We carried out an unannounced inspection of the service on 6 June 2017

Rutland Care Village provides nursing and personal care for up to 84 people. At the time of our inspection 76 people were using the service. Rutland Care Village is a purpose built service consisting of four buildings. All accommodation and communal areas are on ground floor level. The village includes a day care facility used by people who use the service and people who live in Rutland.

At the last inspection in May 2015 the service was rated Good overall. We rated the service as requiring improvement for being Responsive because a person’s care was not consistent with what was in their care plan. We found at this inspection that the care and support people received was in line with their needs and preferences.

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.

People were safe because staff knew how to recognise and report signs of abuse. People were supported to be as independent as they wanted to be. Staff were safely recruited and enough suitably skilled and experienced staff were available to meet people’s needs, though on occasion the provider’s procedures for covering unplanned staff absences did not work. This was something the registered manager was addressing.

Staff used equipment safely when they transferred people or assisted them with their mobility.

People received their medicines on time, though arrangements for administering medicines did not always reflect best practice. The registered manager addressed this on the day of our inspection and arranged by amending the medicines administration policy.

People using the service told us they felt staff were knowledgeable about their needs Staff received relevant training and support to be able to meet the needs of people using the service. Refresher training was sometimes late, but all staff had training scheduled. Staff had received specialist training about supporting people who lived with dementia.

The registered manager, deputy manager and all staff we spoke with had a good working knowledge of the relevance of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; polices and systems in the service supported this practice.

People’s nutritional needs were met. People had a choice of foods and drinks and most spoke in complimentary terms about the meals that were provided. Meals were prepared by a chef and looked appetising and well presented. Staff were attentive to people’s health needs and supported people to access health services when they needed them. People had access to a medical centre adjacent to Rutland Care Village. The service worked collaboratively with the medical centre to meet people’s health needs.

Staff were caring. We saw examples of staff showing kindness and compassion. People using the service and their relatives had opportunities to be involved in decisions about their care and support. People were treated with dignity and staff respected people’s privacy.

People received care and support that was centred on their needs. People had access to social activities and staff supported people to follow their interests and hobbies. They were supported with their cultural and faith needs.

The provider had commissioned a consultant to lead a project to improve the décor and furnishings of an area used by people who lived with dementia. The improvements had a beneficial impact on the people who lived in and used that area. People had opportunities to make suggestions and raise concerns. Th

We carried out an unannounced inspection of the service on 20 May 2015.

Rutland Care Village provides nursing and personal care for up to 84 people. At the time of our inspection 76 people were using the service. Rutland Care Village is a purpose built home split into four units. The village includes a day care facility.

A registered manager left the service in January 2015 when an interim manager took over the management of the service. At the time of our inspection the interim manager had applied to be the 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 were safe because staff knew how to recognise and report signs of abuse. People were supported to be as independent as possible. Enough suitably skilled and experienced staff were available to meet people’s needs.

Staff used equipment safely when they transferred people or assisted them with their mobility.

The provider had robust recruitment procedures.

People received their medicines on time.

People using the service told us they felt staff were knowledgeable about their needs Staff received relevant training and support to be able to meet the needs of people using the service.

The manager, deputy manager and senior staff had a good working knowledge of the relevance of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Other staff had an awareness of the legislation.

People’s nutritional needs were met. People had a choice of foods and drinks and spoke in complimentary terms about the meals that were provided. Staff were attentive to people’s health needs and supported people to access health services when they needed them.

Staff were caring. We saw examples of staff showing kindness and compassion. People using the service and their relatives had opportunities to be involved in decisions about their care and support. People were treated with dignity and staff respected people’s privacy.

People received care and support that was centred on their needs. However, we saw that recent changes to a person’s care plan had not been implemented and they may have been at risk had we not brought the matter to the provider’s attention. People had access to social activities and staff supported people to follow their interests and hobbies. The provider had begun to pilot a new programme to support people living with dementia by providing individually tailored activities for them.

People had opportunities to make suggestions and raise concerns. They told us they were confident about raising concerns and that they would be listened to. The provider had acted upon people’s comments and feedback, for example in relation to social activities.

The management team were clearly visible and available to people using the service. The management team had clearly defined aims and objectives about what they wanted to achieve for the service. Staff felt well led. The provider had effective procedures for monitoring and assessing the service.

Rutland Care Village provides nursing care, personal care and support for up to 82 people. It is made up of a purpose built home split into four units, one of which is a specialist dementia care unit. The village also includes a day care facility known as ‘Brambles’ and residential bungalows. These were not included in our inspection.

We found the provider had appropriate systems in place to help ensure that people were protected from the risk of abuse and avoidable harm. When appropriate, people’s capacity to make decisions had been considered and the provider had acted in their best interests. People were cared for in an environment that was safe and appropriate for their needs. People and their relatives felt their care and support needs were being met and nobody we spoke with raised any concerns about their care or treatment.

People received care and support that met their needs and promoted many aspects of their well-being. Care plans provided guidance for staff about how people’s needs should be met and these had been regularly reviewed and updated. We found that people’s health had been monitored and guidance from health professionals had been sought when appropriate. People had been protected from the risk of malnutrition and dehydration and people’s special diets or food preferences had been catered for.  However, care plans did not always record people’s involvement in the planning and delivery of their care.

