This inspection took place on 4 and 9 October 2018. It was an unannounced inspection.

St Katharine’s House is registered to provide accommodation for up to 76 people who require nursing care. At the time of the inspection there were 55 people living at the service.

At the time of the inspection there was no 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.

We last carried out an unannounced inspection of St Katharine’s House in December 2017. Following our inspection in December 2017 we published a report in which we rated the service as requires improvement. During our December 2017 inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). This related to incomplete and inaccurate care records. At this inspection we found that the service had failed to address the concerns.

There was not an effective system in place to monitor call bell response times. The provider's procedures to formally assess, review and monitor the quality of the service were not always effective.

Risk assessments were not always accurate, complete or up to date. People were not always protected from risk due to environmental hazards. Medicines prescribed to people were not always held in stock and were not always stored securely.

People were not always protected from the risk of infection. The premises and the equipment were not always clean, and staff did not always follow the provider's infection control policy to prevent and manage potential risks of infection. Equipment was not always maintained in line with manufacturer's guidance.

Records relating to people’s care were not always accurate and complete. Care records did not always contain guidance provided by other healthcare professionals.

Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who understood the dietary needs of the people they were catering for. However, people did not always receive person-centred support at mealtimes.

People we spoke with told us there was a constant change in management and that the service was not always well led. Staff had not completed training on planned dates to ensure that their knowledge and practices were up to date.

The service did not always respond effectively to people’s changing needs. Care records did not always capture person centred information about people's backgrounds, hobbies and interest and daily routines.

People had access to activities that included live entertainment. We observed people enjoying some live entertainment. People knew how to make a complaint and information on how to complain was available in the home.

The service supported people in line with the principles of the Mental Capacity Act (2005) and the service followed the correct procedures when depriving people of their liberty.

People and their relatives told us they benefited from caring relationships with the staff who supported them. There was good communication between staff and the people who used the service. Staff received regular supervision, which is a one to one meeting with their manager.

The overall rating for this service is 'Inadequate' and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequat

We inspected St Katharine's House on 13 December 2017. The inspection was unannounced. St Katharine's 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 Katharine's House is a care home providing care for up to 76 people. At the time of the inspection there were 59 people using the service.

At the time of the inspection there was no 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. The home manager told us they would be applying to register with the CQC.

People's care records were not always kept up to date and did not always reflect changes in their care needs. Records relating to assessed risks were not always kept up to date and care plans did not always contain up to date plans relating to how risks were managed.

There were sufficient staff deployed to meet people's needs. People commented on the number of agency staff working in the service and the provider was proactive in looking for ways to recruit permanent staff. Changes had been made to the rota for permanent staff to ensure there was an appropriate skill mix to meet people's needs.

People received their medicines as prescribed by staff who were trained and competent to do so. Infection control measures were in place to protect people from the risk of cross infection.

We saw people enjoying their meals and they were positive about recent improvements made to the food and drink. Where people had specific dietary requirements these were provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported through regular supervision and had access to training and development to ensure they had the skills and knowledge to meet people's needs. Staff felt valued and were involved in the development of the service.

People were treated with dignity and respect by staff who were kind and compassionate. People were complimentary about staff and had developed positive relationships with staff and others. We observed many kind and caring interactions where staff displayed their understanding of people's needs and knowledge of them as individuals.

There were a range of activities taking place during the inspection and we saw people enjoying them. People were positive about the activities team and the effort made to ensure people were able to access activities that interested them.

The manager was passionate about the service and was committed to making improvements. Staff felt valued and listened to and were complimentary about the manager and the changes they had made.

There was an open culture which was promoted through the provider's vision and values. People were seen as unique individuals and the service promoted a culture of inclusiveness that valued everyone as individuals.

There were systems in place to monitor and improve the service and we saw that where issues were identified action was taken to improve. However, the systems had not identified the issues we found during the inspection.

We found one breach 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.

We inspected this service on 3 December 2015. This was an unannounced inspection.

St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. At the time of the inspection there were 47 people living at the service. The home is arranged into three units; Willow Walk provides care for people living with dementia, St Lukes Wing provides nursing care for people and the ground and second floor of the main building provide residential care for older people.

