About the service:

Rookery Cottage is a small residential care home providing personal care and accommodation for up to 13 people, some of whom have dementia. There were 10 people living in the home at the time of our inspection.

People’s experience of using this service:

• There were sufficient staff to meet people’s care and support needs. Staff had been recruited safely and improvements had been made with regards to retaining proof of staff identity.

• The management team had developed and implemented comprehensive audits to monitor the quality and safety of the service..

• People, relatives, staff and healthcare professionals told us Rookery Cottage had a homely atmosphere and a strong emphasis on the importance of family and community connections.

• The environment had recently been refurbished to a high standard; people had a comfortable and clean place to live.

• Staff felt a strong sense of ownership and pride in the service and felt well supported by the management team. Any concerns raised were effectively responded to and acted on appropriately.

• Plans of care had been developed and reviewed with people and their relatives, and the staff team knew people they were supporting well.

• People’s personal preferences had been identified and they were supported to attend a diverse range of activities.

• People and relatives fed back they were happy with the care provided.

• Risks associated with people’s care and support had been appropriately assessed and managed. People told us they felt safe living at the service and with the staff team who supported them. The team were aware of their responsibilities for keeping people safe and had received the relevant safeguarding training.

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

• People received kind and compassionate care at the end of their lives.

More information about the inspection is in the full report.

Rating at last inspection:

At our last inspection, the service was rated Requires Improvement in Safe and Well Led and Requires Improvement overall. Our last report was published on 23 March 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and assess if improvements have been made.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

Rookery Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rookery Cottage provides personal care for up to thirteen older people, some of whom are living with dementia. At the time of our inspection there were thirteen people living at the home.

At the last inspection, on the 8 December 2015, the service was rated ‘Good’. At this inspection we found that the service ‘Required Improvement’.

There were two registered managers in post at the time of the inspection, they were also the provider. 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.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening to ensure the provider had sufficient oversight of the service.

Staff did not consistently follow the procedures in place to ensure the safe handling of medicines. People did receive their medicines as prescribed; however, improvements were required to ensure sufficient oversight of medicines administration.

Safe recruitment processes were in place, however, the provider needs to ensure that appropriate documentation is retained after staff have started work at the service.

People continued to receive safe care. Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety.

Risk assessments were in place to manage risks within people’s lives. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staffing levels ensured that people's care and support needs were safely met. Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff were well supported and supervised by the provider.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People were encouraged to make decisions about how their care was provided and staff had a good understanding of people's needs and preferences. Staff treated people with kindness, dignity and respect, and spent time getting to know them and their specific needs and wishes.

Staff supported people to access support from healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

The service had an open culture, which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and this was used to drive improvement.

This inspection took place on the 8 December 2015 and was unannounced. At the time of our inspection the service was supporting 13 older people

The service provides care for older people both on a long term basis and for short stay respite care.

The service has a 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.

Rookery Cottage was led and managed by a family who were dedicated to providing care which met individual needs. We saw that people were well cared for and the home had a relaxed and friendly atmosphere. Everyone we spoke to spoke highly of the staff that supported them and families felt welcomed and involved in the care of their relative. People commented that nothing was too much trouble for anyone.

There were enough staff to support people. The registered manager had a thorough and robust recruitment process in place which ensured that people were being cared for by people whose background had been looked into before they were allowed to care for people. People felt safe in the home and staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through regular supervisions and were well trained. The staff undertook regular training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People received care from staff that respected their individuality and were kind and compassionate. Their needs were assessed prior to coming to the home and individualised care plans were in place and were kept under review. People and their families were encouraged to spend time at the home to ensure it felt right for them and to ensure that their needs could be met. The registered manager also ensured that the local health professionals were able to meet the medical needs of people.

Staff spent time with people and had gathered a good understanding of people’s likes, dislikes and past life’s; this enabled people to continue with any interests or hobbies they may have enjoyed prior to coming to live at Rookery Cottage. The home also provided activities and encouraged people to take part in events within the village.

People were cared for by staff who were respectful of their dignity and who supported people in the way they wished to be supported, always asking people how they wished their support to be given. Relatives commented positively about the care their relative was receiving and it was evident that people could approach management and staff to discuss any issues or concerns they had.

The registered manager and provider were visible and open to feedback. They strived to ensure the level of care was of a high standard, regularly seeking feedback from people and acting on the feedback given to drive improvements within the home. They were pro-active in looking outside of the home to learn from other services and work with health professionals to ensure people were getting the best possible care they could have.

 There were a variety of audits in place and action was taken to address any shortfalls.

We carried out this inspection to check if the provider had made the improvements we asked them to make when we inspected in July 2013.

People told us that Rookery Cottage was a homely place and that they loved living there.

We spoke with four people that used the service. A person said, ‘’This is a happy and comfortable home and I would not live anywhere else.’’ Another person told us, ‘’The staff frequently discuss with me how they would support me to be as independent as possible. That way they make sure they give me the right support.‘’

We found that the provider had made the improvements we required at our last inspection. We saw that the home had introduced a system that ensured people’s care plans had been updated and reflected the changed needs of people that lived at the home. Where possible the provider had agreed the updated plan with the person that used the service or their representative. That meant people that used the service and or their representatives were aware of people's care and support needs and care was given to them in a way that met their individual needs.

We spoke with four people that lived at Rookery Cottage. They told us that they liked living at the home. One person said, ‘’We are like an extended family here’’ while another person said, ‘’I can’t fault them, they are very kind and caring.’’

Everyone we spoke with told us that care staff had provided them with the support they had needed and were always polite and respectful. We found people were able to make choices with their care, and treated with dignity. One person we spoke with told us, ‘’I am very comfortable here and the care staff respect my wishes. The religious minister was here earlier and I asked to be excused and that was fine.’’

We found that care staff interacted with people in a friendly and polite manner. Although health care plans were in place for people that used the service we found these lacked details of the care to be provided.

Care staff we spoke with told us that they felt supported by the manager and received the training they needed to carry out their roles. One staff member we spoke with said, ‘’We work well as a team and support each other.’’

People told us that the food was good and they always had enough to eat and drink. One person we spoke with said, ‘’today the salmon was delicious, I had double portions.’’

The provider had adequate procedures in place to ensure the quality of the services provided.

We carried out this compliance review as part of our planned inspection programme.

We spoke with three people one of whom was a relative. A person told us that they were ‘‘very happy’‘with the care that they received. Another person told us ‘‘I am very pleased with my room and the care received’‘. One relative told us that because this home is small staff gave ‘‘more attention’‘to residents.