This inspection took place on 14th December 2016 and was unannounced. Russettings Care Home is a nursing home registered to accommodate up to 45 people with a range of needs including those living with dementia and /or long term health conditions. The home also provides a short –breaks and respite service for some people. The building is a large purpose built nursing home set in its own grounds on the edge of Balcombe Village. There is a large garden at the back of the property.

The home 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.

People‘s care needs were assessed and care plans were regularly reviewed. However people did not always have enough to do. Whilst there was a programme of organised activities arranged people were not always supported to follow their interests or provided with meaningful occupation or activities that were suitable for their needs. One person told us, “I am bored, the staff are kind but I rely on visits from my family and it’s not enough.” A visitor said, “My relative has said they are bored occasionally, I feel that they need more stimulation.” We have made a recommendation that the provider seeks advice about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.

People were supported by staff who understood how to assess and manage risks. Staff knew their responsibilities with regard to keeping people safe and when to report any concerns with regard to safeguarding people from abuse. There were enough staff to care for people and people received the medicines they needed safely.

Staff received the training and support they needed to care for the needs of people they were looking after. People and their relatives spoke highly of the staff. One relative said, “I have been very impressed with all the staff, they are really on the ball.” Staff had a good understanding of their responsibilities with regard to the Mental Capacity Act 2005. Staff checked that they had people’s consent before providing care. One staff member explained, “It’s important to provide choices, and to respect people’s choices.”

People told us they enjoyed the food at Russettings Care Home. People’s choices were respected and they were supported to have enough to eat and drink. Risks to hydration and nutritional needs were identified and managed effectively. People were supported to access health care services when they needed to and staff had developed effective working relationships with health and social care professionals.

Staff knew the people they were caring for well and had developed positive relationships with them. Comments from relatives included, “All the staff are absolutely caring, they have been really marvellous with my relative,” and “They have a good crew here, people are treated with care and kindness.” People were supported to be involved in expressing their views about their care. One staff member said, “It’s important that people have control over their care and that we respect their views.” People’s privacy and dignity was respected and their personal information was kept securely.

The provider had a clear complaints procedure in place and people and their relatives knew how to raise any concerns. The registered manager actively sought the views of people, staff and relatives about developments at the home and a questionnaire was used to gather feedback on the service.

Staff had developed good links with the local community and health and social care professionals spoke highly of the management of the home and the care provided.

The registered manager had effective systems in place to monitor the qua

We carried out an unannounced comprehensive inspection at Russettings Care Home on 10 & 12 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of pressure care, the recording of accidents, incidents and electrical equipment risk assessments; Issues with storage of medicines and gaps in Medicine Administration Record (MAR) charts; People not receiving appropriate nutrition; care plans not being up to date, people not being involved in the running of the service and audits not identifying areas for improvement and consequent actions. At this comprehensive inspection, we found that improvements had been made and that breaches in regulations had now been all addressed.

Russettings Care Home is registered to accommodate up to 45 people with a range of needs, including those living with dementia and/or long-term health conditions. The service also provides a short-breaks and respite service. At the time of our inspection, there were 39 people living at the service. Russettings Care Home is a purpose built nursing home set in its own grounds and is situated on the edge of Balcombe village. People have their own rooms and some have en-suite facilities. There is a large communal lounge area, dining room and conservatory overlooking the grounds; a separate garden has been made accessible to wheelchair users.

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. The service changed providers less than a year ago and the new registered manager started at the service in April 2014.

People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the manager

Information in recruitment files was difficult to find and not readily available. We have made a recommendation regarding this.

We observed lunch, people had enough to eat and drink. They were given choices of food from a menu. Drinks were available throughout the day. One person told us “The food is nice”. They were encouraged and supported to eat and drink enough to maintain a balanced diet. The service monitored people’s weights and recorded how much they ate and drank to keep them healthy. One person said “It’s not bad here, staff are nice and the food is good”.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice.

Staff had received all essential training and some were working toward an award in health and social Care. They received supervisions from their line managers.