At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook a focused inspection in May 2015 to check that the provider had followed their action plan and to identify if the service met legal requirements. Although improvements had been made, the inspection in May 2015 found continued shortfalls in relation to people’s care records which meant people were at risk of inappropriate care or treatment. We told the provider they must continue to make improvements.

At this inspection on 3 December 2015 we found action had been taken to ensure peoples care records accurately reflected the care, support and treatment people were receiving. People had been involved in reviewing their care. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. People were assessed regularly and care plans were detailed. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met.

A manager was in post and was in the process of registering with the Care Quality Commission to become the 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, their relatives, staff and visiting professionals felt the service was well led and were complementary about the manager and staff team. People felt involved in the running of the service. The manager was continually striving to improve the quality of care.

People felt supported by competent staff. Staff were motivated to improve the quality of care and benefitted from regular supervision, team meetings and training to help them meet the needs of the people they were caring for.

There was a calm, warm and friendly atmosphere at the service. People were cared for in a respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff knew people well and understood their individual preferences.

People were supported to have their nutritional needs met. People were complementary about the food and were given choice and variety. The menu was flexible to ensure people were able to have what they wanted at each mealtime. Where people required support to eat this was done in a dignified way.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way.

We visited St Katharine’s to follow up on concerns that had been identified with respect to people’s health and welfare. During our visits on 25 November and 5 December 2013 we identified specific concerns that related to some people who were at risk of choking. Following our visit we issued the provider with a warning notice stating that they must take action to address these risks, by 17 January 2014.

At our visit on 3 March 2014 we found that action had been taken by the provider in relation to the concerns raised. An assessment of the risks associated with one person’s choice not to follow professional recommendations with respect of drinking had been undertaken. Measures had been put in place to reduce and manage these risks. We spoke with care workers who understood the risks and were able to describe the actions they would take to ensure that people who were at risk of choking were safe.

During our visit on 3 March 2014 we also looked more broadly at the care and welfare of people who used the service. We spoke with seven people who used the service and three people’s relatives. People told us they were happy living at St Katharine’s House. Comments included; “you won’t get a better home than this” and “it’s very good. No complaints”. Relatives gave us a mixed opinion. Whilst one raised concerns that their relative was not supported to drink enough , others were very positive about the care provided. One said “staff are good, everyone knows her [their relative], knows how to look after her and they look after her very well”. We spoke with eight care staff, three kitchen staff and the senior nurse. Care staff told us there had been changes and improvements within the home, particularly with respect to planning and delivery of care. One said ““the care plans are so much easier to understand now. We had training on the care plans, a few months ago and now I know where to find all the information I need”.

We looked at how the risk of people not eating and drinking enough was managed within Willow Walk. We saw that people, who had been assessed as being at risk, were having their food and drink intake monitored. We saw that where concerns had been identified that people might not be eating and drinking enough, appropriate action had been taken. Professional advice had been taken and the recommendations made were being followed by care workers in accordance with those recommendations. We found some specific concerns with respect of one person and passed these on to the unit manager so that they could be immediately assessed. We saw that where management plans had been put in place with respect of people’s skin integrity, appropriate equipment was in place and care workers were acting in accordance with the plans. Care and treatment was being planned and delivered in a way that ensured people’s safety and welfare.

We found people were involved in making decisions about their care and treatment. People we spoke with said that they were able to make decisions about how they wanted to spend their day. One person said “they’ll let you sit up if you want to chat and watch TV. They’ve never forced us to go to bed”.

We found care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. Where risks had been identified these had not always been addressed. The variable quality of entries meant that nurses and care workers could not be sure that care was being delivered in line with individual care plans.

We found that the lift had been out of order on 11 occasions since our previous visit. We spoke with one person whose relative was disabled and used a wheelchair. Their relative had been unable to visit on a number of occasions due to the lift breaking down.

We found that staffing levels in the home had improved since our previous visit. One relative we spoke with told us “there was a time when there weren’t enough staff, six months ago”.

We found improvement in record keeping. Records were organised in a way that made easily accessible for care workers. One care worker told us “the files have improved and it is easier to find records in the file”.

People told us that there was an inadequate water heating system to the dementia unit. People asked us during the visit when the water was going to be put back on. During the inspection we witnessed one lady being assisted down the stairs due to the lift not working her comment during this process was ' what a to do '.

