The Shrubbery Rest Home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 26 people in one adapted building, arranged over two floors. At the time of our inspection, there were 22 people living there, some of whom were living with dementia. There are several communal lounges and a separate dining room. There is also a conservatory and garden area that people can access.

There is a registered manager in post. 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 had been considered and risk assessments were in place when needed. After incidents occurred within the home, these were reviewed to ensure they were up to date and relevant. There were enough staff available for people and they did not have to wait for support. The provider had a system in place to ensure adequate staffing levels within the home. Medicines were managed in a safe way to ensure people were protected from the risks associated with these.

People were supported by suitably recruited staff and were happy with the care they received. Staff received training and an induction that helped them to support people. There were safeguarding procedures in place to ensure people were protected from potential harm and these were followed when needed. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated in a kind and caring way and were happy with the support they received from staff. They were involved with reviewing their care. People were encouraged to be independent and make choices how to spend their day. People’s privacy and dignity was also upheld.

People enjoyed the food and were offered a choice. People were supported to access health professionals when needed and the home worked jointly with these professionals. People had the opportunity to participate in activities they enjoyed.

The home was decorated in peoples preferred way and the environment was clean and free from infection. There was signage around the home to help prompt people living with dementia and information was available for people in their preferred format. People’s cultural and religious needs had been considered.

There were systems in place to monitor the quality of the home and when needed, action was taken to drive improvements. The provider sought the opinions of people and relatives and used this information to make changes. A registered manager was in post and they understood their responsibilities around registration with us and notified us of significant events that had occurred within the home. They were also displaying their rating in line with our requirements. There was a system in place when things went wrong in the home so that lessons could be learnt.

The inspection took place on 7 November 2017 and was unannounced. The Shrubbery is a care home that provides accommodation and personal care. The Shrubbery is registered to accommodate 26 people in one adapted building. At the time of our inspection 21 people were using the service. The Shrubbery accommodates people in one building and support is provided on three floors. There are two communal lounges, a dining area, a conservatory and a large garden that people can access.

The service had a registered manager in post. 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.

When we completed our previous inspection on 31 January 2017 we found concerns relating to how risks to people were managed. The information staff required to transfer people safely was not always available and when people had behaviours that may challenge staff did not always know how to support them in a consistent way. We also found further improvements were needed to ensure people were protected from potential harm or abuse. When needed mental capacity assessments had been completed however decisions had not always been made in people’s best interests. The provider had not always notified us about significant events that had occurred in the home. The quality audits that had been introduced had not always been completed and therefore we could not be sure they were effective. The provider was rated as requires improvement overall. At this inspection we found improvements had been made however further improvements were needed. This is the second consecutive time the service has been rated Requires Improvement.

We could not be assured there were always enough staff to offer support to people. Our views were also shared by other professionals we spoke with. There were long periods when people in communal areas were unsupported and interactions from staff were task focused.

The provider had not always considered people’s cultural needs and the pre assessment the provider completed did not always cover people’s diverse needs. Where people were living with dementia we could not be sure how they had been supported to make choices, as information was often in written form.

Risks to people were managed in a safe way and staff had the information available. Staff knew how to recognise and report potential abuse and the provider had safeguarding procedures in place, when needed we saw these had been followed. Staff knew people well and people were happy with the care they received. Medicines were managed to ensure people were protected from the risks associated to them.

Infection control procedures were in place and implemented by staff and the provider when needed. Staff received an induction and training that helped them offer support to people. When people lacked capacity to make decisions for themselves we saw capacity assessments were in place and decisions made in people’s best interests. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us they enjoyed the food and were offered a choice. People and relatives said they were involved with reviewing their care and when needed people had access to health professionals. People’s privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day and remain independent. Some people were offered the opportunity to participate in activities and pastimes they enjoyed.

Staff felt listened to and were able to raise concerns. The provider used feedback from people and relatives to bring about changes. Quality monitoring

We inspected this service on 31 January 2017. This was an unannounced inspection. Our last inspection took place in November 2015 and we found when people lacked capacity to make decisions for themselves capacity assessment and best interest decisions had not been completed. At this inspection we found the provider had made some improvements however further improvements were needed.

The service was registered to provide accommodation for up to 26 people. At the time of our inspection, 23 people were using the service.

There was not a registered manager in post. A new manager had very recently been appointed who had commenced the CQC registered managers application process. 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 not always protected from potential abuse as concerns were not investigated or reported appropriately. Risks to people were not always managed in a safe way. When incidents occurred sometimes no action was taken to ensure these were reviewed and avoid any reoccurrence. When people had behaviours that may challenge staff offered an inconsistent approach. Staff did not always have information about moving and handling to ensure people were supported in a safe way. When needed mental capacity assessments had been completed however decision had not always been made in people’s best interests.

The provider was not always notifying us about significant events that had occurred in the home. The quality audits that had been introduced had not all been completed and therefore we could not be sure they were effective.

People were supported in a caring way by staff they liked. Staff had received an induction and training to help them offer support to people. There were enough staff available to offer support. People were encouraged to make choices about their day and remain independent.

People enjoyed the food and were offered a choice. They had the opportunity to participate in activities they enjoyed. Medicines were managed in a safe way to ensure people were protected from the risks associated to them. When needed people had access to health professionals.

Staff felt listened to and supported by the new manager. People knew how to complain and complaints had been responded to in line with the provider’s procedures. Staff knew people well and they felt involved with planning their care.

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.