St Martin’s is a ‘care home’ that provides accommodation for a maximum of 40 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 34 people living at the service. 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 Martin’s is situated in the town of Camborne. It is a purpose built one storey building with a range of aids and adaptations in place to meet the needs of people living there. There were people living at the service who were living with dementia and were independently mobile. There was pictorial signage at the service to support some people, who may require additional support with recognising their surroundings. There is a central hub of lounge and dining spaces, as well as three separate lounges. People’s bedrooms were personalised and were for single occupancy. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a courtyard which people could use.

This unannounced comprehensive inspection took place on 5 November 2018. At the last inspection, in May 2016 the service was rated Good. At this inspection we found the service remained Good.

The registered manager commenced at St Martins in April 2018. People and relatives were positive about recent management changes and said management were approachable, would listen to suggestions and felt supported. Staff told us with the change of manager and changes at senior management level there had been a number of positive improvements to the service.

The registered provider had improved quality assurance and governance arrangements. The management team were keen to implement changes that would improve the quality of people’s care and assist staff. For example, they had reviewed the deployment of staff to ensure that people’s needs were better met. One impact fof this was the number of incidents at the service had reduced significantly.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and understood their needs and preferences. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they needed and wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to themselves and other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

Staff held a daily handover where information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

There were systems in place for the mana

We carried out an unannounced comprehensive inspection of St Martins on 17 May 2016. The previous comprehensive inspection in February 2015 found there were breaches of regulations. This was because people’s medicines were not being managed safely. The service was not acting on the actions identified in audits where people’s nutrition and hydration was being monitored. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’.

St Martins provides nursing care and support to predominately older people who have a diagnosis of dementia. The service can accommodate up to a maximum of 40 people. There were 36 people living at St Martins when we inspected the service.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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 atmosphere at the service was welcoming, calm and friendly. The service had a central hub of lounge and dining space, as well as three separate lounges. People were able to spend their time in various areas of the service as they chose. There were a range of mobility aids and equipment to support people. People’s bedrooms were personalised as were the furnishings in lounge areas. There was an ongoing maintenance programme taking place with two rooms being decorated at the time of the inspection visit.

Most people had complex needs and were not able to tell us about their experiences. However, comments from relatives and friends visiting told us they felt people were safe because there were sufficient staff on duty to meet their needs. Comments included, “The home is very good and I wouldn’t want (relative) in another home. I am in the home most days for about 3 hours and I’ve never seen or heard any abuse to the residents” and “I am totally confident in the staff. Yes I believe residents are very safe here.”

People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure people’s safety. Care records included details of people’s choices, personal preferences and dislikes.

The service had reviewed the way it was staffed and had made changes to increase staffing levels at the busiest times of the day. This ensured there were enough staff on duty to respond to people’s needs.

Staff had been suitably trained to recognise potential signs of abuse and to take action should they be concerned about a person’s welfare.

Staff managed medicines competently. They were given as prescribed and stored and disposed of correctly. Additional training had been delivered to senior care staff to support nurses when administering medicines. A nurse told us, “It’s been really helpful to have care staff trained to HCA 3 level because it gives us (nurses) more time to deal with nursing tasks.”

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. A member of staff told us, "The training has been good, really helpful." Staff received other suitable training to carry out their roles.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

People were offered a choice of healthy and nutritious meals. Staff made sure people's dietary and fluid intake was sufficient for good nutrition. People had a choice of meals and relatives said they often saw snacks and drinks outside of meal times. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ens

We previously carried out a comprehensive inspection on 24 February 2015. At which time breaches of legal requirements were found. This was because medicine records were not always accurate. Some medicines which had been administered had not been recorded. Also, one person had missed their prescribed medicine on one occasion, because the late provision of this medicine meant there was insufficient time before the next dosage was required.

At our previous inspection healthcare records were not always being completed. For example where a person’s nutritional and hydration needs had needed to be monitored, there were gaps in their records. Where meals were refused over a four day period, there was no evidence as to what action had been taken. The person’s fluid intake was not being recorded regularly as instructed in the care plan. There were no calculations taking place to measure what amounts of fluid the person had received each day.

During the comprehensive inspection in February 2015 we found the service had not responded to areas of concern relating to healthcare monitoring records during an internal audit. This meant action had not been taken to improve records reporting on a person’s healthcare needs.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. As a result we undertook a focused inspection on 9 July 2015 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Martins on our website at www.cqc.org.uk.

St Martins is a care home with nursing for up to 40 predominately older people. The majority of people were living with dementia. Some people had physical or sensory disabilities. At the time of the focused inspection on 9 July 2015 there were 34 people living at 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.

At this focused inspection we found the registered provider had made improvements to medicine procedures to ensure they were safe. Medicines were being administered at the right times as prescribed. Records were accurate and complete.