Staff had a good understanding of the needs of people who used the service and had many had completed an induction programme. However, the staff team had not always been supported to deliver appropriate and effective care as many had not received training in important areas such as infection control, Mental Capacity Act and Dementia Awareness. This meant there had been a breach of the relevant legal regulation and the action we have asked the provider to take can be found at the back of this report.

We observed that the staff team were mostly friendly and professional in their interactions with people and staff were able to give examples of how they protected people’s privacy and promoted their dignity. We used our SOFI (Short Observational Framework for Inspection) tool to see what the experiences of people living in the specialist dementia unit were. We found that staff did not always have the skills required to support people with dementia. Staff interactions were focused on tasks such as giving people drinks and taking them to the toilet rather than positive communication. Many staff had not shown consideration for people’s emotional well-being when supporting them during our period of observations. We saw limited attempts to interact with people or provide activities in any meaningful way. However, when staff did take the time to engage with people we found they did respond positively. We have asked the provider to make improvements in this area.

There were sufficient numbers of staff to ensure the safe and effective delivery of care and our observations showed that staff responded promptly to people when they required support. Most of the staff we spoke with felt staffing numbers were adequate and people we spoke with told us they had the care and support they required at the time it was needed.

People and their relatives had been involved in the running of the service and had been asked for their views in regular meetings and an annual questionnaire. However there was no action plan to record the improvements highlighted by the meetings or survey or to assure that they would be made. People’s complaints and concerns were recorded and responded to promptly.

However, people’s involvement in the planning and delivery of their care was not always consistent. The majority of care plans and records we looked at contained insufficient information about people’s choices, wishes and preferences so they could not be assured that they would be met. The provider had a day centre which had a programme of activities. However, many people had not been encouraged to access this service and during our inspection people who did not visit the day centre were not encouraged to engage in alternative activities that were relevant to them. Some people told us they would have liked more opportunities to go into the community or attend activities and others told us they had been lonely at times.  This meant there had been a breach of the relevant legal regulation and the action we have asked the provider to take can be found at the back of this report.

People we spoke with and their relatives considered that the service was well managed and many of them told us about the improvements the registered manager had made since they had been in post. Staff were also positive about the management of the service and were clear about their roles and responsibilities.

There was a management system in place which monitored and assessed the quality of service provided. This included audits and reviews of care plans and records, checks of the environment and other audits such as call bell audits and falls audits. These had been carried out regularly and were well documented. However this could be improved by ensuring that action taken as result of these checks had been recorded.

We visited Rutland Care Village to see whether improvements had been made since our visit 03 and 04 July 2013. We found that there had been improvements to the recording and monitoring of people’s care. We noted some areas where the provider may need to make further improvements.

We looked at a sample of monitoring sheets and found an improvment in the detail recorded. We spoke with the team leaders on each unit and they told us that they checked the monitoring sheets twice a day to ensure people were having adequate food and drinks and that care was being given appropriately. We found a few instances where there were discrepancies on the monitoring sheets but no record that this had been identified or addressed.

We spoke with twelve people who used the service and five relatives. The feedback we received was generally positive with comments such as, “The girls (staff) are good here. I trust my relative with them.” And “Absolutely brilliant. You cannot fault any of them”.

We looked at a selection of the audits that had been completed such as audits of the numbers and treatment of pressure ulcers, audit of when people had fallen and an audit of response times for staff to answer people’s call bells. We saw that the manager had included a front sheet with details of the purpose of the audit and a summary of the findings and actions.

People that used the service told us they were satisfied with the way that the service manages their medicines.

One person who used the service said “I am very happy here, the staff are nice, and I like my room, they always make sure I have my call bell”

Some of the people who lived at the home had limited communication, we were unable to ascertain what a number people felt about their experiences.

We spoke to several staff on nights and the following day staff. None indicated a staff shortage at any time, one member of staff did say “this is a dementia unit, you could always use an extra pair of hands.” The same person stated they had been short of staff on occasions, where people had phoned in sick, however this was not the case recently. Overall we spoke to 7 members of staff, none were concerned regarding poor staffing levels at the home.

We visited Rutland Care Village to check the improvements made by the provider following the compliance actions set from our visit 31 January and 01 February 2013. We spent time on three of the four units within the home.

When we visited Rutland Care Village on 31 January and 01 February 2013 we found that the system to monitor food and fluid charts; charts showing when people were assisted to change position and observation charts, was not always effective and was not identifying when people were not receiving care as specified in their care plans. Following our visit the manager told us that she had introduced new recording charts for monitoring food and fluid intake, when people were repositioned and other observations. When we visited 03 and 04 July 2013 we found that new recording charts had been introduced but these charts were not being regularly monitored or reviewed to ensure people were receiving appropriate and safe care in line with their assessed needs.

Records showed that people were not being assisted to change position as often as specified in their care plans. This meant that people were at increased risk of developing pressure ulcers.

We found instances where people’s fluid and food intake was recorded as being low but this had not been identified by the monitoring sheets and there was no record of action taken to offer people additional drinks.