At this inspection we found the service remained Good.

Rashwood provides personal and nursing care for up to 53 older people. There were 49 people who were living at the home on the day of our visit.

People continued to receive safe care as people lived in a safe environment as staff knew how to protect people from harm. Staff made sure risk assessments were in place and took actions to minimise risks. People told us that staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels reflected the needs of people who lived at the home. People’s medicines were administered and managed in a safe way.

The service had improved from requires improvement in effective to a good rating. This was because the service had not always ensured people were restricted lawfully. While we found there had been improvements at the last inspection, we needed to ensure this practice was embedded before the rating could be reviewed. At this inspection we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The registered manager supported staff by arranging training so staff developed the skills to provide care and support to people which was in-line with best practice. People and relatives told us of the positive benefits this had on the care and support received. People were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals when they required them.

The service remained caring towards people. People were treated well which had a positive impact on their mental and physical well-being. People told us that staff treated them kindly, with dignity and their privacy was respected. Staff helped people to make choices about their care and their views and decisions they had made about their care were listened and acted upon. People were involved in the planning around their care.

The service remained responsive to people’s needs. People were involved in the planning and review of their care and support and family members continued to play an important role. People were supported to continue with their hobbies and interests. Where people had any concerns they were able to make a complaint and this was responded to.

The service remained well-led. The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The checks the registered manager and provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure lessons were learnt and used to improve staff practice.

Further information is in the detailed findings below

We completed an unannounced comprehensive inspection of this service on 18 and 19 November 2014. We found there was a breach in the legal requirements and regulation associated with the Health and Social Care Act 2008. The provider did not make sure where people had restrictions in place to meet their needs these had been lawfully applied for so that people were not unnecessarily deprived of their liberty. We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulation and when their actions would be completed by.

We undertook this focused inspection to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Rashwood on our website at www.cqc.org.uk.

The provider is registered to provide accommodation and personal and nursing care for up to 53 people at Rashwood. The home environment is divided into three areas, two for people with nursing care needs and one for people with residential care needs.

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 were supported by staff who knew the importance of using people’s own communication preferences so that they could make their own choices and decisions. We saw staff waited for people to consent to their care and make their own choices which included what they wanted to do, where they wanted to be and the food they wanted. People told us they received care and support in the least restrictive way which promoted their own lifestyles and daily routines.

We saw for people who were unable to make a specific decision about an aspect of their care and treatment this had been made in their best interests by people who had the authority to do this. Where people had potential restrictions in place and did not have the mental capacity to agree to these the registered manager had now made Deprivation of Liberty applications to the supervisory body for authorisation. By doing this, the registered manager had followed the correct process to take on the legal responsibility to make sure people were not unlawfully restricted of their freedom or liberty unnecessarily.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made continue to be implemented and embedded into practice.

We inspected Rashwood and spoke with seven people who lived at the home and with two relatives. We observed the care and support people received. We looked at their care files and other supporting documents. We had discussions with the registered manager and eight staff about how people were being supported.

We saw that people had given their consent to staff meeting their day to day care needs and where able had signed their care plans. One person who lived at the home told us: “The care plan is in my room, but I also talk to the staff to tell them what I need”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People who lived at the home told us: “I’m not just OK here, I’m happy” and: “It’s a very lovely place to be if you are not well”.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

The home had a complaints policy in place and demonstrated that they listened to and responded to people’s comments about the home.

During our inspection we spoke with four people who used the service. We observed how staff interacted with people to support them in making decisions about their care needs. We saw that staff respected the decisions that people made. We spoke with a person who said, "I am very happy indeed here."

The five care files that we reviewed indicated that arrangements had been made to support people in receiving their health and care needs. We saw recordings that confirmed that staff had actively promoted people's health and well-being. From discussions held with five staff we found that people were well supported in leading a lifestyle that suited their individual preferences. A visiting professional we spoke with provided positive feedback about people's care.