Care records showed improvements had been made to ensure records were reflective of what the people’s needs were and how and when intervention was taking place. Food and Hydration records had been reviewed. Improvements had been made to make sure the amounts recorded were accurate and reflected what the person had eaten or drank and how much. This provided staff with much more accurate information to make judgements on a person’s wellbeing.

The way internal audits were managed and acted upon had been reviewed. A recent audit had identified some weight monitoring records were unclear. Immediate action was taken by the registered manager to rectify this, by speaking with staff and carrying out more frequent audits of weight monitoring records. Revised audit processes had improved the way actions were addressed. This ensured the process was more robust.

This unannounced inspection took place on 24 February 2015.

St Martins provides nursing care and support to predominately older people who have a diagnosis of dementia. The service can accommodate up to a maximum of 40 people. There were 37 people living at St Martins when we inspected the service. Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia or other mental health conditions.

The service had a manager registered 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 and associated Regulations about how the service is run.

When we inspected the service in August 2014 we found breaches of legal requirements relating to the safe management of medicines and the assessing and monitoring of the quality of the service. This was because the management of medicines at St Martins did not protect people from potential risk. Quality assurance tools were used, but when issues were identified action or a change in practice was not evident. People who used the service and their representatives were not asked for their views about their care and treatment. Care plans did not show people's involvement in their care.

The provider responded by sending the Care Quality Commission (CQC) an action plan of how they were addressing the breaches identified.

The way medicines were being managed had improved since the inspection of the service in August 2014. However, records were not always accurate. Some medicines which had been administered had not been recorded. There was an occasion when 0ne person could not have prescribed medicine because the time for administration of the next dosage was too close to the previous.

Records reporting on people’s healthcare and any identified risks were being completed and regularly updated. However, in one instance we saw that where a person’s nutritional and hydration needs had needed to be monitored, there were gaps in their records. Where meals were refused over a four day period, there was no evidence as to what action had been taken. The person’s fluid intake was not being recorded regularly as instructed in the care plan. There were no calculations taking place to measure what amounts of fluid the person had received each day.

The inspection of August 2014 identified the service was not responding to issues identified during its internal audit process. During this inspection we found regular internal audits were taking place. However, the service had not responded to areas identified including, records not being completed in relation to peoples’ care and treatment. A sample of food and fluid charts had not been completed in full. Not all records recording people’s weights had been completed. Although the issues had been identified during this audit, the same issues were then found during this inspection.

There was evidence the service had responded to complaints raised in a timely manner and recorded what action had been taken in order to identify any trends or themes. However, information informing people how to raise complaints or concerns was not readily available. People told us they would approach the manager but they did not have any formal information to follow. Two recent complaints had been raised verbally with the registered manager who had addressed the issues and informed people of the outcome.

Improvements had been made in the way the service was being staffed. More permanent staff with an appropriate mix of skills had been employed to work in the service. This had reduced the reliance on agency staff. Staff told us this had meant there was more continuity in how care and support was being delivered.

Staff recruitment records showed all relevant recruitment checks were in place which helped to ensure that staff were suitable and safe to work in a care environment. Where nurses were being employed professional registration checks were taking place to ensure they were safe to practice.

Staff told us they received support to carry out their role from senior staff and the registered manager, however formal supervision was not offered regularly. Supervision is a vital tool used between an employer and an employee to capture working practices. It is an opportunity to discuss on-going training and development. The service’s own audit had identified supervision was not taking place. The registered manager showed us evidence this had been recognised and a plan put in place to begin the process.

Suitable arrangements were in place to protect people from abuse and unsafe care. Staff understood their responsibilities to report unsafe care or abusive practices.

Steps had been taken to carry out mental capacity assessments and best interest decisions were being recorded where necessary The registered manager demonstrated an understanding of the legislation as laid down by the Mental Capacity Act (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). Staff understood what was meant by restrictive practice in respect of depriving somebody of their liberty.

People told us they felt well cared for living at St Martins and that staff were kind and compassionate. Visitors told us, “We have noticed the staff with other residents. They speak in a caring and respectful way. We don’t have to worry about (our relatives) care and safety”.

Staff and visitors told us they were being informed of changes occurring in the management of the service. They told us they felt listened to and involved in the development of the service. Regular staff and relatives meetings were taking place to ensure communication was effective and people had the opportunity to share their views about the running of the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

We gathered evidence against the outcomes we inspected to help answer our 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, their relatives and the staff told us.

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

Is the service safe?

During our inspection of St Martins we saw evidence to support a judgement that this service was not always safe.

People were treated with dignity and respect by the staff. During our inspection we did not speak with people living in the home because the vast majority had a communication deficit caused by a dementia-type illness or a mental illness. We did speak with one visiting relative who told us they were “confident their relative was safe”.

Care plans were not personalised to the individual, and gave inconsistently clear guidance for staff to follow to meet people’s needs. This included how staff should provide care to people who had complex needs and were not always orientated to their surroundings.

Staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm.

The management of medicines at St Martins did not protect people from potential risk.

