Risby Park Nursing Home provides accommodation, nursing and personal care for up to 54 older people. There were 45 people living in the home on the day of our inspection. This inspection took place on 4 July and 13 July 2017 and was unannounced on the first day.

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.

At our last inspection on 17 March 2015 we rated the service good overall and requires improvement in safe because we had concerns about the staffing levels. At this inspection we found significant improvements. The service had continued to develop and had further strengthened the very caring approach, responsiveness and how well the service was led. People received exceptional care that was personalised to them, taking account of their individual needs and wishes.

Extremely caring relationships had been built between people and staff. Staff working in the home were especially caring and compassionate. Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. Where people needed support in order to make their own day to day decisions this was provided by staff. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them. People receiving end of life care were treated with exceptional care and compassion.

Risby Park Nursing Home was exceptionally well-led. The registered manager was a highly skilled leader who had clear oversight of the home and a passion for delivering the very best care to people. The registered manager ensured staff were meeting people’s needs holistically. There were processes in place to seek feedback from people, relatives and supporting health and social care professionals to drive improvements in the quality of the service. Complaints were managed in accordance with the provider's policy. Where concerns were raised these were dealt with speedily and in depth. Relatives said they felt welcomed and supported at the home and would highly recommend it to other people.

People received exceptionally personalised care and support which they were in control of. People were encouraged and supported to express their views and opinions about how they wanted to be looked after and cared for. People were at the forefront of their care and staff went the extra mile to ensure people had their care needs met in the way they wanted them. People and their relatives were listened to if they were unhappy or had comments to make. Actions were taken where appropriate in order to improve the quality of care provided. Improvements were made as a result of feedback received.

The registered manager and provider strived for excellence and improving the lives of people who lived at the home through involvement with external organisations and the local community.

There were extremely effective quality monitoring processes in place which covered all areas of the home and care delivered to people. Staff morale in the home was extremely high. Staff were proud to work at Risby Park and were remarkably enthusiastic and passionate about delivering high quality care.

Staff were proud to work at the home. They were particularly positive about the way the home was managed and were very happy in their work. There was a clear management structure in place; staff understood their roles and responsibilities. The home was highly organised and well run and the culture was open and transparent.

Care practice at the home was based on best practice and the registered manager ensured that they kept themselves up to date with their knowledge for

We inspected this service on the 17 March 2105 and it was unannounced. The last inspection to the service was on the 29 October 2014. It was carried out because of concerns raised about staffing levels and how some people’s needs were being met. We made compliance actions. The home has made significant improvements in terms of meeting people’s needs but there were still some concerns about staffing levels.

The service is registered for: accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. They are registered for up to 54 people both over and under 65 years old, with or without dementia.  

There is 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.’  

The service was well managed and run in the interest of people using it. During our inspection we saw that there were enough staff to meet people’s needs. However we received feedback to suggest this was not always the case and a minority of people told us that at times there were insufficient staffing. This meant we were not confident staffing levels were always appropriate to people’s needs.  

There were systems in place to ensure people had the medicine they needed and staff received training to ensure they were competent and able to administer medicines safely.  

Staff received training on how to recognise abuse and actions they should take if they believed a person was at risk of harm or abuse. Staff demonstrated enough understanding of safeguarding and had policies they could refer to which told them how to report concerns.  

Risks to people’s safety had been assessed and as far as possible reduced which meant people were as safe as they could be and their health and welfare was promoted.  

Staff have the necessary skills, training and support to meet people’s needs and demonstrated that they knew what the requirements of the job were.  

People were supported to eat and drink in sufficient quantities and people’s weights were monitored to ensure they were not unintentionally losing weight.  

People’s rights were upheld and staff acted lawfully when supporting people to make decisions about their care and welfare. They were asked about how they would like their care to be provided and gave their consent before it was.  

People’s emotional and health care needs were met and a plan was in place informing staff how people wished to have their needs met.  

The home had a complaints procedure and the service acted upon suggestions and complaints to improve the service.  

The service was well led with a strong ethos and person centred values. Investment in the staff and good quality assurances processes meant the service provided was good and took into account people’s views and acted upon them.  

The health and safety of people was promoted through good risk assessment processes and audits which identified risk so it could be reduced as far as possible.   

We carried out this unannounced inspection in response to concerns raised with us by relatives and a social worker. There was concern that the service did not have sufficient staff to meet people's needs.

As part of this inspection we looked at five people's care plans, spoke with six members of staff, five people living in the service and four relatives.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe:

We found that the service was not safe. Care plans were not up to date and guidance given by care professionals had not always been followed. There were not always sufficient staff to meet people's needs.

Is the service effective:

The service was not effective. People were not always supported to have their meals by staff that had time to spend with them.

Is the service caring:

The service was caring. People told us, "The care is good" and "The girls are lovely."

Is the service responsive:

The service was not responsive. People's assessed needs were not always met. Risk assessments and care plans were not reviewed regularly.

Is the service well-led?

The service was well-led. Relatives and staff told us they found the registered manager approachable and if they made a complaint it was dealt with. However, one relative did qualify this by saying that they had had to make the same complaint a number of times as things improved initially but then slipped back.

There was a registered manager in place.

We chatted with six people using the service about the care they received and they all confirmed to us that they were happy and well supported. One person told us, "Staff go out their way to keep me happy." We noted that the service had identified people's social and emotional needs alongside their physical and mental health needs. Staff recognised the importance of supporting people to maintain their self esteem. We also spoke with four visiting relatives who confirmed to us that they were satisfied with the service provided. One said, "Staff support my relative to maintain a strict routine in order to manage their energy levels. I can come whenever I like and staff told me to treat the service like home. We have had a huge amount of support from the manager and staff listen hard to ensure that care given is optimal."

We found that people were well supported to access adequate hydration and nutrition. People were offered choices around what and when and where they ate. Staff were on hand to assist people at mealtimes to ensure that people received an adequate diet.

Medications were stored and administered appropriately and staff were trained and competent in managing people's prescribed drugs.

We saw that there was an adequate complaints policy in place and that people were aware of how to complain if they needed to.

As part of this inspection we spoke with five relatives, nine people using the service, and ten staff. We observed the care provided including lunch time. One relative told us, “My family member was very anxious when they came in but settled within three months and now regards it as home." Another relative said, “I cannot praise the staff here enough with how they treat my mum.” One person told us, “The staff are very good and kind here.” Another said, “The food is excellent and I have a great choice of food.” We observed people's care and staff had a good knowledge of people's needs.

People were provided with a balanced diet and weights were monitored. People's health care needs were met but care records did not show how people had been consulted. Daily notes gave limited information so it would be difficult to evaluate the effectiveness of the care being provided.

The environment was well maintained and fit for purpose. It was both stimulating and comfortable. We saw evidence of activities being provided to promote people's emotional well being.

Staff were appropriately supported but improvements to the recruitment process were necessary. Staffing levels were not always maintained to an appropriate level for people's safety. Staff told us that staffing levels were short at times which compromised people's care.

The service had effective systems in place to measure and assess the care provided so knew what improvements were necessary.

The people living in Risby Park Nursing Home told us that they liked living there, that the care staff showed them respect and protected their dignity. They also told us that they were comfortable in the home. A relative told us that they had been worried about leaving their family member at the home, but that they need not have worried because the family member had settled well.