The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Why we inspected – The inspection was prompted in part by receiving information of an incident following which a person using the service sustained a serious injury. The information shared with CQC about the incident indicated potential concerns about the management and leadership at the home. This inspection examined these concerns. This incident was being reviewed by the local authority safeguarding team at the time of the visit and had not been concluded.

Inspection team: The first two days of the inspection were carried out by two adult social care inspectors. One adult social care inspector returned to the home unannounced on the third day to complete the inspection process.

Service and service type: Rushley House Retirement Home 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: The first and last day of the inspection were unannounced.

What we did: Before the inspection, we reviewed information we held about the service. This included previous inspection reports and notifications submitted by the provider related to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people who lived at the home. We also spoke with the Lancashire County Council safeguarding and contracts and commissioning team. This allowed us to gain information related to the quality and safety of service being provided. We used our planning tool to collate and analyse this information to help us plan our inspection visit.

During the inspection process we spoke with three people and five relatives. We spoke with three members of staff and the registered manager.

To gather information, we looked at a variety of records. This included care records related to three people who used the service. We also looked at other information related to the management of the service. We did this to ensure the registered manager had oversight on the home and to ensure the service could be appropriately managed.

Following the inspection visit we spoke with Lancashire County Council safeguarding team, the infection prevention and control team and Lancashire Fire and Rescue Service to update them with our findings.

This inspection took place on 06 February 2018 and was unannounced. Rushley House Retirement Home is a residential care home for 13 people. The home is situated near Morecambe town centre, close to local shops and amenities. Private car parking is available. The home is a large detached house built over two floors, set in its own grounds. All bedrooms are for single occupancy and a number are provided with an en-suite facility. Communal space consists of a main lounge, dining room and a separate conservatory. There is a stair lift for access to the first floor. At the time of our inspection visit there were 12 people who lived at the home.

There were two registered managers who were also the owners of the home. 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 the last inspection in September 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives. One person told us, “I think they [staff] are respectful, I can have a laugh with them.”

We found there were sufficient staff during our inspection visit. They were trained and able to deliver care in a compassionate and patient manner. One person commented, “There is always quite a few on [staff]. There is always one on at night, and she keeps a check on me to make sure that I am alright.”

Staff we spoke with confirmed they did not start their job until the registered provider received relevant checks. We checked staff records and noted employees received training appropriate to their roles. One staff member told us, “It made a difference. You couldn’t just come in and get on with it.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the home and found it had been maintained and was a safe place for people to live. For example, we found equipment had been serviced and maintained as required.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at Rushley House Retirement Home. Staff had relevant training to assist them in the safe administration of medicines.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

People were supported to have maximum choice and control of their lives and staff helped them in the least restrictive way possible; the policies and systems in the service supported this practice.

We received positive comments about the quality of meals provided. Comments included, “I keep putting on weight the food is that good.” They added, “They make a menu of what we want and it varies a lot. I even have breakfast in bed.” We observed lunch time service and noted people had their meal in the dining room, where they sat or in their own bedroom. People told us it was their choice where they ate their meal.

We observed positive interactions between staff and people who lived at Rushley House Retirement Home. There was a culture of promoting dignity and respect towards people. People told us staff treated them as individuals and delivered personalised care that was focused on them as an individual. Care plans seen confirmed this.

People who lived at the home and their visitors told us they were happy with the activities on offer.

There was a complaints procedure which was made available to people and their re

During the inspection we looked at care, staff training records, staff supervision arrangements, the services safeguarding procedures and quality monitoring arrangements. We also spoke with a number of people visiting the home and staff throughout the inspection. We observed the quality of care and support provided by staff during the inspection. We did this to confirm people were having their care needs met. We also wanted to identify staff had been trained and appropriate support arrangements were in place for them.

Good care practices were observed and people were found to be having their nutritional needs met. We saw the staff team providing sensitive and flexible personal care support. The staff were kind and patient and showed a good understanding of the needs of the person in their care.

The people we spoke with said their relatives were receiving safe and appropriate care which was meeting their needs. One person said, “I am really pleased with mum’s care. She is a poorly lady and I know she can be difficult. The staff are very kind and patient with her”. Another person said, “I visit my friend three times a week. She loves it here. The girls are brilliant with her. The meals are lovely and the staff are always available with tea and biscuits”.

