This inspection took place on 04 and 05 October 2016 and was unannounced. The home provides accommodation and care for up to 38 older people, including people living with dementia. There were 36 people living in the home when we visited. Accommodation is provided in either the main building or a second building in the grounds providing eight individual ‘apartments’.’

At our previous inspection, on the 07 and 10 July 2015, we found three breaches of regulations. The service was not meeting the regulations relating to keeping people safe from risk of harm, monitored the risk to people’s health and governance arrangements. We issued a warning notice and required the provider to make improvements. We returned to the service on the 14 December 2015 and found they had taken appropriate action. At this inspection we found improvements had been made and the identified concerns had been addressed.

There was a registered manager in place. 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 felt safe living at Stanwell Rest Home and they were very much at the heart of the service. The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people. Staff received training in safeguarding adults and knew how to report concerns.

Staff were trained and assessed as competent to support people with medicines. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices.

People had a choice and access to a wide range of activities and were able to access healthcare services.

‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

Staff were responsive to people’s needs which were detailed in people’s care plans. Regular audits of the service were carried out to asses and monitor the quality of the service. Staff felt supported by the registered manager.

We carried out a focused inspection on the 14 December 2015 to check whether Stanwell Rest Home has taken action to meet the requirements of a warning notice we issued on 21 September 2015. This report only covers our findings in relation to these topics.

We undertook an unannounced comprehensive inspection at Stanwell Rest Home on 7 and 10 July 2015 at which breaches of regulations were found. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Stanwell Rest Home’ on our website at www.cqc.org.uk.’

Stanwell Rest Home is registered to provide accommodation for persons requiring nursing or personal care. Stanwell Rest Home is a residential care home for up to 38 older people. At the time of our inspection 30 people were living in the home some of whom had physical disabilities or were living with a diagnosis of dementia.

The home 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.

Risks to people’s health and wellbeing were assessed and mitigating action was taken to reduce the risk. The risks to people were managed safely and risk assessments updated to reflect people's current needs.

The home had introduced a series of audits and improved the way they monitored the quality and safety of the service. Quality systems were effective in driving improvements in the home and actions were followed up and acted upon. Meetings were held to discuss quality systems and to review progress and support staff.

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected.

During this inspection, we looked at the outcomes related to the care and welfare, safeguarding adult’s process, medicines management, staffing, the process for assessing and monitoring the quality of service and records management.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with 11 people who use the service, three relatives and visitors to the service, the manager, two visiting healthcare professionals and seven staff. We reviewed seven care plans and records relating to the management of the service.

We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

The service was not safe because the arrangement for the effective management of people’s medicines was not adequate. This may put people at risk of not receiving their medicines in a safely and consistently and according to their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

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. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to incidents of potential abuse.

The provider had arrangements in place to ensure staff received regular training to update their skills. There were not always enough staff to meet people’s needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. The manager confirmed there was no one who was subject of a DoLS authorisation at the time of the inspection.

Is the service effective?

People were at risk of not receiving effective care. There were some assessments carried out but they did not cover all risks. The care plans contained detailed information about people’s care and staff were knowledgeable about the people they cared for. This included appropriate support with food and fluids to meet people's nutritional needs. Equipment was in place to support people’s mobility and to maintain their independence.

Is the service caring?

We saw people were supported in a caring way. Staff and people using the service had developed good relationships with people who were treated with respect. One person told us the staff were “kind "and another person said “the staff are all right and help you”. We saw people being supported in a caring manner with their meals. However, healthcare professionals raised concerns about certain staff’s attitude, shown by the way they spoke to people and the tone of voice used. We also observed one incident which we shared with the manager at the time of the inspection.

Is the service responsive?

The service was mainly responsive because people told us they were satisfied with the care and support they were receiving. We saw people were supported to access external healthcare facilities as needed. Two visitors said their relative was able to access medical help as needed.

Is the service well-led?

The service was not always well led. The system to regularly assess and monitor the quality of service provided was not robust. This did not effectively identify shortfalls for action to be taken. The quality improvement system did not evidence how improvements would be embedded in practice. There was a lack of auditing to assess the quality of care provided including infection control, care plans and medicines.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the quality of the service provision and monitoring the outcomes for people.

There was a complaints process to support people to raise their concerns and this information was available to people

At the time of our visit there were 33 people using the service. We spoke with nine of them, and two relatives who were visiting family members. They were all happy with the care and support provided. One said “Everybody is very happy here”, and another “I wouldn’t want to be anywhere else”. They told us they were happy with their needs assessments and care plans, and that care was provided according to their needs. They said they were satisfied with the cleanliness of the home and the responsiveness of the staff. If they had requests or ideas, staff listened to them.

