The inspection took place over two days on 29 and 30 November 2016. The inspection was unannounced. The last inspection took place in September 2014 and no breaches of legal requirements were found at this time.

The home provides nursing care and accommodation. At the time of our inspection there were 36 people living in the home.

There was a new manager in place who had begun the registration process. 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 were supported by staff who were kind and caring in their approach. We made observations throughout our inspection of people being treated with respect and kindness. People and their relatives were positive about the care provided in the home and told us they were involved in planning and reviewing their care. Comments included “Staff are very very good”, “I have trouble with my mobility but staff are only too pleased to help”, “I like it here”, “staff are lovely” and “I think it’s a happy place”.

Care and support was tailored to people’s individual needs. For one person we saw how the manager had sourced equipment to help them with a particular health need. Care plans required some attention in places to ensure they were accurate and up to date; however they described people’s needs and provided guidance for staff in meeting their particular needs.

Care and support was effective. People’s health needs were met and they were able to see healthcare professionals when they needed to. People who were at risk of pressure damage to the skin had specialist mattresses in place and we saw that these were at the correct setting. Where people had particular clinical needs, such as the use of a catheter, there were clear plans in place for how this should be managed.

People’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguard (DoLS). Applications had been made for a number of people in the home. For those people who lacked capacity to make their own decisions about their care and support, best interests decisions had been taken on their behalf. We did highlight with the manager that in some cases, although people’s rights had been protected, the principles of the MCA had not been followed in full.

People in the home were safe because staff had received training in how to safeguard people from abuse. There were also risk assessments in place to guide staff in providing safe care and support. There were sufficient numbers of staff to ensure people were safe and their needs were met.

People were able to take part in a programme of activities if they wished to. This included activities such as knitting, holistic therapies and helping with aspects of the running of the home. For example, we saw one person being encouraged to take part in food preparation.

The home was well-led. There was a programme of quality monitoring and audits in place and this included gathering feedback from people who used the service. There was a culture of openness and transparency in the home and there were plans in place to improve the service further.

An adult social care inspector and pharmacy inspector carried out this inspection with the help of an expert by experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with 10 people who use the service, six relatives, the registered manager, a representative of the provider and six staff. We observed how people were supported and cared for. We reviewed records relating to several people's care as well as records relating to the management of medicines. We also reviewed records relating to complaints, staff training, staff duty rosters and cleaning systems. We also reviewed several documents and records relating to the service's quality monitoring system.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff received updated information about people's condition and needs. People's risks had been assessed and arrangements were in place to reduce these. For example, specialised equipment had been introduced to reduce the risks of pressure ulcer development. People at risk of poor nutrition or falling were monitored and appropriate action taken to reduce associated risks.

There were enough staff to meet people's care and health needs. Although the service had gone through a period where there had been a shortage of its own nurses, agency nurses had been used but predominantly the service's own nurses had worked additional hours. This meant care staff had continued to receive direction on people's care/treatment from nurses who knew people's health care needs well.

There were systems in place to prevent the spread of infection and people lived in a clean environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One DoLS application had been submitted and responded to by the relevant authority in order to deprive one person of their liberty lawfully. Relevant staff had been trained to understand when a DoLS application should be made and how to submit one.

Is the service effective?

The service was effective because people received care that met their individual needs, choices and preferences. Care plans gave detailed information about how people's care should be provided. Staff also received good verbal guidance and information about people's condition and needs. People said, “I’m very happy” and “I think we’re looked after very well”. One relative said, “They’ve got it pretty well sorted out” and another told us the care was "adequate".

Staff delivered people’s care with either their consent or after a decision had been made in the person's best interests. Staff were aware of their responsibilities and had the right skills and knowledge to meet people's needs.

People who were at risk of not getting enough food and drink were supported to do so in a way that suited their specific needs. Everyone had access to professionals that provided basic primary health care advice/treatment such as their GP, community nurses and a chiropodist. People with more complex needs had access to health care specialists who advised and supported the staff in how to meet these needs. This included professionals such as a speech and language therapist where there were swallowing problems, a dietician where people had more complex nutritional needs, and mental health specialists.

Is the service caring?

The service was caring because it recognised people had the right to be involved in decisions made about their health and care. One person who uses the service said, "Yes, yes, yes” when we asked if they had been involved in making decisions about their care. When talking to one relative about how decisions had been made about their relative's care they said, “Yes, I was there, and the social worker” and another said, “Yes, I was involved. I’d been looking after (name) for 10 years”.

