This inspection was carried out on 19 and 30 April 2018. The first day of the inspection was unannounced.

Christopher Grange Rhona House 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.

Rhona House is part of a larger complex that also provides a separately registered care home without nursing. The site has a reception area, chapel, main kitchen and laundry which are shared by both care homes. Some staff including activities, laundry and maintenance staff work across both homes and people can attend activities held anywhere on the site.

All accommodation at Rhona House is provided in single bedrooms and is at ground floor level. An enclosed garden and shared lounge and dining room are also available within Rhona House.

Rhona House accommodates up to 28 people. At the time of the inspection 26 people were living there.

At our last inspection of the home in October 2016 published in January 2017 the service was rated requires Improvement overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 9 and17.

This was because people's care was not always designed in such a way as to meet their needs and reflect their preferences and the provider's systems and processes to assess, monitor and improve the quality of the services, required further development to ensure they were consistently effective.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of these regulations.

The home has a registered manager. 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.

Comments we received from relatives and people living at Rhona House included, “They get very good care here. I wish they were all like this,” and “The care is very good.”

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. Staff had received training and knew what action to take if they felt people were at risk of abuse. A system was also in place for raising and addressing concerns or complaints and people living at the home and their relatives told us they would feel confident to raise a concern.

Equipment and the building were monitored regularly to ensure they were safe. The building had adaptations and equipment to support people with their mobility and personal care. This included hoists, stand aids and call bells.

People’s medication was safely managed and they received it on time and as prescribed. Staff provided people with the support they needed to manage their personal and health care needs.

Assessments of people’s care needs had been carried out and where they required support this was detailed in their care plans which provided guidance for staff on how to meet people’s needs safely and well. These had been regularly reviewed to check they were up to date and accurate.

There was enough staff working at the home to meet people’s care needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

People liked the staff team and told us they were kind and caring. Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us they felt supported and we saw that they had regular staff meetings and supervisions with senior staff. They told us that the registered manag

The inspection took place on 13 October 2016 and was unannounced. We last inspected the home on 18 December 2013 and found the provider was meeting the regulations we inspected at that time.

The home is registered to provide nursing and personal care to up to 28 older people, some of whom are living with dementia. At the time of our inspection 25 people were living at the home.

The home had a registered manager. 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 provider had breached the regulations relating to good governance and person centred care. Care plan audits had lapsed and some training had not been completed. Staff one to one supervisions were also overdue. Care plans were not personalised or detailed enough to describe the care people needed. Some people did not always have a positive lunch time experience.

You can see what action we have asked the provider to take at the back of the full version of this report.

People and family members told us they felt the home was a safe place to receive care. Care workers told us they felt the care they provided was safe.

Care workers had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to raise concerns. Care workers did not have any concerns about people’s safety.

People confirmed there were sufficient staff on duty. They said if they needed assistance this was provided quickly.

Medicines were managed appropriately. People only received their medicines from trained and competent nurses. Medicines records were accurate and medicines were stored securely in a locked treatment room.

Recruitment checks including requesting references and Disclosure and Barring Service (DBS) checks had been completed to ensure new care workers were suitable to work at the home.

Incidents and accidents were logged and investigated. Where required action had been taken to help prevent the incident from happening again.

Regular health and safety checks were carried out, such as checks of the fire safety systems, water temperature, gas and electrical safety. Risk assessments were in place to help minimise potential risks to people’s safety.

Procedures and guidance to help care workers deal with emergency situations were available.

Staff confirmed they felt well supported by the registered manager and their colleagues.

The provider was following the Mental Capacity Act (MCA) 2005 and had submitted Deprivation of Liberty Safeguards (DoLS) applications to the local authority. Care workers had a good understanding of how to support people with decision making.

People were accessing external health care services when required, such as GPs, community nurses and other specialist services.

People had been involved in assessing their needs. Care records contained some information about people’s preferences including any allergies, likes and dislikes they had.

People knew how to complain but told us they did not have any concerns about their care. Previous complaints had been logged, investigated and resolved.

People said there was a good atmosphere in the home. They also told us the registered manager was approachable if they needed to speak with them.

During our inspection, we observed the provider had procedures in place to both gain and review consent from people who use services and act upon them. Where the person lacked capacity, the provider acted within legal requirements. All care plans were present at Christopher Grange Nursing Home which included thorough risk assessments which were all reviewed on a monthly basis. We observed good interaction between staff and people using services at all times of the day. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Medicines were safely administered and were disposed of appropriately.

There were effective recruitment and selection processes in place which meant people were cared for, or supported by, suitably qualified, skilled and experienced staff. There was a complaints system in place at Christopher Grange which aimed to listen to and respond effectively, within a stated time-scale, to any complaints that had been received. In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with a range of people about the service, we did this to gain a balanced overview of what people experienced. The people we spoke to included the registered manager, staff members a person who lived at the service, family members/visitors and a visiting health professional.

This service cares for people with a range of conditions and conversation with most residents was limited due to their complex needs. We therefore spent much of the time in the communal areas making observations of how people were being cared for. We observed staff assisting people who required care and support with personal care. From our observations we saw that staff treated people with respect and ensured their privacy when supporting them. We saw the staff provided support and attention as people requested it.

Everyone we spoke to gave us good feedback about the service and said they felt the standards of care were good. People told us they had never had reason to make a complaint and that they felt the atmosphere at the service was welcoming and that staff communicated well with them.

We spoke with five people who lived at the home and asked them if they felt that the staff respected their privacy and dignity. All confirmed that the staff were courteous and respectful at all times. Each said that they were supported to live their lives the way that they wanted.

People were asked about the care they were given. They said that they were pleased with it and their comments include:

‘The care is good. The staff know what they are doing’. ‘Everything is done the way I like it’. One visitor said ‘Everyone is so kind and caring. My relative is getting the best care that you could ask for’. Another visitor said ‘My relative has improved so much since coming here’.

People said that the home was exceptionally clean. Comments include: ‘The housekeeping staff work really hard and clean my room every day. Everywhere is clean and fresh’. ‘The place is spotless. The staff are always cleaning’.

People spoke highly of the staff and described them as kind, caring and available at all times. One person said ‘There have been a lot of changes in the staff. I don’t like that but all the new ones are lovely’.