During our inspection we contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with a range of people about the home. They included the owner/ manager, staff and people who lived at the home. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced living at Rushley House.

Although some residents had limited verbal communication due to a dementia condition, we did receive positive comments about the service. They included, “The place is ‘top hole’, it couldn’t be any better.” Another resident said, “The staff and owner are wonderful nothing is a bother to them.”

People we spoke with told us they could express their views and were involved in discussions about their care. They told us they felt listened to when discussing their care needs.

Staff members we spoke with were knowledgeable about people’s individual needs and how they could be met. One staff member said, “It’s a small home and we are all involved in the care of residents. This helps us get to know everyone well.”

Residents and staff we spoke with said the home was kept clean and they were happy with the level of cleanliness maintained. People liked their bedrooms and were able to furnish them with their own belongings and possessions. One resident said, “Look at all my pictures it reminds me so much of home.” Another resident spoken with about the cleanliness of the home said, “It’s always clean and tidy the staff do a good job.”

During the course of the visit we spoke individually with the registered manager, a District Nurse who was visiting, the friend of a person living at the home, two residents and three members of staff. In addition some short, informal discussion also took place with several other residents in the lounge area of the home. However discussion with some people was more limited because of mental incapacity. One person told us “The staff are very nice, cannot complain about them”. Another person said, “They try their best”. A third person confirmed that he had seen and had discussed the content of his care plan which he signed. This same person also told us that he signed the care plan every month when it was reviewed; he was happy with the content of the care plan and stated that the care delivered was as described in the care plan. We were also told that although some activities do take place this is an area that could be improved in order to keep people more interested and stimulated.

Comments made about the care and support provided by the staff team was positive. One person told us, “The best thing here is the care”. A resident said, “This is as good as there is. We are looked after”.

A relative told us that staff were: “Good at getting the doctor out”. A District Nurse who was visiting told us, “There is nothing to worry about here” and confirmed that there was a good working relationship with staff at the home. A person living at the home described a visit by a mental health specialist several days earlier and stated, “If there is anything wrong I tell **** (Registered manager) and she sorts it out”.

When asked, one person we spoke with said that he felt safe and comfortable living at the home. A member of staff confirmed that everybody working at the home had received adult abuse training that was regularly updated.

A resident said, “The staff will do anything and sit and talk including the night staff. They will make me a cup of tea at 5:00am and sit and chat”. A friend of a person living at the home told us, “Staff are great, they really are fantastic. I am not just saying that, nothing is too much trouble for them, absolutely brilliant”. Staff spoke positively about the training provided.

A person living at the home told us that they were asked their thoughts and views regarding the service provided to them. A friend of a person living at Rushley House confirmed that friends and relatives were always encouraged to voice their opinions and suggestions for improvement.

One person told us that he knew who to speak with if he did have a concern and that it would be ‘dealt with’. The friend of a service user spoken with stated that there was good communication with the staff team and that she felt confident that any concern would be addressed.

This unannounced inspection took place on 10 & 11 September 2015.

Rushley House is a residential care home for 13 people. The home is situated near Morecambe town centre, close to local shops and amenities. The home is a large detached house built over two floors, set in its own grounds. All bedrooms are for single occupancy and a number are provided with an en-suite facility. Communal space consists of a main lounge, dining room and a separate conservatory. There is a stair lift for access to the first floor.

There were thirteen people living at the home on the day of inspection.

There was a registered manager in place. 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 last inspected 05 November 2013. We identified no concerns at this inspection and found the provider was meeting all standards that we assessed.

Feedback from relatives and visitors was mainly positive and people who lived at the service spoke highly about the quality of service provision on offer.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Robust recruitment procedures were in place to ensure staff were correctly vetted before being employed.

People were not always safe. We found suitable arrangements were not in place for storage of prescribed items and the registered manager had failed to identify environmental hazards that have the potential to cause harm. Window restrictors were not in situ for all windows and infection control processes were sometimes compromised.

All people had a detailed care plan which covered their support needs and personal wishes. We saw plans had been reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Staff were positive about their work and confirmed they were supported by the manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.