This inspection took place on the 8 and 9 December 2016 and was unannounced.

Rustington Hall provides accommodation for up to 62 older people who require nursing and personal care. At the time of our inspection there were 51 people staying there.

The service had 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 registered manager was dedicated to providing the best possible standard of care and inspired the staff to provide care which focussed on the individual. Staff were well supported and encouraged to continually develop their skills and knowledge to deliver excellent person centred care. People were treated as individuals and their wishes and preferences respected.

The provider was committed to making Rustington Hall as ‘homely’ as possible in order to meet people’s individual needs; they had invested in their staff and environment. The home had been decorated and furnished in a way which helped people living with dementia remain as independent as possible and there was up to date, well maintained equipment available to support people’s personal care needs effectively.

People received care from staff that knew them very well and who were kind, compassionate and respectful. People received care that was person centred and there was an ethos of ‘how can we’ not ‘why we can’t’. Staff strived to enable people to continue to live rewarding and fulfilling lives. People’s needs were assessed prior to coming to the home and care plans were written in a person centred way ensuring people had choices and opportunities to receive their care in line with their personal preferences. Care plans were kept under constant review and every effort was made to ensure people and their families stayed involved with the planning of people’s care. People participated in a range of activities and received the support they needed to help them do this.

Staff supported people in a manner that ensured that their health and well-being was maintained and actively promoted. The service provided very good end of life care. People experienced a comfortable, dignified death in line with their wishes.

Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people's rights. There was guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, registered provider and staff ensured that people were supported in ways that did not restrict their freedom and were supported appropriately to uphold their rights.

There were sufficient staff to meet people's needs; staffing levels were kept under review and adjusted to meet people’s changing needs. Staff were not rushed in their duties and had time to talk with people. Throughout the inspection there was a friendly and calm atmosphere; staff responded promptly to people who needed support. The service had appropriate recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. Care plans contained risk assessments which gave detailed instructions to staff as to how to mitigate risks; these enabled and empowered people to live as independent a life as possible safely.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke p

During our visit we met and spoke with seven people living at the service. We also gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

Everyone that we spoke with told us that they were happy living at the service and that they felt that their care needs were being met. One person said, “The staff are lovely, they are more friends than members of staff”. Another person said, “I am well looked after here, I have nothing but praise for the place”.

We found that people had planned care that met with their needs, and that people had been consulted about their care needs and preferences. People also told us that staff treated them with respect and promoted their privacy.

We found that the service had systems in place to administer medications safely. We also found that the service had followed safe recruitment processes, and had systems in place to ensure that people living at their received a safe and good quality service.

During our visit we spoke to two relatives and to three people who used the service. People told us that they experienced care and treatment that met their needs. One person said, "I am aware of my care needs and staff are very helpful". A family member said, "I know my relative feels safe and secure here". The users of the service also told us that they were each given detailed information on how care and treatment would be offered. i.e. the service would be centred around their personal needs, health needs and be offered choices.

We spoke to two staff who informed us that they knew how to report abuse. The home had procedures in place to report any allegations of abuse.

We examined the recruitment process and found all relevant checks had been carried out, ensuring the staff had the right qualifications and experience to provide care to older people.

During our inspection we were able to confirm the home had systems in place to evaluate and monitor the quality of the service given.

People told us that they were able to look round the home before making a decision about whether or not to move in.

People said that they are treated with dignity and respect.

People told us that they get the care and support they need and that they have been consulted about their care needs. People also said that they can spend their time as they wish. One person said that he/she preferred to not join in with the activities in the home.

People said that the staff treat them well, commenting: ‘They’re all very nice to me. I haven’t seen anybody not treated properly.’

People also said that staff respond to their needs and that staff answer their requests for help when using the call points in their rooms.

People who live at the service gave us generally positive remarks about how they are treated and the service they receive. There were, however, some exceptions to this.

People reported that they are treated with respect and dignity. Comments included, ‘The staff are very helpful, they are always respectful and kind.’ We were told that staff always knock people’s bedroom door before entering, although we observed that this did not happen on one occasion during our visit.

People said that they receive the care and support they need with the exception that 2 people said that staff are slow to respond when they ask for help using the call points in their rooms. One person pointed out that staff had not placed the call point within his/her reach. People said that they were satisfied with the bathing arrangements, although one person said that he/she had not been bathed at the frequency agreed. Other people said that they can have a bath whenever they like. Relatives of people said that the home is good at meeting personal care needs.

Two people commented that they had been disturbed by the behaviour of some of the other residents.

5 of the 6 people spoken to said that the home has enough staff to meet their needs, although 1 person said that there are not enough staff, and that this was the reason staff did not respond to the call point. 2 of the 3 staff spoken to said that there are enough staff to meet people’s needs, but 1 staff member said that on occasions the residential part of the home did not have enough staff.

Health and social care professionals gave mixed views about the care provided by the home. Staffing levels were said to be sufficient to meet people’s needs. One professional reported that staff had not adequately dealt with the care needs of 1 person, whilst acknowledging that for another person, with similar needs, personal care was ‘of a good standard.’ Professionals said that the home had not fully assessed people to check that their needs could be met by the home. One professional stated that the service had failed to meet one person’s needs, that care plans had not been fully completed and that assistance had to be given to ensure that the person’s needs were assessed and a care plan devised.

People told us that the home is kept clean.

Social services and people referred to temporary moves to other bedrooms to accommodate building work and that this had affected peoples’ quality of life.