The inspection of Rushymead Residential Care Home took place on 22 and 23 February 2018 and was unannounced. The previous inspection carried out on 30 and 31 January 2017 found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have robust quality assurance systems in place to effectively monitor the safety and quality of people’s care. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good We found during this inspection the provider had made improvements and was now meeting the regulation.

Rushymead Residential Care 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.

Rushymead Residential Care Home accommodates 28 people in one adapted building. At the time of our inspection there were 24 people using the service. The service accommodates people across three separate units, each of which have separate adapted facilities. All of the units specialises in providing care to people living with dementia. Rushymead Residential Care Home stands in several acres of grounds and has a terraced area for people to sit on warm days.

The service requires a registered manager to manage 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. At the time of our inspection there was a registered manager in post.

We received positive comments from people we spoke with in relation to how well cared for people felt. One person commented on how they felt supported and listened to. Relatives we spoke with told us their family member was safe and well looked after. For example, “I know she is safe. I can’t fault them” and “No worries mum is well cared for.”

Staff showed kindness and compassion for people they supported. We observed positive engagement between staff and people throughout our visit.

Staff undertook training in relation to safeguarding people at risk. Staff told us they knew what to do if they suspected abuse of any kind. We saw contact details of the local safeguarding authority displayed within the premises.

Risk assessments were in place for people identified at risk. We saw these were current and updated as required. Personal Emergency Evacuation Plans (PEEPs) were in place in the event of an emergency.

Medicines were managed safely and effectively. People received their medicines as prescribed by the GP.

Staffing levels were sufficient to meet people’s needs. The service used agency staff when required. We were told that the same agency staff were used where possible.

Recruitment procedures were robust and ensured only suitable staff were employed. Staff files we saw contained relevant documentation.

People told us the food was good and they had a choice of menu. People’s nutritional needs were identified and monitored. The chef had a list of people’s dietary requirements where they required a specific diet.

People and their relatives told us they knew how to make a complaint. A comments box was located in the main reception area for anyone wishing to make a suggestion. In addition a ‘make a wish’ tree was available for anyone to leave suggestions or comments.

Staff spoke positively about the management structure of the service. They told us they would always speak to the manager or team leader if they had any concerns. Staff received regular supervisions where they could discuss their progress and feedback about any

We undertook an unannounced inspection of Rushymead Residential Care Home on 30 and 31 January 2017.

Rushymead Residential Care Home provides personal care for up to 28 people, some of whom may have dementia. At the time of our inspection there were 25 people living at the service.

There was 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.

People and their families told us they felt safe at Rushymead Residential Care Home. One relative told us “Mum is a lot safer here than at home, without a doubt.”

Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed. However, temperature checks were not always being maintained of people’s medicine.

We have made a recommendation that the provider follow NICE guidance on safe storage of medicine.

People benefitted from caring relationships with the staff. Relatives commented “They (staff) care for her very well”; “Mum is in the best place, food and care is good and mum is well looked after and safe” and “Staff are all very nice and friendly”. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives and staff told us how people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place. However these did not always contain all the areas of risk.

We have made a recommendation that the provider review the safety of the use of the stair cases in the home.

Staff sought people’s consent and involved them in their care where possible.

At the time of our inspection there were sufficient staff to meet people’s needs. However, relatives and staff told us, at times, there were not enough staff on duty to meet people’s needs. Staff rotas confirmed planned staffing levels were not always maintained. The service had recruitment procedures in place and conducted background checks to ensure staff were suitable to undertake their care role. However, there were some where references had not been obtained.

We have made a recommendation about how the dependency levels of people are calculated.

People and their families told us people had enough to eat and drink. People were given a choice of meals and their preferences were respected. People’s nutritional needs were identified, monitored and managed.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Systems were in place to ensure people were protected against the risks of unsafe or inappropriate care, but these were not always effective or robust.

