About the service:

Remyck House is a residential care home. The service was providing personal care for 26 people at the time of inspection. People supported included older people, and people living with dementia.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

People’s experience of using the service:

People received a service that was safe. Systems and processes were in place to manage medicines safely and protect people from the risk of abuse.

• Staff had the right skills and were trained efficiently to support the people they cared for. People’s care and support led to good outcomes.

• Care workers had developed meaningful relationships with people they supported. They respected people’s dignity and privacy, and promoted their independence.

• People’s care and support met their needs and reflected their preferences.

• Management processes were in place to monitor and improve the quality of the service. There was an empowering, positive and open culture.

Rating at last inspection:

• At the last inspection the service was rated Good (19 October 2016).

Why we inspected:

• This was a planned inspection to check that this service remained Good.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

This was an unannounced inspection which took place on 19 October 2016.

Remyck House is registered to provide care (without nursing) for up to 29 older people. There were 26 people resident on the day of the visit. The building offers accommodation over two floors in 23 single and three double rooms. The double rooms were used for single occupancy, therefore the service had no vacancies on the day of the inspection. The second floor was accessed via a staircase or lift. The shared areas within the service were adequate to meet the needs and wishes of people who live in the home.

The service has a registered manager running the service. 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, staff and visitors to the service were generally kept safe. However, we have made a recommendation about areas of safety that required review to ensure people were as safe as possible. Most risks were identified and managed to make sure that people and others were kept safe. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. They were able to describe how they kept people safe from all forms of abuse and harm.

There were enough staff to safely support people. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and deprivation of liberties applications had been made, as was appropriate.

People were supported by staff that were given training and were skilled enough to provide safe and effective care. People were assisted to receive health and well-being care from appropriate professionals. Staff were trained in any necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built relationships with people so that they were able to provide caring and compassionate support. People were encouraged to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences

The service was led by an experienced registered manager. The registered manager was described by staff as approachable and supportive. The provider and registered manager assessed and reviewed the quality of care provided. Some improvements were needed with regard to effective record keeping.

Since our previous inspection on 16 February 2014, we found that actions had been taken by the provider to ensure that records for people and staff were accurate and fit for purpose. This meant that people were not placed at risk of receiving inappropriate care

The registered manager told us, "Every aspect of each person’s care is reviewed every month when they are resident of the day. At that time I ensure that only up to date, relevant documents are in people’s care plans. Everything else is archived in the manager’s office and kept under lock and key. Staff now sign regularly to confirm that they have read the file and understand the person’s care needs". This meant that the provider had introduced a process designed to ensure that staff were working only with current information which had been regularly updated.

We saw that staff records had been filed alphabetically, were structured and easy to navigate. The records indicated that effective recruitment checks and procedures had been carried out. This meant that people were likely to receive safe care because the provider had clearly documented care records and staff records which were current, easily located and fit for purpose.

The four people we spoke with who used the service were all positive about the care they had received at Remyck House. One person told us “I’m thankful that I’m looked after so well. I have a roof over my head and plenty of good food. What more would I need"?

We found that people who used the service felt they were safe and had confidence in the staff to protect them from abuse. One person we spoke with told us, “I’m very happy here and wouldn’t want to move now. I’m very settled and I feel safe with the staff and manager here to look after me”.

The four people and one relative that we spoke with all thought that staff numbers were adequate. One person said, “The staff know what they’re doing and look after our needs very well. I never have to wait long and they always have a smile on their faces”. A relative told us, “I drop in quite often, sometimes at odd hours and as far as I can see there are always enough staff.

We reviewed the registered manager’s action plan produced in response to feedback from people, their relatives and staff. This demonstrated that the management had reviewed some working practices affecting the care and welfare of people and had made adjustments.

We found that because old material had not been archived and that all notes relating to each person were not stored in a central location there was potential for confusion and increased risk of inappropriate care being provided.

People told us that their individual needs and preferences were assessed and catered for. One person who preferred to spend time alone said, “The staff tell me what’s going on when they bring me my paper and the manager pops in to see me every day, so I never feel left out”.

Although in need of some cosmetic redecoration we found that the property was suitable in design and layout for the purpose to which it was being put and was safely maintained.

We found that staff were trained and supported in their professional development. One member of staff told us, “I just had my first annual appraisal here. I found it very good because you get told what you do well and not so well, so you can work on it. This encourages you to improve”.

People who used the service, their relatives and staff confirmed that their feedback was sought regarding care and support provided by the service. We found that the provider had processes in place to assess this information and act on it to make improvements.