People were encouraged and supported to do things for themselves and were given choices. One person commented about the activities, "I get involved with them all. I love scrabble and movement to music."

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

We found that there were enough staff allocated to work for each shift so that people's health and care needs were met. Staff had received training to carry out their roles effectively.

People told us they knew how to make a complaint but that they had not needed to. We found that there was an appropriate system in place to monitor the quality of service provided.

We carried out this review to check on the care and welfare of people using this service.

When we visited Rashwood we spoke with people who lived there, relatives, staff on duty, the registered manager and clinical care manager. People who used the service told us that their privacy and dignity was respected at all times. They told us they were addressed by staff in the way they wanted, for example by their first name and this was used at all times. One person told us that the care they received was “very good” and when they called for assistance the “staff arrive in moments”. They said the staff “treat her like an old auntie” and were “very kind”. Another person that we spoke with told us they were very happy with the level of care provided and the living environment at Rashwood. They said that “on the whole, I feel very comfortable and looked after”. We were told that Rashwood was a community and people were sympathetic when others felt unwell, they supported each other and celebrated each other’s birthdays. We were told that Rashwood was “a real home”.

People were very complimentary about the food. One person said “I love my breakfast; it’s a very good breakfast”. People told us they had a choice of six main courses each day. One person said that one day they did not like any of the choices, so the chef made her something else that they liked. One person who required a special diet told us how they were consulted every time a new menu was produced to discuss how that menu would impact on them and what changes could be made to make the meal more appropriate for their nutritional needs.

We spoke with two relatives of people who used the service and they both said they “can’t fault the care here”. One person said that they “could not find anywhere better” for their relative to stay.

We pathway tracked the care of people and looked at how their care was provided and managed. We saw that staff looked after people well. Discussion with staff demonstrated they were aware of people’s care and support needs. We found that people were receiving effective and appropriate care, treatment and support to meet their personal needs.

We spoke with people who used the service about their care records. Two people told us that they felt they were informed and involved in decisions about their care. We saw that staff had printed off care plans for people to review and sign as the care planning was computerised at Rashwood.

We found that the care records we looked at during this visit were personalised and informative, but they had not always been updated when reviewed to make sure that they contained the most up to date information about peoples care needs.

We found that improvements were needed in auditing of the quality of the service, to make sure that the information could be used to improve the quality of care and treatment to make it more effective for people using the service.

This unannounced inspection was carried out over two days on 18 and 19 November 2014.

Rashwood is a care home that provides accommodation and nursing or personal care for up to 53 people. The home is divided into three areas, two for people with nursing care needs and one for people with residential care needs. At the time of our inspection 51 people lived at the home.

There was a registered manager in post at the time of our inspection. 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 Care Quality Commission are required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). The provider had not followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). It was identified that some people would not be able to leave the home without close supervision but applications had not been made to the local authority for this to be assessed. This meant that some people were potentially unlawfully having their movements restricted.

All the people we spoke with told us they were happy at the home and felt safe. They said staff were kind and helped them to maintain their interests. People’s relatives told us that the staff were kind, considerate and caring. We saw people chatted happily with staff about their day and how they felt. People told us that there was always enough staff on duty to care for them and help them safely take their medicines. Our observations during the inspection supported this.

We saw there were systems and processes in place to help protect people from the risk of harm. The staff were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about someone’s safety or welfare. They told us they would be confident reporting any concerns to a senior person in the home.

Staff knew about people’s care needs. They were provided with the skills and knowledge to care for people safely. Nurses told us they received training specific to their role so they had the skills needed to carry out their clinical duties effectively.

People were supported by staff to keep healthy and well which included helping people to maintain a healthy diet. Where staff had concerns about a person’s nutrition, they involved appropriate professionals to provide guidance.

The registered manager was open to managing people’s comments and complaints and people were confident these would be responded to.

The management team were approachable and asked the views of people who lived at the home and relatives in order to improve.

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