Staff spoke positively about the support they received from the registered manager and all of the team at the home. Some of the staff received supervision and other meetings were scheduled as were annual appraisals. People, their relatives and staff told us all of the management team were approachable and there was a good level of communication within the service.

Relatives told us the team at Rushymead Residential Care Home were very friendly, responsive and mainly very well managed. Comments received included “Staff are very helpful, could not fault them”. The service sought people’s views and opinions and acted on them.

We found the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action

When we visited Rushymead on the 20 September 2013 we found the provider had not ensured that at all times there were sufficient numbers of staff available to meet the needs of people who used the service. We set a compliance action and required the provider to tell us how and when they would become compliant.

We received an action plan dated 19 November 2013 which set out what actions had been or were to be taken, to achieve compliance.

We visited Rushymead on the 2 January 2014. We looked at records which showed individual service user dependency assessments were reviewed monthly. Staffing numbers were set in order to meet those assessed needs. This ensured the number of staff required to meet people's assessed needs was assessed and kept up to date. We saw the total number of staffing hours provided within the service met the assessed levels.

We looked at staffing rotas for the last two weeks of 2013. We found staffing levels had been maintained throughout that period at the required levels. Where necessary, agency staff had been used to fill any gaps. We cross-checked gaps on the rota with staffing agency invoices and found they agreed. We were told the agency only provided staff who were familiar with Rushymead and its residents. This provided a degree of continuity for people who received care and support where agency staff had to be used.

The manager informed us of a recently introduced system for the recording of staff sickness. This was intended to reduce, where possible, short-notice staff absence which caused particular problems when maintaining staffing levels.

We visited Rushymead on the 28 November 2013 at 5.30 a.m to follow up information of concern received. This suggested people were being got up in the morning at any time from 5 a.m without their consent or involvement in the decision to do so.

We were told night staff were under pressure to get people washed and dressed before day staff came on duty. It was said this was done for the convenience of the service and not for the benefit of the people concerned. We were told telephone calls had been made to night staff during the day following their shifts. These were to find out why more people had not been got up and dressed earlier.

We spoke with night staff and day staff. We spoke with people who were up and dressed before day staff came on duty and with the manager. We looked at care plans, specifically at the information they included about people's preferred morning routines.

We did not find people were being made to get up before they wanted to. We found staff were committed to offering people choice and sought to respect their choices at all times. When we looked at care plans we found the information contained about the person's morning routine was not always up to date. However, we found staff fully respected people's right to change their morning routine from day to day, depending on how the person felt.

People told us they did not feel under any particular pressure to get up before they wanted to. One person told us they would like their breakfast earlier and we were told this would be done in future.

We observed the home was calm and peaceful. Staff, whilst busy, did not rush or hurry people whilst providing their care in the early morning period.

We found there had been some misunderstanding about the expectations on night staff in respect of getting people up in the morning. This had been recognised and appropriate action had been taken to clarify the position. This meant all staff knew what was expected of them. This ensured people who lived in Rushymead would receive the care and support they needed in the way and at the time they chose.

People who lived in Rushymead told us they were satisfied with the standard of the care they received. "I am very lucky to be here" one person told us, whilst another said "The staff are wonderful." People told us their views about how they wanted their care and support provided were respected and listened to.

We found whilst care plans were reviewed to ensure they were up to date, they were not always clear or consistent. We were told the format of care plans was being reviewed.

We reviewed medication records and procedures and found people who required assistance with their medication were supported and protected by the way this was done and recorded.

Staff had been provided with safeguarding training and details of how to respond to any safeguarding concerns were available for staff.

People who lived in Rushymead were very positive about the manager and staff. However, at the time of our visit staff numbers meant people's care experience was not as good as it should be because staff were under pressure. We were informed this had been recognised and action was being taken to address it.

One person told us how they and their family had chosen Rushymead as their home. They said they had all the information they needed and had been able to visit before they made a final decision. They told us they were very happy and felt they had made a good decision about where to live.

