This unannounced inspection took place on the 27 June and 2 July 2018. St Ronans Nursing and Residential Care Home 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 Ronans Nursing and Residential Care Home is registered to provide accommodation for up to 46 people. There were 41 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over three floors with bedrooms on all floors. Floors could be accessed by people, staff and visitors via a passenger lift, staircases and stair lifts. The majority of bedrooms were for single occupancy and had ensuite facilities. There was a number of communal areas available to people, including two dining areas, one of which was also used as a cinema room and three lounges. The garden area was accessible and well-maintained with a number of seating areas for people to enjoy.

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.

Processes in place to monitor risks to people were not always robust and did not ensure that people received effective care to ensure their safety and wellbeing. Staff were not always provided with consistent and detailed information and guidance about how people’s needs should be met to mitigate risks.

There were a number of audits in place to check the quality and safety of the service, however, some of these were not always robust or effective in identifying concerns. Some areas of the home were not clean and some practices did not protect people from the risk of cross infection. The provider had failed to act on the issues in relation to the cleanliness of the home prior to the inspection and the infection control audit had failed to highlight the issues raised by the inspectors. Care file audits had not always identified the inconsistencies within the care files or that capacity assessments and best interest decisions had not been completed or made following the principles of the Mental Capacity Act.

The principles of the Mental Capacity Act 2005 were not being followed as required to ensure people were only cared for with consent; capacity assessments had not always been completed and best interest decisions were not in place for all people that required them.

Information within peoples care files did not always contain detailed, person centred or consistent information about people’s needs and care monitoring records had not been put in place or did not always confirm that care had been provided as required to meet people’s individual needs.

People felt safe living at St Ronans Nursing and Residential Care Home. Staff knew how to identify, prevent and report abuse. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

There were enough staff to meet people’s needs in a timely way and staff were able to support people in a relaxed and unhurried way.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. People had access to health professionals and other specialists if they needed them. Procedures were in place to help ensure that people received consistent support when they moved between services.

People were cared for by staff who were competent and appropriately trained. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People were cared for with dignity and respect and were treated in a kind and caring way by staff. Sta

This comprehensive inspection took place on 22 November 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. St Ronans Nursing and Residential Care Home is registered to provide accommodation, support and nursing care for up to 46 people. At the time of the inspection, there were 44 people living at the home.

At the last inspection on 26 November 2013 we found the service to be compliant with all of the regulations we assessed at that time.

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.

People living at the home said they felt safe. The visiting relatives we spoke with also said they felt their family members were safe as a result of the care provided.

We looked at four staff personnel files and there was evidence of robust recruitment procedures in place. Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. People living at the home said they felt there were enough staff working at the home and did not have to wait long periods for assistance.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place and this told staff what action to take if they had any concerns. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use.

We saw that quarterly infection control audits were in place and an annual infection control statement was produced. Staff were aware of precautions to take to help prevent the spread of infection. The premises were clean throughout and free from any malodours. There was an up to date fire policy and procedure.

Medicines were managed safely. Medicines which were stored on the medication trolley and treatment room were stored safely and at appropriate temperatures which were monitored daily. There was information available to guide nurses when a variable dose of medicine was prescribed to support nurses to administer the most appropriate dose of medicine. Documentation of creams didn't enable staff to sign each time it had been administered as it was only documented on the chart once.

Shortly after the date of the inspection the service contacted us to identify a number of actions they intended to take to rectify the issues we identified.

People told us they felt staff had the sufficient skills, knowledge and training to care for them effectively. Staff told us they received an induction when they first started working at the home which gave them a good introduction to working in a care environment.

Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role, such as food hygiene, dementia, infection control, fire safety, first aid, safeguarding, equality and diversity and medicines handling.

Staff had access to regular supervision and appraisal as part of their on-going development.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the au

The registered manager was not present on the day of our visit. We therefore spoke with four other members of staff, two visiting health professionals, three people living at the home and one of their relatives. We also reviewed the care plans of four people using the service.

The two health professionals we spoke with who were visiting the home commented that the provider had good links with the general practitioner (GP) and community psychiatric nurse (CPN). A relative of a person living at the home told us that the privacy and dignity of their family member was respected by the care staff and that they were "very pleased" because the staff "really looked after Mum".

We found that people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were protected from the risk of infection because appropriate guidance had been followed.

People using the service spoke positively about the care provided at the home. They told us that members of staff were helpful and always gave them attention. Peoples’ needs were assessed and care and treatment was planned and delivered in line with their individual care. They told us care was delivered in a professional manner which respected their rights and dignity. One person told us they liked to spend time in the garden in the summer and members of staff always ensured they took him out. People told us they liked the food provided. One person told us they always got a choice in what they ate.

People who used the service told us that they were happy in the home and that they felt well supported. They told us that staff were kind and caring and that when they needed support there was a member of staff available to help them.

People said that they received the help they needed and also that they were supported to manage things for themselves where possible. They said that where they needed assistance in getting around the home, then staff would always help them with this.

People told us that they liked the meals, but were not always sure about any choices available if they didn't like what was on the menu.

People were generally happy with the environment, although it was felt that some of the communal areas did not have a lot of room.

People said that they enjoyed the activities and some people told us that they especially enjoyed the trips out.

The people we spoke with did not have any complaints and told us that they would be happy to speak to the manager or staff if they were unhappy.