People told us that staff were kind, caring and approachable. One person told us. “Staff are very caring”. We observed staff treating people with dignity and respect and involving them in their care. Another person said of staff “They are so caring and the nurses are very good”.

People’s care plans were up to date and contained information about their individual preferences and needs. Some of these care records were difficult to follow and information was sometimes hard to find. Standardising care record for effectiveness and ease of use was an area that needs further improvement.

Straff were responsive to people’s individual needs and demonstrated that they knew people well and new the detail of their day to day lives, for example how people liked their tea and what topics of conversation people liked to chat about.

The registered manager responded to concerns and complaints in a timely manner. A positive culture was promoted and new staff had a good understanding of how to communicate with people in an accessible way. The management team were transparent with people and relatives about the improvements that had needed to be made and on-going improvements that were being implemented. There was a range of audit tools and processes in place to monitor the care that was delivered and the registered manager worked in partnership with visiting professionals to the home.

The inspection took place on 10 and 12 February 2015 and was unannounced.

Russettings Care Home is registered to accommodate up to 45 people with a range of needs, including people living with dementia and/or long-term health conditions. The service also provides a short-breaks and respite service. At the time of our inspection, there were 39 people living at the service. Russettings Care Home is a purpose built nursing home set in its own grounds and is situated on the edge of Balcombe village. People have their own rooms and some have en-suite facilities. There is a large communal lounge area, dining room and conservatory overlooking the grounds; a separate garden has been made accessible to wheelchair users.

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. The service changed providers less than a year ago and the new registered manager started at the service in April 2015.

Risks to people had not always been assessed appropriately. Where risks had been assessed they had not been reviewed on a regular basis.. Where people were at risk of developing a pressure ulcer, there were inconsistencies in how the risks were assessed or managed. Accidents and incidents were recorded, but there was no analysis or monitoring system in place. The premises were undergoing refurbishment and there was a risk to people and staff because of the way the building works were managed and lack of environmental risk assessments.

People’s medicines were not managed safely and Medication Administration Records (MAR) charts had not always been fully completed. The medicines trolley was left unlocked during a medicines round.

Staff knew how to recognise the signs of abuse and what action to take to keep people safe. Staffing levels were sufficient and the service employed agency staff to address any unplanned gaps in staffing. Safe recruitment practices were in place to ensure that statutory checks had been undertaken for new staff. People were protected against the risk of infection and staff demonstrated their understanding of infection prevention and control.

People were not always supported or encouraged to eat their meals. Some staff did not notice when people needed help and people were at risk of having little or nothing to eat. Where people had been identified as at risk of malnutrition or dehydration, they had not always been weighed frequently. Care plans did not always show what action had been taken to address people’s dietary requirements or nutritional needs. Food and fluid monitoring and recording was inconsistent. People had access to healthcare services and professionals.

Staff completed an induction programme and had received all essential training, although not all staff had received dementia awareness training. They demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and the associated legislation and put this into practice. Staff received regular supervisions and attended staff meetings.

Care records were inconsistently completed and were not always person-centred as they lacked personal details about people. The registered manager was in the process of updating all care plans. Activities were organised on a daily basis and people were supported by staff to be engaged in these activities. However, it was not clear how much involvement people had in the planning of activities. Relatives and friends could visit people freely. Residents and relatives’ meetings were held, but some people appeared to be unaware of them. Complaints were listened and responded to within a week and resolved within 28 days.

People were not actively involved in developing the service. There were some systems in place to monitor and measure the quality of care provided, however, these were not robust enough to drive continuous improvement. Where audits had been undertaken, they were not planned on a regular basis and where gaps or inconsistencies were identified, these had not always been addressed or acted upon.

Staff felt they were well supported and motivated to carry out their responsibilities. They felt that things had improved since the service had changed ownership. External agencies were contacted and worked in partnership with the service. People were cared for by kind, caring and compassionate staff and were involved in decisions about their care. They spoke highly of staff. As people reached the end of their life, they were involved in decisions about how they wished to be cared for. Staff were sensitive in their approach to end of life care and provided support to the person and their family.

We found a number of 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.