People we spoke with during the visit expressed concern about the number of staff available to work on the dementia unit. Concern was also expressed about the imminent departure of the unit manager. We also found that a newly installed bath was out of order and the sluicing facilities were also not working.We asked for an action plan. We were told the hot water was back up to heat the following day. No action plan was received for the installation of the bath or sluicing facilities.

We have made compliance actions.

The home has been placed on Red Alert by Oxfordshire Social Services Commissioning who will not place anybody in the home until improvements have been made.

The inspection was carried out on 18 July 2012 as part of the schedule of visits and included reviewing information about the service received by the Care Quality Commission (CQC) during the last 12 months.

The last inspection of the service by the commission was carried out in 2011 and we have received routine information about the service since that period.

At the time of the inspection visit the home was not fully occupied as there had been a programme of refurbishment in the residential area of the building. 65 of the 76 beds were in use. There were 15 people living in the unit which provided support for people with dementia. 25 people were living in the part of the home that provided nursing care. We met and spoke with five people who used the service, two visitors to the home and eight staff.

We observed staff speaking to people respectfully and saw they encouraged them to make decisions about what they wanted to do. We found that staff ensured that personal care was provided appropriately maintaining peoples privacy and dignity. One person said that the move to the home was the ‘best thing’ for them as their health had greatly improved since being admitted and they were ‘not on their own.’

People told us that there were enough staff on duty to support them. We were told that they did not have to wait too long if they called for assistance. We saw staff were always in attendance in the lounges and communal rooms when they were in use. Staff answered call bells promptly and responded to requests for assistance quickly.

People told us they felt safe living in the home. Comments had included, ‘very safe’, ‘I can speak to staff.’ And ‘there is always someone around.’

Some of the people we spoke to were concerned that they were no longer involved in the future planning for the service. They were also concerned as they thought that no one listened to their views. They told us that they received the support that they needed for personal care. However, they stated that they were not receiving the assistance to maintain their interests and social lives that they had enjoyed.

They told us that the food was not as good as it used to be. They felt there was a lack of choice at mealtimes. People told us that they thought the home was kept clean and tidy and they were generally happy with the environment. They did state that they were not confident about the lack of fire safety practices in the home.

People living in the home thought that there were less staff working there than previously. However, they were complimentary about staff and used words such as ‘super’ and ’remain pleasant and cheerful’.

We inspected this service on 5 and 6 May 2015. This was an unannounced inspection.

St Katharine's House is registered to provide accommodation for 76 older people who require nursing and personal care. At the time of the inspection there were 55 people living at the service. The home is arranged into three units; Willow Walk provides care for people living with dementia, St Lukes Wing provides nursing care for people and the ground and second floor of the main building provide residential care for elderly people.

At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with three compliance actions in relation to staffing, equipment and quality assurance. We also issued a warning notice in relation to records stating the service must make improvements by 31 January 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to continue making improvements to meet the legal requirements in relation to those breaches. We undertook this focused inspection in May 2015 to check that the provider had followed their action plan and to identify if the service now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Katharine's House on our website at www.cqc.org.uk.

This inspection was the eighth inspection of St Katharine's House since December 2012. At each inspection we saw changes had been made to bring the service up to the required standard but also highlighted further areas for improvement. There has not been a stable management team at the home during this time, which meant the improvements had not all been sustained or embedded in practice. At this inspection in May 2015 a new manager was in post because the registered manager had left the service three weeks prior to 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.

At this inspection people, relatives and staff were complimentary about the management team. The management team sought feedback from people and their relatives and was continually striving to improve the quality of the service.

There were continued shortfalls in relation to care records. Some care plans and assessments had not been completed or updated. Records did not always accurately reflect the care, support and treatment people were receiving. This meant people were at risk of inappropriate care or treatment.

Action had been taken to ensure there were enough staff to meet people’s needs. The manager had recruited further staff, reviewed people's dependency needs and looked at how staff were working together to meet those needs.

Equipment had been serviced in line with nationally recognised schedules and a plan was in place to ensure future services would take place when they were due.

Since our last inspection we had received concerns about how people medicines were managed. We were accompanied on this inspection by a specialist pharmacy inspector. The service was meeting the legal requirements in relation to medicines.

Although some of the required improvements had been made we have not changed the ratings for this service, because we want to be sure that improvements continue to be made and will be sustained and embedded in practice. We will check this during our next planned comprehensive inspection.