We found that an effective and accessible complaints system was in place and staff were aware of their responsibility to support people to make complaints if they wished to. A care worker told us, “It’s much better now. We keep complaints forms at the nursing station. People don’t have to ask for one, they can just pick it up”.

This follow up inspection visit was carried out in order to assess if the provider had taken action to address concerns that had been identified at the previous inspection. These concerns related to supporting workers, complaints and notifications. We did not need to speak with people using the service on this occasion.

We found that systems had been implemented to ensure staff received regular supervisions and personal development planning; however these were not fit for purpose. A number of yearly appraisals had taken place; however, there were not appropriate systems in place to monitor appraisal scheduling or recording. We saw no evidence that action plans relating to the outcome of supervisions and appraisals had been created or that actions taken had been recorded.

We found that the service’s complaints policy had been updated to include the details of the local government ombudsman; however, details of the registered manager and the service provider had been removed. We saw copies of the reviewed complaints policy had been placed within ‘service user guides’ and placed in people’s rooms. Previous complaints had not been acknowledged and staff did not have access to the complaints policy.

We found the accidents and incidents folder had been brought up to date and any notifiable incidents had been referred to the correct parties.

We spoke with three people who used the service. One person said “I’m very happy here. I feel well taken care of”. A second person we spoke with said “I’m very happy here and the people are very helpful”. The third person we spoke with said “we’re very well looked after. I think it’s wonderful”.

We found people looked well groomed and we observed staff following good manual handling practices when they assisted people. We saw the home had systems in place for the hygenic management of waste.

We saw staff rotas had been completed a month in advance and ensured sufficient staff were on duty throughout the day and night to meet people’s needs. We found the service had ensured the Care Quality Commission (CQC) were notified of a number of notifiable incidents however we were unable to determine whether all notifiable incidents had been correctly notified as the service’s incident book was out of date.

At the time of our inspection 22 people were living in the service. Our inspection was facilitated by the owners and the deputy manager.

One person we spoke with told us, ”They look after us very well here”. Relatives that we spoke with told us that Remyck House had a happy atmosphere and welcoming staff.

We saw that people who used the service had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support.

We observed that people looked well cared for and that those who wished to were engaged in group or one to one activities with staff.

We noted that guidance regarding safeguarding people from abuse was available to staff and that they had received recent relevant training.

A relative that we spoke with after the inspection visit told us, “I have no concerns about my relative’s safety here. They are very happy”.

Staff, relatives and people who used the service that we spoke with told us that staff were able to meet people's care needs safely. We found that there were enough qualified, skilled and experienced staff to meet people’s needs.

However, we found that the performance and professional development of staff was not being supported.

We reviewed the procedure for handling, storage and administration of medicines and found this to be compliant.

We noted that there was a complaints system in place but that it was not easily accessible to people using the service.

At the time of our visit, most people who lived at Remyck House had either a clinical diagnosis of dementia, or were suffering from the symptoms of dementia.

So we were not able to talk to people or to gain their views. We gathered evidence of people’s experiences of the service by reviewing comments made to us via our website. We found that overall relatives were very satisfied with the care and support their relative was receiving from Remyck House.

We looked at all areas of the home, including the bedrooms, bathrooms, kitchen and communal areas. We talked with members of staff on duty on the day of our visit.

We found the home to be clean and well maintained. People were warm and comfortable and we observed good care by staff.

Residents told us they enjoyed the food.

One resident told us the home had dedicated domestic staff that cleaned their bedroom daily and that the home was clean.

Not all the people that used the service at Remyck House were able to tell us about their

experiences. To help us to understand the experiences people had, during our visit, we

used our SOFI (Short Observational Framework for Inspection) tool. We made use of this

several times during the visit.

We talked to two people about their medicines and both expressed that they were happy with the home handling their medicines for them and that this worked well for them.

Not all the people that use the service at Remyck House were able to tell us about their experiences. To help us to understand the experiences people had, during our visit, we used our SOFI (Short Observational Framework for Inspection) tool. We made use of this several times during the visit and spoke to one relative. We were told that their relative living at the home appeared well cared for and enjoyed the food. They said that the home appeared clean when they visited, which was at least once a week. They said the staff were friendly.

During our visit to the home, we found that only two residents of the thirteen residents being accommodated were not suffering from advanced dementia and were able or prepared to talk to us.

Of these two, one was prepared to talk to us. This individual expressed neither negative or positive opinions about the service they were receiving and added very little to the other evidence we gathered during our visit.