This unannounced comprehensive inspection took place on 24 and 29 January 2018. The last comprehensive inspection took place on 24 November 2015. The service was meeting the requirements of the regulations at that time.

St Teresa's - Care Home with Nursing Physical Disabilities 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 Teresa's - Care Home with Nursing Physical Disabilities provides single room accommodation for up to 27 people with nursing physical disabilities. At the time of the inspection there were 26 people using the service including two people who were staying at St Teresa’s on periods of respite. The service is based in a purpose built single storey detached property which was suitably adapted for the purpose of providing nursing care and support to people. St Teresa’s is close to the local amenities in Marazion and Penzance.

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.

Some people who lived at St Teresa’s had limited communication skills meaning we were unable to gain some people’s verbal views on the service. We observed staff interactions and spoke with seven people who lived there. We observed that people were relaxed, engaged in their own choice of activities and appeared to be happy and well supported by the service. We also spoke with people’s relatives and staff to understand their experiences.

The atmosphere at the service was welcoming, calm and friendly. The service was divided into three units but people moved freely between each one. Each unit area provided large lounges and dining areas suitable for people to use with mobility aids. 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.

Some people had complex needs and were not able to tell us about their experiences. Comments from those people we spoke with about the quality of their care and support were positive. People told us, “They [the staff] have given me a life back, I can do things I thought I would never do” and “This is our home, not just a care home.”.

We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect. People told us, “Staff are lovely, they will do anything for you.”. Staff demonstrated a good depth of knowledge about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals.

St Teresa’s used a staffing assessment tool to work out the required numbers required to staff the service. Staffing levels were perceived to be low by both service users and staff. People commented, “They could do with more staff. I know other people need help too but sometimes I have to wait for a really long time before it’s my turn to get up” and “It’s an excellent place, they do an excellent job but the staff are really stretched.” Staff commented, “Our units are pretty well staffed. Recently we have had a large amount of sickness which is unusual. It is rare for us to have agency but we have had to use agency recently”. We spoke with the registered manager about this and were shown the staffing assessment that demonstrated that the core staffing hours was currently being met. The registered manage

This inspection took place on 24 November 2015 and was unannounced. St Teresa’s Care Home provides care and nursing for up to 27 people with nursing physical disabilities. The service is a single storey detached property which has had a number of extensions. The service was suitably adapted for the purpose of providing nursing care and support to people. St Teresas is close to the town amenities of Penzance and the local town of Marazion. At the time of the inspection visit twenty seven people were using the service.

The service received a comprehensive inspection in March 2014 at which time it was found to be meeting the requirements of regulations.

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.

People who used the service were looked after by staff who understood they had a duty to protect people from harm and abuse. Staff had been suitably trained to recognise potential signs of abuse and knew how to report abuse. Staff said they would raise issues with the registered manager or local authority.

The atmosphere at the service was welcoming, calm and friendly. The service was divided into three units but people moved freely between each one. Each unit area provided large lounges and dining areas suitable for people to use with mobility aids. 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.

Some people had complex needs and were not able to tell us about their experiences. However comments from those people we spoke with told us they felt safe because there were sufficient staff on duty to meet their needs. Comments included, “The staff are always around I don’t have to wait long before they [staff] answer my call” and “You never have to wait long. I don’t need as much help as some people but you never see the staff having to rush around”. People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure peoples safety. Care records included details of people’s choices, personal preferences and dislikes.

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

The medicines system was well organised, and people received their medicines on time and there were safe systems for storage. People had access to a general practitioner (GP), and other medical professionals including a dentist, chiropodist and an optician. Where referrals for further investigation were made by a GP, staff had made sure records were regularly updated so there was a clear audit trail for any prescribed treatment.

People’s nutrition and hydration needs were being met. 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 ensure they stayed healthy.

Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs. The service had signed up and achieved the Gold Standard Framework. This aims to provide optimal care for people approaching the end of life.

We found the building met the needs of people who lived there. For example, corridors were wide and spacious for people who used a wheelchair. There was overhead tracking from everyone’s en-suite facility to their bed which

The home accommodated people who had a range of disabilities such as neurological conditions (for example Multiple Sclerosis and Motor Neurone Disease), people having injuries due to road traffic accidents, brain injury or severe learning disabilities. All of the people accommodated had a physical disability. People’s ages ranged from their mid 20’s to their 80’s. The majority of people considered St Teresa’s their permanent home, although respite (short stay) accommodation and support was provided to some people.

This inspection was completed as at our previous inspection in July 2013, we had concerns about staffing levels at the Trelowan unit. Subsequently we issued a compliance action requiring the registered persons to improve staffing levels. At this inspection we judged the improvements made as satisfactory but have suggested they still need to be kept under close review.

Prior to this inspection we also received concerns from a member of the public regarding standards of cleanliness, storage arrangements for medication, that people who lived at the home did not get their incontinence pads changed as frequently as they should, and staff were not trained appropriately.

As a consequence of the concerns which were raised to us, we inspected the relevant outcome areas as part of this inspection. This inspection concluded there were no concerns about standards in these areas.

We were able to speak with several of the staff on duty, and people who lived in the home. The people we spoke with were all positive about their experiences.

In summary people who lived in the home were cared for to a high standard. Systems regarding the storage, administration and recording of medication were appropriate. The home was clean and staff received appropriate training about infection control standards. Staff were trained appropriately, appeared knowledgeable about their roles, and appeared caring in their attitudes. There were appropriate levels of staff available to people.

At the time of the inspection the home accommodated people who had a range of disabilities such as neurological conditions (for example Multiple Sclerosis and Motor Neurone Disease), people having injuries due to road traffic accidents, brain injury or severe learning disabilities. All of the people accommodated had a physical disability. People’s ages ranged from their mid 20’s to their 80’s. The majority of people considered St Teresa’s their permanent home, although respite (short stay) accommodation and support was provided to some people.

On the day of the inspection, we spoke with 12 of the 25 people who lived at St Teresa’s. People were positive about the care and support they received. Comments regarding the care included “it’s great,” “everything is tickety boo” and the home was “my home,” “a very nice place,” “is appropriately adapted for our needs and is always kept clean.” People said the food was to a good standard, there was a relaxed atmosphere, there were no fixed routines and choice was encouraged regarding what people wanted to do and eat.

When we inspected the home was clean and odour free. The home was well maintained, well furnished and decorated to a good standard.

We had some concerns raised regarding staffing levels, although staff were observed working professionally and doing their best to meet the needs of the people that lived in the home. Quality assurance systems were satisfactory.

At the time of the inspection the home accommodated people who had a range of disabilities such as neurological conditions (for example Multiple Sclerosis and Motor Neurone Disease), people having injuries due to road traffic accidents, brain injury or severe learning disabilities. All of the people accommodated had a physical disability. People’s ages ranged from their mid-20’s to their 80’s. The majority of people considered St Teresa’s their permanent home, although respite (short stay) accommodation and support was provided to some people.

This inspection focused on the Trelowan unit. This was because at the previous inspection, when we inspected all the units, we had particular concerns about staffing levels at the Trelowan unit.

The inspection was carried out over two days. We spoke with five of the people who lived at Trelowan. People were positive about the care they received, the food provided and staff attitudes.

When we inspected the home it was clean and odour free. The home was well maintained, well-furnished and decorated to a good standard. Leonard Cheshire planned to redevelop the Trelowan unit in the next year which will provide a more purpose built facility for people with physical disabilities.

We had concerns about staffing levels at the home and improvement was required in this area. Staff recruitment processes and training were to a good standard.