Throughout our visit we observed very positive interactions between care staff and people living in Rushymead. Staff spoke to people respectfully and with consideration. "The carers look after us very well" was one person's comment. Care plans included a range of risk assessments, covering for example falls and weight loss, together with details of how these were to be eliminated or managed.The amount of personal life history in care plans varied. However in most cases there was clear information given about specific likes and dislikes or particular allergies, for example in respect of food.

When we spoke with people living in Rushymead they told us the manager and staff were very approachable. They said they would raise any concerns they had about their care with them.

All of the staff we spoke with were very positive about the training they undertook. They gave us details of recent training and told us they felt that they had the skills necessary to provide a high standard of care. This view was supported by comments made to us by people living in the home and those relatives we spoke with. "The staff are really first class" one person told us.

People who use the service told us that staff were good at respecting their privacy and would knock on the door and wait before entering. They said they were encouraged to be independent and staff involved them in discussions about their likes and preferences.

People said they or their relatives had been able to visit the service to see if it was suitable. They said they had been asked about their needs and staff displayed a good awareness of their needs. They said there were plenty of activities for them to participate in and visitors were made very welcome.

They told us they felt safe and secure at Rushymead and that staff were very good at responding to call alarms when they needed them. They said that a member of staff could always be located when needed and that staff were considerate and respectful to them. One person said: “The staff here are great and the manager is a very lovely lady”.

People told us they felt very comfortable raising any concerns or issues they may have and that the manager was very approachable. They were confident that any issues would be taken seriously. Some people said they had recently been able to complete a questionnaire asking for their views on the service.

One person summarised her feelings towards Rushymead by saying: “If I had to go anywhere, I couldn’t have done any better than here”.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 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 Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Rushymead Residential Care Home provides accommodation and care for up to 28 older people, some of whom may live with dementia. At the time of our visits there were 23 people living in the service. Rushymead was previously a private country house which has been adapted for use as a residential care home. It is set within extensive grounds with views over the adjoining countryside.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People who lived in Rushymead, their relatives and health and social care professionals involved with them were very positive about the standard of care they received or observed. They said staff were very caring and capable. Most of them thought there were sufficient staff numbers to meet their care needs effectively. One person told us they had sometimes experienced a delay in response to their call bell at night. Other people told us this had not been an issue for them.

Staffing levels had recently been increased at key times, for example during the early morning to help get people up and ready for the day. Staff said this had been a significant improvement for them and the people they provided care and support for. An additional activity organiser had been appointed with specific responsibility to provide social stimulation for people living with dementia.

Whilst people told us they felt safe we found there were some environmental risks to their safety which had not been addressed or had not been dealt with promptly. For example, there were some potential trip hazards within the home and externally in the garden. We also found in one case the recruitment process had not been fully completed before the person started work. Recruitment records did not show how any potential risk, arising from a Disclosure and Barring Service check had been assessed to make sure the applicant was suitable, although we were told this had been done.

Staff had received appropriate training to enable them to provide safe and effective care to the people they support. Staff training was monitored and meant people could be confident their care was provided by staff that had the necessary skills and training.

People were supported to stay healthy, including eating and drinking enough. Care plans had recently been revised in order to make them easier to use and more effective. People were involved in decisions about their care where possible. There were regular reviews of people’s needs and associated risks to their health and safety. Where these had changed, appropriate action was taken and care records were updated. Where people did not have the capacity to make certain decisions about their care, there was an appropriate, robust process in place. This was being followed to ensure any decisions made were in their best interest. Staff were trained to identify signs of abuse and knew how to report it.

Although there were no regular meetings of people or their relatives, reviews of care involved them and they said they felt free to raise any issues or concerns they had directly with the registered manager or staff.

There was a formal complaints process in place, and people were asked for their views of the service through regular surveys. Any issues arising from these were noted and where possible, action taken to address them.