Opportunities were also provided for people to be actively involved in making suggestions and decisions about the service. For example being able to choose the colour scheme for the dining room, requesting more pictures and pot plants. This meant staff recognised the service as being the home of the people who use it.

We observed people being treated with respect and dignity. We observed staff making sure people were decently covered when transferring them in a hoist. Staff were kind and patient with people who required additional time and attention such as those who were confused and had dementia. Reassurance and encouragement was given to people in a way that did not belittle them.

Where people had needed support from staff to wash and dress they had been given choices on what they wore and time had been taken to help them looked groomed and feel comfortable. Caring was also shown in little ways such as making sure people's spectacles were cleaned and polished. A relative said, “I do not want to be a nuisance but I come in every day” and they said they "felt welcomed”. Relatives told us they were always offered a cup of tea when the trolley came round.

Is the service responsive?

The service was responsive because it responded to people’s care needs and to when these needs altered. There were examples of people being provided with more care and monitoring when it was needed as well as staff recognising when people were more able and wanted more independence.

Staff sought additional support or intervention from appropriate people when needed. Referrals were made to health care professionals and other services when advice or support was required and their advice was followed.

When people raised a concern/complaint the service responded according to the provider's (the company's) complaints policy and the issues raised were investigated. This was done in a way that aimed to reassure the complainant, improve people’s experiences of the service and learn from the situation.

Is the service well led?

The service was well led because there was a permanent registered manager in post who was approachable and involved in what went on in the service. This manager had provided the service with leadership and had made improvements to the service since starting in January 2014. This improvement had been enabled and continued to develop because good support had also been provided by representatives of the provider. The provider had robust arrangements in place to both support and monitor the registered manager's performance.

People who use the service and their representatives were able to meet with the registered manager. The registered manager was open to receiving feedback on the services provided and suggestions on how the service could be improved.

Leaders within the service were clear about their areas of responsibility. Different departments such as the care team, kitchen, domestics and maintenance team worked together to provide a service that met people's needs. The performance of these departments and of individual staff was monitored to ensure people's safety and welfare was maintained. Staff were provided with training and support to improve their knowledge and practice. The culture of the service was one of being committed to looking after the people who use it and to improve their quality of life.

There were arrangements in place which resulted in accidents and incidents being reported. Accidents such as falls were analysed to look for trends/patterns which helped staff take appropriate action to prevent a reoccurrence.

We found improvements to how medicines were being obtained for people. New and improved arrangements between the service, GP surgeries and a pharmacy had started at the time of the inspection. As the next month's medicine order was not due to be delivered until the week after the inspection, we were unable to report on this further. We did however witness the new process of prescriptions being checked within the service before being sent to the pharmacy. This new arrangement gave the service more control over following up missing prescriptions before they finalised their monthly order.

We found improvements in the records relating to people's medicines although medicine administration records (MARs) for creams and ointments did not always show this improvement. We have informed the provider of this. One person who used the service told us that their creams and ointments were applied when they should be. The MAR however had several signature gaps implying that the creams and ointments had not been applied. Other people were unable to tell us about their experiences due to their complex needs. We therefore inspected additional care records and spoke to staff in order to ascertain if people were receiving their treatment. We found, on some dates, where the relevant MAR had not been signed, a record had been made elsewhere of people's treatment having been given. Action to improve record keeping in this area had been taken by the interim manager and continues to be taken.

We found that there had been improvements in all the standards we checked since our previous inspection. Despite this further action was needed to manage risks relating to the recording and administration of medicines. Otherwise the care provided was safe. Staff were caring and told us that “the quality of care has improved”. However, further improvements were required in some areas to make sure that care was always effective and responsive to everyone’s needs.

Staff were working in a way which upheld people’s rights and had increased understanding of how to protect the rights of people with limited or fluctuating capacity.

Risk assessments and care plans were reviewed and updated regularly. When a person’s needs changed a new care plan was put in place and staff were alerted to this at handover. Feedback from visiting health professionals was positive. The people who use the service gave mixed feedback relating to staffing levels at Rodley House. We saw that the service was meeting people’s needs for the majority of the time but when staff sickness could not be covered some people had to wait too long to receive support.

Appropriate quality checks had been carried out and action plans were being completed to address identified shortfalls. Minor complaints had not always been logged by staff if they could resolve them immediately. This meant that common themes or problems areas could not be identified. Complaints that had been logged had been managed effectively.