provided. People told us they were actively involved in the running of the service with staff to improve the service delivery. One relative commented that the care was “excellent and staff were supportive”. Two people told us “good food was offered” and choices of activities were available during the day.

We found that people’s support plans had been agreed by them and or their next of kin and demonstrated their involvement in the planning and delivery of their care. We saw that people’s nutrition and hydration needs were being met, and we observed positive interactions between staff and residents during the lunchtime meal. The provider had systems in place to monitor equipment and support staff with relevant training to ensure the safe use of equipment. People that we spoke with told us they had observed an improvement in staffing levels due to recent recruitment of staff. We saw that the provider had systems in place to monitor staffing levels to ensure people’s care needs were met. We found the provider had a complaints procedure in place and appropriate actions had been taken to address people’s individual complaints.

Most people using the service we spoke with told us they received good treatment and care, and thought staff were competent and looked after them well. For example, one person said; “The staff do all that is possible to be done”. Most people said they and their relatives were properly involved in making decisions about their treatment, and that care was provided in ways that suited them. Most people told us staff were attentive to their needs and said their treatment and care could not be improved upon. Nevertheless, they would have no difficulty raising any problems or concerns with staff. People said the home was clean and hygienic.

One person we spoke with was not happy with the service, for example they waited a long time for their meals and for help changing the TV channel. They said there had been a lot of meetings but that things had not got better.

At our last inspection on 05 March 2012 we found improvements were needed in the planning of advanced care and the formal supervision and appraisal of staff. These improvements had been made at our inspection on 05 December 2012. We also found arrangements were in place for obtaining consent to treatment and care, and acting in people’s best interests; ensuring people experienced care and treatment that met their needs and people were protected from the risk of infection; supporting staff to be competent in their jobs; and maintaining accurate and appropriate records.

People using the service and their relatives we spoke with during our visit on 5 March 2012 told us that St Cecilia’s - Care Home with Nursing Physical Disabilities met their needs. They said they were provided with information before they came to live at home that they could understand, and they valued the home’s continuing involvement of their relatives in their care and support. Overall they felt that the service respected their privacy and dignity.

People told us that they were able to discuss any concerns with their key worker and with the manager of the home. They also said they played an active part in the development and management of the service, including the recruitment of staff and planning activities and events.

People told us they were aware of the difficulties the home faced in recruiting staff. They were nevertheless concerned about the impact of the use of agency staff on the continuity of care they received.

This inspection took place on 17 & 18 June 2015 and was unannounced. At our previous inspection in September 2013, we found the provider was meeting the regulations in relation to the outcomes we inspected.

St Cecilia's Care Home with Nursing Physical Disabilities accommodates up to 30 people, most of whom have complex physical disabilities. At the time of our inspection the home was providing support to 30 people. The home had 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was not enough qualified staff deployed within the home to meet people’s needs safely and to an appropriate standard. Staff did not receive supervision on a regular basis and appraisals in line with the provider’s policy to enable them to carry out their duties appropriately. There were some failings in keeping and maintaining accurate and contemporaneous records that was not reflective of the care and support provided by staff.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. People were protected from the risk of abuse because staff had received training to enable them to identify the possibility of abuse and take appropriate actions to escalate concerns.

Assessments were conducted to assess and monitor people’s level of physical and mental health risks. Care plans documented guidance for staff that ensured risks were minimised. Accidents and incidents involving people using the service were recorded and acted on appropriately and there were arrangements in place to deal with foreseeable emergencies.

There were systems in place to monitor the safety of the premises and equipment used within the home and medicines were stored and administered appropriately.

Staff received appropriate training to support them to do their jobs and the home facilitated staff training to ensure training was kept up to date and was effective in meeting staffing needs. Staff had good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and authorisations for DoLS where in place where appropriate.

People were supported to eat and drink sufficient amounts to meet their needs and where appropriate people’s food and fluid intake was monitored to ensure well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff had positive relationships with people and treated people in a respectful and dignified manner. People were provided with appropriate information that met their needs and were supported to understand the care and support choices available to them.

Care plans showed people’s care needs were regularly assessed and reviewed in line with the provider’s policy and daily records were kept by staff about people’s day to day wellbeing and activities to ensure that people’s planned care met their needs.

People’s diverse needs, independence and human rights were supported, promoted and respected. People had access to specialist equipment that enabled greater independence that met physical, emotional and sensory needs.

People were provided with information about how to make a complaint and we saw information was displayed throughout the home and gave details about who to contact to make a complaint.

There were systems in place to monitor and evaluate the service and records showed that safeguarding, complaints and accidents and incidents were analysed. The home took account of people’s views with regard to the service provided through resident’s satisfaction surveys that were conducted on an annual basis.