The inspection took place on 1 and 2 May 2018 and the first day was unannounced. This was the first inspection of this service registered with a new provider (owner) in April 2017. St Mary’s Nursing Home (St Mary’s) under the previous provider was known as Alexian Brothers Care Centre.

St Mary’s 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 Mary’s is registered to provide accommodation and care to up to 74 people across three floors. On the day of the inspection there were 59 people using the service.

There was a registered manager in place at the home. 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 registered manager was supported in their role by an operations support manager and the operations manager.

We found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to safe care and treatment, need for consent, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection, we found the atmosphere at St Mary’s was calm. People were well presented, settled and looked happy to be living here. We saw that families and visitors could visit as they wished and, on the whole, they were satisfied with how their loved ones were cared for at the home. Staff including the registered manager knew people and understood their needs.

People, their relatives and visitors told us St Mary’s was a safe environment and that staff knew what to do to help ensure people living there were safe. There were clear processes in place to record and report incidents and the home was well maintained and visibly clean and free from malodours. However we found examples where people were not always kept safe. We found the home’s management of medicines needed to be strengthened and personal evacuation plans were not in place for everyone living at the service. These examples were evidence of a breach of the regulations relating to the safe care and treatment of people living at St Mary’s.

The service did not always follow the principles of Mental Capacity Act as required by law. We found not all care records contained the required documentation or signed consent forms. This was a breach of the regulation relating to need for consent and meant people were potentially receiving care or support where consent had not been obtained in the right way.

Recruitment processes were inconsistent and needed to be strengthened. We found not all pre-employment checks had been carried out such as gaps in employment history that had not been investigated at interview. This information helps to ensure staff employed are fit for the role. We made a recommendation that the provider ensure the current recruitment process consistently addressed all aspects of pre-employment checks and was fit for purpose.

Preadmission assessments were carried out prior to people coming to live at St Mary’s; this process helped to ensure the home was able to provide the care and support required. We found examples where care and support was not always responsive to the person’s individual needs. Some care records were incomplete or contained information that was not current. This meant staff did not always have appropriate information to guide them in providing support. This evidence was a breach of the regulation relating to person centred care.

There was a clear procedure in place for managing concerns and complaints, both written and verbal. We fo