We saw St Martins understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people’s needs.

Is the service effective?

During our inspection of St Martins we saw evidence to support a judgement that this service was effective.

People’s health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of St Martins we saw evidence to support a judgement that this service was caring.

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people’s families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people’s wishes.

Staff were seen to be caring and attentive to people’s needs. A visitor to the home told us “they [staff] are very good” and “staff look after X very well”. We observed staff responded to people in a kind and sensitive manner.

Is the service responsive?

During our inspection of St Martins we saw evidence to support a judgement that this service was responsive.

People were able to take part in a range of group and individual activities such as card games, listening to music, outings in the local community and craft work, although the activities were not always well recorded.

St Martins gave clear information to people about how to complain. We saw the home responded appropriately when complaints were made and took prompt action to resolve the concerns raised.

Is the service well-led?

During our inspection of St Martins we saw evidence to support a judgement that this service was not well-led.

The home worked with other services to ensure people’s health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

Best interest meetings had been held to ensure the care and support provided was still meeting the needs of the person.

People who used the service and their representatives were not asked for their views about their care and treatment. Care plans did not show people’s involvement in their care.

Quality assurance tools were used, but when issues were identified action or a change in practice was not evident.

We previously inspected this service in December 2013. The Commission issued a compliance action as the service had been found to be non-complaint with the Essential Standards of Quality and Safety relating to records. (Regulation 21 of the Health and Social Care Act 2008). We found peoples’ care records did not accurately reflect the care and support people received. Since our previous inspection in December 2013 is was apparent the manager had been working hard to make improvements to become compliant with the Essential Standards of Quality and Safety.

As part of our inspection we spoke with the deputy manager and the nurse on duty. We did not speak with people who lived at St. Martins House due to their health needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

At this inspection we saw care plans were in place to direct staff as to the care and support people needed. The care plans had been reviewed since the last inspection and people's records were personalised and provided clear information about the person’s wishes and abilities.

Information about people’s lifestyle in the daily records was consistent. It was now clear how information was collected. Food and drink charts, were consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

This inspection was as a result of a compliance action set at the previous inspection in September 2013 about the care records at St Martins.

At this inspection we saw care plans were in place to direct staff as to the care and support people needed. Some of the care plans had been reviewed since the last inspection and people's records were personalised and provided reasonably clear information about the person’s wishes and abilities.

Information about people’s lifestyle in the daily records was inconsistent. It was unclear how information collected, such as by food and drink charts, was consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

This inspection was as a result of information of concern received about the care provided and care records at St Martins. We spent time watching what was happening, observing the type of support people got and whether they had positive experiences. We spent time with one person who lived at St Martins, chatting with them and also observing them participate in a social activity. We saw people talked with staff during personal care and when being assisted.

During our inspection, we found people’s privacy; dignity and independence were respected. We saw people were spoken with in an adult, attentive, respectful, and caring way. We saw people assisted by staff and equipment being used properly, for example, staff took the time to put on protective equipment such as aprons and gloves.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided reasonably clear information about the person’s wishes and abilities, although this was inconsistent.

It was unclear how information collected, such as by food and drink charts, was consistently monitored, interpreted and communicated so that appropriate action could be taken where necessary.

We spent time watching what was happening, observing the type of support people got and whether they had positive experiences. We spoke with two visiting relatives, both of whom told us they were happy with the care provided. We saw people talked with staff during personal care and when being assisted. One visitor told us “the staff are excellent, they tell me everything I need to know and I can speak to the manager anytime I want”.

During our inspection, we found people’s privacy; dignity and independence were respected. We saw people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw people assisted by staff and equipment being used properly, for example, wheelchairs with footrests in place.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided clear information about the person’s wishes and abilities.

St Martins adhered to robust and safe medicine practices in order to protect people.

Two visitors were complimentary about the environment their relatives lived in and they thought the home was clean and tidy.

There were enough staff on duty to provide care that met people’s care needs.

We reviewed all the information we hold about this provider, carried out a visit on 2 July 2012, observed how people were being cared for, talked with people who used services, talked with staff, and checked records. We also used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on and helped us record how people spent their time, the type of support they got and whether they had positive experiences.

We spoke with people who lived at St Martins, but many were not able to describe their quality of life at the home by reason of their illness. We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people who used the service or by staff. We spoke to a visitor to the home, who said that the home and the staff were “wonderful”. Staff told us that people had visitors coming in at varying frequencies, and the visitors’ book near the entrance supported this.

People who used the service were moving freely around the home and staff were seen to interact well with them: taking the time to stop what they were doing to ensure people’s safety or to try to ascertain what they wanted. We saw that people who used the service were very happy to approach any member of staff.

We saw that the routines being observed during the inspection showed that people were able to get up when they wanted and had choices about where and how they spent their time.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People were engaged with staff during personal care, and when being assisted with meals and drinks.

A visitor said they felt they could approach staff with any questions or concerns.