This inspection took place on 5 and 6 March 2018 and was unannounced. At our last inspection on 1 November 2016 we found three breaches of legal requirements. These were breaches of Regulation 12 because risk assessments regarding the environment had not always been completed, medicines were not stored safely and the environment did not promote good infection prevention and control; Regulation 16 because complaints were not effectively managed; Regulation 17 because there was a lack of robust and regular auditing. The provider was required to send us an action plan telling us what they would do to meet the requirements of the law. They sent this to us and we found at this inspection improvements had been made.

Russets is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. Russets provides full time residential care to up to seven people and respite care to up to 11 people, in one adapted building. There are two flats within the building, one accommodates four people and the other accommodates three people. The rest of the building provides support to those people receiving respite care. Respite care is short term.

A registered manager was in post. A registered manager is a person who has registered with 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 registered manager was due to leave employment at Russets and the provider had recruited a new manager to take over this role. This person was due to start before the current registered manager left in order to ensure a comprehensive handover.

The registered persons had not always notified CQC of significant events that had occurred in the service. There were systems in place to monitor quality and safety of the service provided, however, these were not always effective and did not identify concerns with records and incident analysis that we had.

People, relatives and staff were positive about the registered manager who was described as open, approachable and easy to talk to. Staff were committed to meeting the needs of people and providing a service people wanted. People and their families were encouraged to provide feedback on the service through meetings and an annual survey. They were also supported to raise complaints should they wish to.

Improvements had been made to the assessment and management of risk. Environment risks had been assessed and measures taken to reduce these. Risks associated with people’s care and support were well known by staff. The management of medicines had improved and was safe. Infection control measures had improved and Russets was clean and tidy throughout. There were enough safely recruited staff deployed to meet people's needs. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with others to ensure decisions made in people’s best interests were reached, although improvements to the documenting of this was needed and we made a recommendation about this. People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the deprivation of liberty safeguards (DoLS) in place for people.

Prior to people moving into the home, assessments were undertaken to ensure the service could meet the person’s needs. People told us that staff knew them well and this was apparent throughout our discussion with staff about people. Care plans were in place, which reflected individual preferences and support needs. Activities w

This was an unannounced inspection which took place on 1 November 2016. The service was last inspected on 9 May 2014 when we found it was meeting all the outcomes we inspected.

Russets provided accommodation for up to 18 people who have personal care needs and have a diagnosis of a learning disability. The service provided support to people on a residential basis and also offered a respite service. On the day of our inspection there were seven people using the residential service and 11 people using the respite service. We were not able to speak to many people who used the service to ask them questions due to the nature of their diagnosis and lack of capacity. We therefore spoke with a relative, visiting professional and staff members and undertook observations around the service.

The service had a registered manager in place 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.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Risk assessments that were in place for people who used the service had not been subjected to reviews as stipulated by the service. This meant that staff would not know if they had access to up to date information in order to keep people safe and minimise risks. There were no risk assessments in place in relation to the environment such as kitchens and bathrooms. Therefore no consideration had been made to the health and safety of people using the service.

Keys to the medicines cabinet in one unit had been left in an unlocked room and unattended and therefore accessible to unauthorised persons, placing people at risk. Medicines that were to be stored in a fridge were being store in the main fridge and therefore accessible to unauthorised persons, again placing people at risk.

We found a number of infection control issues; in one bedroom the washbowl had been placed in the bowl of the toilet and a drinking bottle was being stored on the top of a toilet cistern. A tambourine and some plastic balls were stored in another bathroom. In one communal bathroom we found a number of commode lids were being store on the floor behind the bath; when these were moved there was a large amount of dust and dirt underneath. The laundry was disorganised and sinks contained cleaning products and a mop bucket; rather than being clean for hand washing. We also observed a staff member and service user enter the kitchen and were cooking for a person who lived at Russets, without wearing any personal protective equipment (PPE) or washing their hands.

We recommend the service considers suitable training for all staff members in relation to food hygiene and safety.

All staff members we spoke with knew how to keep people safe and were able to recognise the different types of abuse and how to respond to any concerns.

Fire guidelines were in place for each person who used the service. These should ensure that people are safely evacuated in an emergency situation.

Robust recruitment processes and systems were in place to ensure staff members were safe to work with vulnerable people. Checks had been carried out with the Disclosure and Barring Service (DBS).The DBS identifies people who are barred from working with children and vulnerable adults and informs the service provider of any criminal convictions noted against the applicant.

We recommend the service considers current best practice guidance on meeting the end of life wishes of people who use the service.

Staff members told us and records we looked at confirmed that staff received regular

There were 16 people who used the service at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We observed the care provided and looked at supporting documentation. We talked to three people who used the service, three members of support staff, the registered manager, two relatives and a care manager.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People only moved into this service once they had undergone a thorough assessment. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. People spoken with confirmed that they had access to medical support as necessary. A relative said, “They contact the GP if they have any concerns”.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People had been cared for in an environment that was safe, and well maintained. People who used the service were protected by the service's recruitment and selection process.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people’s care and support needs and that they knew them well. Staff had been well trained, and were provided with support so they could provide the appropriate level of care to people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. One relative commented, “I am very happy with the way ….is looked after”.

Is the service responsive?

Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them. People were supported to maintain and increase their independence.

Is the service well-led?

People were able to contribute to decision making within the service. Their views were listened to. Staff received appropriate support and guidance from the manager and they were consulted regularly.

At the time of our inspection there were 6 people residing at the service and 8 people using the respite service. The atmosphere at the service was pleasant and busy but relaxed. The environment was clean and well presented.

We spoke with two people who use the service, four relatives, six staff and two health professionals. The people who used the service told us they were happy with the care and support they received. One said “I love it here they [staff] are all nice to me”.

A relative told us; "I would recommend here. This place is perfect”. Another relative said; “They are brilliant. They have a dedicated team that keeps the place going as if it’s home”.

We found that people’s views and experiences were taken into account in the way that the service was provided; their care was assessed and delivered. A visiting health professional told us; “Russets go out of their way to be supportive and meet service user’s needs”. Another health professional said; “Staff take looking after people very seriously. I would recommend the service”.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people’s needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with one person who told us he liked staying there as it “was like a home.” Another person told us people “were kind and nice.” We spoke with three relatives who told us that they were “delighted” with the service provided by the home. They told us that members of staff were “kind and helpful” and “took time to spend with people.” They also told us that there were activities for people to get involved in and that the home had a good atmosphere.