About the service:

Rheola Care Home is a residential care home that was providing personal care to 34 older people at the time of this inspection.

People’s experience of using this service:

People we met and spoke with were happy with the care home and the staff that provided their care. One person told us, “These [staff] are really kind, sometimes I’m fed up, they give me a lift; pull my leg. It’s very jolly.”

People felt safe living at the home because staff knew what they were doing, they had been trained and cared for people in the way people wanted. Risks in the home were assessed and reduced as much as possible. There were enough staff, and the registered manager also spoke with people regularly. Key recruitment checks were obtained before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people with meals and drinks. They used protective equipment, such as gloves and aprons. Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected. Staff worked well together, they understood the home’s aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. Complaints were dealt with and resolved quickly.

Systems to monitor how well the home was running were carried out well. Where concerns were identified, the registered manager followed this up to make sure action was taken to rectify the issue. Changes were made where issues had occurred elsewhere, so that the risk of a similar incident occurring again was reduced. People were asked their view of the home and action was taken to change any areas they were not happy with.

Rating at last inspection: Requires improvement. (Report published March 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor information we receive about the service until we return to visit as scheduled in our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Rheola Care Centre (Rheola) is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates up to 42 people in one adapted building, which is divided into a number of units. One of the units provides care to people living with advanced dementia. Nursing care is not provided.

At our previous inspection in November 2015 the home was rated Good. At our inspection on 3 and 10 January 2018 the service had deteriorated to Requires Improvement. The inspection visits to the home took place on 3 and 10 January 2018. On 3 January 2018 the visit was unannounced. We arranged with the registered manager to return on 10 January 2018.

There was a registered manager in post who had been managing the home for five years. A registered manager is a person who has registered with the CQC to manage the home. 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 home is run.

During our first visit to the home we found that medicines were not always being managed safely and care planning was not complete or up to date. By our second visit, the registered manager had strengthened the systems in place to check medicine management and care plans had been re-written. Safeguarding concerns had not always been discussed with the local authority safeguarding team. Quality assurance processes were in place but were not always robust enough to ensure that a quality service was being provided.

People felt safe living at the home, with the staff and with the care and support the staff gave them. Assessments of all potential risks to people were carried out and guidance put in place to minimise the risks.

There was a sufficient number of staff with the right experience, skills and knowledge deployed to make sure that people were kept as safe as possible. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. Staff followed the correct procedures to prevent the spread of infection.

Assessments of people’s support needs were carried out before the person was offered a place at the home, to ensure that the staff could provide the care and support that the person needed and in the way they preferred. Technology and equipment, such as a mobile phone for use when people went out unescorted, electronic care records and hoists were used to enhance the support being provided.

Staff received induction, training and support to enable them to do their job well. People were provided with healthy, nutritious and appetizing meals and special diets were catered for. A range of external health and social care professionals worked with the staff team to support people to maintain their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives praised the staff, had good relationships with them and described them as caring, supportive and professional. Staff made people feel they mattered and knew each person and the details about the care and support the person needed, very well.

People and their relatives were involved in planning their care. Information about advocacy services was available if anyone wanted an independent person to assist them with their affairs. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible.

At our second visit staff had updated care plans and they were more personalised than previously. Activities, entertainment and outings were arranged if people wanted to join in. A complaints process was in place and people were confident that any issue

Rheola Care Centre is registered to provide accommodation and personal care for up to 42 people. The home is a converted and extended Edwardian property located near the centre of St Ives. Accommodation is offered on two floors and there are dining and lounge areas on both floors. A separate unit, accessed by a covered corridor, offers accommodation to people living with dementia.

This comprehensive inspection took place on 25 November 2015 and was unannounced. There were 36 people in residence.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their relatives told us they were happy with the care being provided at Rheola Care Centre and said they felt safe. They were complimentary about the management and were effusive in their praise of the staff of the home. Several people and their relatives had sent written compliments to the home. We saw that people who lived there and the staff got on well together, had caring, respectful relationships and were comfortable in each other’s company.

Staff had undergone training and were competent to recognise and report any incidents of harm. Potential risks to people were assessed, recorded and managed so that people were kept as safe as possible.

There was a sufficient number of staff on duty to meet people’s assessed needs and staff had been recruited in a way that ensured that only staff suitable to work in a care environment were employed. Staff had undertaken a range of training courses so that they were equipped to do their job well. Medicines were managed safely.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Appropriate applications had been made to the relevant authority to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good health and well-being. People were given sufficient amounts of food and drink and the nutritional needs of people who required special diets were met.

Staff showed that they cared about the people they were looking after. Staff treated people with kindness, respect and compassion and made sure that people’s privacy and dignity were upheld at all times. People’s personal information was kept securely so that their confidentiality and privacy were maintained.

People were involved in the planning of their care. Staff gathered as much information as possible about each person so that care plans were personalised. This meant that people received the care they needed in the way they preferred. Some activities, outings and entertainments were offered to people although some improvement was needed in this area. People knew how to complain and complaints were responded to in a timely manner.

There was a homely, friendly and open culture in the home. People and their relatives were encouraged to share their views about the service being provided to them in a number of both formal and informal ways. Staff were also given opportunities to share their views about ways in which the service could continue to improve. Audits of all aspects of the service were carried out to make sure that the best possible service was provided. Records were maintained as required.

People were treated well and with respect and were aware of the reasons for their admission to Rheola Care Centre.

The majority of people who we spoke with were very satisfied with the standard and quality of their support and care. One person, for instance, told us that there was always something for them to do and said that their support and care needs were met in the way that they preferred.

People said that they were given a choice of what they would like to like to eat and drink. They also said that the food was good and that there was always plenty of it. We saw that people were supported to eat and drink sufficient amounts.

Rheola Care Centre was a safe place for people to live, visit and work because equipment was maintained and safe for people to use.

Members of staff were well liked by people who used the service and their family members. There were recruitment systems in place which protected people who used the service from unsuitable, prospective members of staff.

People were made aware of the complaints procedure. They were also provided with opportunities to make suggestions and comments about the standard of their support and care. Where people had made a complaint or concern, they were satisfied with the how the management of Rheola Care Centre had responded.

People we spoke with told us that they were satisfied with the care provided and described the staff as being kind and caring when providing assistance with their personal care and support. One person commented, "They are always kind and I am pleased with staff"

A relative we spoke with told us that the care her relative received was, "Absolutely stunning" and that any concerns were appropriately dealt with by the staff and manager.

However, one person told us that they would like to have their hair washed more often. and another person said they would like to see more activities arranged in the home.

People told us they liked living at the home were treated with respect and felt they had some influence over their care and the decision making affecting their life and their care arrangements.

People advised us that they would make their complaints known to the manager and to care workers. Relatives told us they had taken their complaints to the manager and were satisfied with how their issues were dealt with