About the service:

St Mary’s is a care home, providing nursing, personal care and accommodation for up to 56 people. It provides care to older frail people, some of whom are living with dementia. The care home offers short respite nursing care stays and short stays for people discharged from local hospitals on a ‘Discharge to Assess’ basis. Care is provided over two floors. Each floor has communal lounges, dining areas and a kitchenette. At the time of our inspection visit 47 people lived at the home.

What life is like for people using this service:

People’s risks to safety and well-being were assessed, recorded and reviewed. Actions were taken to mitigate risks of harm and injury to people.

There were sufficient staff on during the day shift. A few staff felt the first-floor night time staffing was low and the registered manager told us they would review this.

People had their prescribed medicines available to them and were supported with these by nursing staff.

Staff received an induction, training and support from within the staff team and managers.

The home was clean and tidy, and staff understood how to prevent risks of cross infection.

People had their needs assessed before they moved into the home. However, people’s individual oral care needs were not always assessed.

Staff were suitably skilled to meet people’s day to day needs and protect people from the risks of abuse.

People had opportunities to engage in one to one activities, which reduced risks of social isolation.

People had access to healthcare when required.

Overall, people were offered enough food and drink to meet their dietary requirements. However, the lack of staff’s organisation at lunchtime meant two people did not receive their meals as intended.

People’s dignity was promoted by staff, who showed respect and valued people.

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

Staff did not consistently complete important records related to people’s care and support. The registered manager and provider had not checked these records were completed by staff as required.

Overall, the provider’s quality assurance system identified where improvements were needed, but this was inconsistent and did not always ensure quality and safety.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 17 Regulated Activities Regulations 2014 – Good Governance

Rating at last inspection: At the last inspection the area of Well Led required some improvements and other areas were rated good. This gave the service an overall rating of Good. (The last report was published on 29 November 2016).

Why we inspected: This was a planned inspection based on the rating of the last inspection. The service is now rated as ‘Requires Improvement’ overall.

Enforcement: Action provider needs to take (refer to end of report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk