We inspected Raynesway View on 20 June 2017. This was an unannounced inspection. The service is registered to provide accommodation and care for up to 35 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 18 people living at the service, including one person who was in hospital.

At our last inspection on 15 June 2016 the service was found to require improvement in areas relating to staffing levels, the management of certain medicines and there were inconsistencies in assessing people's ability to make their own decisions. .At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day of the 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.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The service was clean, well maintained and readily accessible throughout. There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

The inspection visit took place on 15 June 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Raynesway View provides residential care for up to 35 people. At the time of our inspection there were 26 people using the service. The home specialised in caring and supporting people living with dementia.

At our last inspection on 10 April 2014. We found that there were not always enough staff available to safely support people with their care. This was a breach of regulation 22 of the health and social care act (2008) (Regulated Activities) Regulations 2010. This corresponds with regulation 18(1) of the health and social care act (2008) (Regulated Activities) Regulations 2014. At this inspection we found further improvements were still required.

During this inspection we that staffing levels and deployment of staff were not always sufficient to provide support to people when required.

People received their medicine when they needed. However we found that written instructions for ‘as and when required’ medicines were not always in place.

The provider had checks in place to ensure that staff they recruited were safe to support people using the service.

People were asked before support was provided and their wishes were respected. We saw people were given choice about day to day decisions. However, there were inconsistencies in assessing people's ability to make their own decisions. Where decisions had been made on people's behalf the records did not always show that these were made in the person’s best interest.

People were supported to maintain a healthy diet and staff ensured people’s nutritional needs were met.

People were supported by staff that had received appropriate training in supporting people with their care.

People and their relatives told us they were looked after and that staff were kind and caring.

People’s care records were not always specific or individualised which described to staff how people wanted to receive their support.

The service had a registered manager in place 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. However the registered manager was on leave when we carried out the inspection visit.

We found that audits to monitor, assess and improve the service were not always completed. Where issues had been identified these had not been acted on.

People felt the home was well run and said that the registered manager was approachable and helpful.

People told us that they felt comfortable to raise complaints and we saw that there was an effective complaints process in place. We saw where issues had been raised; these were effectively investigated and responded to.

People and their relatives told us they were looked after and that staff were kind and caring.

People’s care records were not always specific or individualised which described to staff how people wanted to receive their support.

The service had a registered manager in place 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. However the registered manager was on leave when we carried out the inspection visit.

We found that audits to monitor, assess and improve the service were not always completed. Where issues had been identified these had not been acted on.

People felt the home was well run and said that the registered manager was approachable and he

The inspection was carried out by an inspector for adult social care. We set out to answer five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a short summary of what we found. The summary is based on our observations during the inspection, the records we looked at and what people who used the service, their relatives and the staff told us.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the staff rotas and found that there were some occasions when there were insufficient staff on duty to meet people’s needs throughout the day. People might not always receive a consistent and safe level of support.

There were arrangements in place to help identify the risks people may face. Plans were in place to explain how these risks would be managed to help protect people’s safety.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding (DoLS). Although no DoLS applications had been made staff were aware of the circumstances when an application should be made and how to submit one.

Is the service effective?

Each person who used the service had an individual care plan which set out the care and support they required. People told us that they had been involved in assessing their care needs and had contributed to developing their care plan.

A range of health care professionals visited the home and, if needed, staff escorted people to hospital appointments.

Is the service caring?

Staff were attentive and engaged in a positive way with the people they supported. One person told us, “The care here is good. The staff are really very, very nice and caring.”

Staff were familiar with people’s individual needs and knew how to communicate with them effectively. They explained things carefully and gave people the opportunity to make choices and confirm consent.

Is the service responsive?

People participated in social and recreational activities. Some were able to pursue their chosen activities independently, whilst others required support and assistance to do this. Some opportunities for social activities and outings were provided.

People told us that if they had any comments or concerns they felt able to raise these with staff and felt confident action would be taken.

Is the service well led?

The home worked well with local health professionals to help support people’s health.

There was a system in place to check the quality of the service and to identify any areas that required improvement. Systems were in place to help capture the views of people who used the service. Results from a recent quality survey showed that overall satisfaction levels were good.

As part of this inspection we spoke to four members of staff including a deputy manager. We also spoke with nine people who used the service and two relatives. We also spoke with a visiting health professional and a social worker.

People we spoke with were happy with the care provided. Comments from people we spoke with included: “you can’t fault anything” and “very good staff, but there doesn’t seem too much activity”. A visiting professional told us that the home was “really nice, and it’s homely. They (staff) take time out to talk to people”.

We found concerns with the care plans in that action had not always been followed through. For example we found that where risk assessments identified that they should be reviewed weekly that this had not always occurred.

We found that not all staff were up to date with date with training in key areas such as safeguarding. There was evidence that staff had also attended additional training such as dementia care and training in dignity.

The provider had quality assurance systems in place to help monitor the quality of the service. Audits were carried out on the building and we saw that appropriate checks had been made to ensure that the building was safe. We found that not all of the audits carried out identified action that should have been taken.

This is follow up report. Please see our previous report for full details.

A health professional told us that the provider "knows their patients very very well" and that they would always contact them promptly if they had any concerns.

All the people we spoke with were happy with the care provided. One person told us "it's like home from home".

We found that there was some concern with care plans. Not all relevant risk assessments had been completed and where risk had been identified action had not always been followed through.