The inspection visit took place on 16 and 20 March 2017 and was unannounced.

Rathmore Care Home is a small residential home situated close to local amenities in the town of St Annes. The home is registered to provide accommodation for up to eight people who require help with personal care.

At the last inspection in December 2014 the service was rated ‘Good’. However, a rating of ‘requires improvement’ had been identified in the ‘well-led’ domain. This was in relation to a lack of recording of checks that were undertaken to monitor and improve the quality of the service. This had now been addressed by the registered manager. At this inspection we found the service remained good.

The registered manager had implemented recording of checks to monitor and improve the quality of the service provided. They used a variety of methods to assess and monitor the quality of care at Rathmore Care Home. These included regular audits of the service, satisfaction surveys and day to day conversations, to seek the views of people about the quality of care at the home.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. Safe systems were in place to manage people’s medicines.

Safe systems of recruitment of staff were in place. Checks were carried out to ensure suitable people were employed to work at the home. Staff confirmed they only commenced employment when all checks had been completed.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Sufficient staff were on duty to support people.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate, their relatives were involved in decisions and consented to their care.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments from people who lived at the home were all positive about the quality of meals provided.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home told us they were encouraged to participate in a range of activities that had been organised and were happy with the level of activities provided.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

This inspection took place on 05 December 2014 and was unannounced, which meant the provider and staff did not know we would be visiting to inspect the service.

Rathmore Care Home is a small residential home situated close to local amenities in the town of St Annes. The home is registered to provide accommodation for up to 8 people who require help with personal care.

The home is operated and run by an experienced 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.

People experienced a good level of care in a safe environment. Staff had been suitably trained to recognise and report abuse and bad practice, in order to try to ensure people did not come to harm. The provider had implemented safe systems for the management of medicines. Only suitable staff were recruited to work at the home, following a series of recruitment checks including a check with the Disclosure and Barring Service.

People’s needs were met by a team staff who were sufficiently skilled and knowledgeable to carry out their role. People’s healthcare needs were monitored and appropriate action was taken, where required, to seek professional guidance or to make referrals to healthcare professionals. People were supported to eat and drink enough to meet their nutrition and hydration needs. The registered manager had a good understanding of the Deprivation of Liberty Safeguards (DoLS) and how this applied to the service. No applications had been made for any of the people who used the service and we found no restrictive practices during our inspection that may constitute a deprivation of liberty.

People were cared for by a kind and considerate staff team who put them at the centre of their care. Staff took time to get to know people well, so that their likes and dislikes could shape the care they received. Staff treated people with dignity and respect.

People were able to choose, amongst other things, how they spent their time and what staff did and did not do to support them. People were able to personalise their rooms and were able to bring furniture and other personal items into the home with them.

People and their relatives confirmed that they were often asked for their views on the care that was provided. They also confirmed they had confidence I the manager and the staff team and were able to make comments and suggestions. Nobody we spoke with on the day of the inspection had any concerns about the service delivered to them.

Records were not kept of any formal audits that were carried out to monitor the quality of the service provided. We have made a recommendation regarding the recording of audits.

We spoke with a range of people about the home. They included the registered provider /manager, staff members on duty and people who lived at the home. We also had responses from external agencies including social services in order to gain a balanced overview of what people experienced living at The Rathmore Residential Home.

During our inspection we used a number of observational tools to gain evidence about what it was like to live at the home. We did this by looking at care planning, staff recruitment and training records. We also looked at how the home managed the quality of the service and listened to people. In addition we spent time in communal areas in order to speak with a range of people as well as making general observations of the routines in the home. One person told us they liked the way they could personalise their room. As part of the inspection we also looked at the general environment in which people lived to give us an overview of the services available to them. A staff member told us, “It’s a nice place to work, very homely”.

People were seen to be cared for in ways that suited them. We saw that people were given opportunities to inform staff of their personal support requirements. Staff were involved in assessing people's needs, and there were systems in place to monitor how those needs were met. One person told us, “Couldn’t think of living anywhere else. We have everything we need living here. It’s like home from home”.

At the time of our visit six people were living at the home. We spoke individually with two people using the service, a relative and members of staff on duty. We also spoke briefly with a number of other people collectively in the lounge area.

People we spoke with including the visitor, told us that staff were always respectful and treated people with dignity and care. People told us that there was a relaxed and homely environment and that they never felt rushed. One person said, “The staff are brilliant, very good and always obliging. I always feel safe here and well looked after. I enjoy my meals. It is very comfortable, my bedroom is lovely and to my liking with my own things”.

Another person told us, “All of them are super, any problem I have they try and sort out for you. The staff are all very kind and helpful and everything is free and easy, if you want some help it is always immediate”.

The relative we spoke with told us that, “***** is as happy as Larry they look after her very well and they look after me as well. They are fantastic, all of them”.

A member of staff described staff as, “Always upbeat and cheerful. If somebody is feeling low there are positive vibes from staff that puts the resident at ease. We also know the families very well. The care is great and personal to the individual. There is never a rushed pace everything is nice and relaxed, there is always time for brew, sit down and a chat with the people living here”.

During the course of the visit we spoke individually with the home owner/registered manager, four people living at the home, a relative who was visiting and three members of staff including the husband of the home owner/registered manager.

As The Rathmore is a small care home it was easy to observe and hear the interaction between residents and staff. One person living at the home told us, “Everything is good, we are well looked after, staff are very kind”. Another person said, “They are extremely kind people, they are lovely, they work hard, nothing is too much trouble for them”. A third person commented, “Everything is very, very good”. A member of staff said, “We provide good support in a family environment, relatives come in and feel welcomed”. This was confirmed by a relative who also told us, “Everything is so very comfortable here”.

People living at the home were without exception, very positive about the care and support provided by the staff team. One person told us, “The home looks after everybody and all are very kind, just kind and caring people all of them”. Another person said, “We are very well looked after”. Another person commented, “Very nice here, really nice”.

When asked, one person we spoke with said she felt safe and comfortable living at the home. The registered manager confirmed that everybody working at the home had received adult abuse training that was regularly updated.

Staff spoke positively about the support and training provided.

People living at the home told us that they were asked about their thoughts and views regarding the service provided to them informally as part of the day to day activity of the home. We were also told they like the discussion with the staff team and people felt very confident that any views expressed would be listened to and taken into account.