We observed the care and support given to people in the communal areas of the home, and in particular the care of five people in the larger lounge. We saw that staff were caring, aware of people’s needs and preferences, and responsive to them.

We spoke with three members of staff and the manager, and reviewed records related to people’s care. We found people’s care needs were assessed and their care plans reflected their needs. Care and support were delivered according to plans which were reviewed regularly. People were cared for in a clean and hygienic environment. We found there were sufficient numbers of staff to provide the care required. Processes were in place to monitor the quality of service provided.

People told us they were happy living at the home. They said “all the carers are ever so good”. People were able to express their views and believed staff would try to respond to their views and wishes. At resident meetings they had the opportunity to discuss ”what was coming up and any complaints.” People commented that the home arranged for them to see health care professionals such as General Practitioners (GP's) when they needed to.

People told us that they were able to make choices about their daily activities and routines; “We are our own bosses.” We were told about how they were able to choose whether to join in with group activities or occupy themselves. People spoke highly about the social activities on offer. These included minibus outings to garden centres and the sea side.

People told us there were always staff available to provide support and respond to call bells promptly. They said they had confidence that staff had the necessary skills to provide the care and support they needed.

For some people living at the home, because of their level of dementia they were unable to directly communicate their needs and views. Because of this we used the Short Observational Framework for Inspection (SOFI) in one of the lounge areas. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Our SOFI observation showed that staff were aware about how different people expressed their decisions. This meant that people who were unable to communicate directly were still able to express their choices and staff would respond.

People told us they were happy with the environment. Two people said they were very pleased with their bedrooms.

Some one who visited the home told us they were concerned about cleanliness and that there were strong odours present.

All people we spoke to said they liked living at Stanwell Rest Home and had no complaints about any aspect of the service they received. They said the food was plentiful, varied and of a good quality with plenty of choices. They felt they had good input into how the home was run and could influence decision making processes.

People expressed satisfaction with the care and support they receive. They said the service promotes their rights and respects their decisions and that they had been made aware of their rights to raise concerns.

They also said that the staff were kind and patient and that there were enough staff on duty to meet their needs.

This inspection took place on 7 & 10 July 2015 and was unannounced. The home provides accommodation and care for a maximum of 38 older people. Some people may be living with dementia or mental health illness. There were 30 people living at the home when we carried out our inspection. Accommodation is provided in either the main building or a second building in the grounds providing eight individual “apartments”.

At the last inspection on 27 & 29 January 2015, we issued compliance actions for care and welfare of people using the service, management of medicines and cleanliness and infection control. The provider send us an action plan and stated they would be compliant by 14 June 2015.

At this inspection we found some improvements had been made, such as cleanliness, infection control and medicines. However, there was insufficient action taken to meet the regulations in other areas assessed. The action plan had not been followed and people remained at risk of not having all their care and welfare needs met.

The home 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 risks of people choking were not managed safely and advice was not always followed or risk assessments updated to reflect people’s current needs.

Risk assessments had been completed for the environment and safety checks had been conducted regularly of gas and electrical equipment. However, various hot water tanks around the home were not secure. They could be accessed easily and presented a risk to people.

The provider had introduced a series of audits and had improved their quality assurance systems. However, these had not picked up the issues we identified relating to the quality and safety of the service provided. Quality systems were not always effective in driving improvements within the home; actions that were outstanding were not followed up.

People felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Care plans were not always representative of people’s current needs and although some contained a lot of individual detail others did not have the current information. Where care plans had been reviewed, this did not necessarily mean the information in them had been update

The provider had made improvements to manage infection control risks and staff demonstrated a good understanding of infection control procedures.

The provider had made improvements to ensure people received their medicines safely from suitably trained staff. There were enough staff to meet people’s needs. Relevant checks were conducted before staff started working at Stanwell to make sure staff were of good character and had the necessary skills. Staff received regular supervision and support where they could discuss their training and development needs.

People felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. When people lacked the ability to make their own decisions these were taken in the best interests of people.

People received varied and nutritious meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu of the day.

People were cared for with kindness, compassion and sensitivity. We observed positive interactions between people and staff. Staff members knew about people’s lives and backgrounds and used this information to support them effectively.

People were supported and encouraged to make choices and had access to a wide range of activities tailored to their specific interests. ‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service.

People liked living at the home. There was an open and transparent culture at the home. Staff and people were encouraged to talk to the manager about any concerns.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.