This inspection took place on the 18 and 22 January 2018 and was unannounced. At the previous inspection of this service in June 2016 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 12, 17, 18 and 19 of the Health and Social Care Act (HSCA) (Regulated Activities) Regulations 2014. This was because care plans and risk assessments, both health and environmental, had not protected people from potential risk. Staff had not received training in safeguarding people and the Mental Capacity Act 2005 (MCA) and had not received regular supervision and appraisals. Robust quality assurance systems had not effectively identified the service shortfalls to enable service improvements to be made.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met.

Gensing Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide support to a maximum of 17 people. Twelve people were using the service at the time of our inspection. People who used the service were younger and older adults with either physical or mental health needs and people with alcohol and substance misuse needs.

The service had 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their Provider Information Return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Gensing has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding people and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Medicines were managed safely and in accordance with current regulations and guidance. There were systems to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and catheter care training. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. People were being supported to make decisions in their best interests. The registered manager and staff

This inspection took place on 03 June 2016. This was an unannounced inspection. This location is registered to provide accommodation with personal care for up to 17 people. People who used the service were younger and older adults with either physical or mental health needs and people with alcohol and substance misuse needs.

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.

Staff had not completed the relevant training in safeguarding adults. Staff could not explain the potential signs of abuse or understood what processes they needed to follow to keep people safe from possible harm. Safe recruitment systems were not in place to ensure the staff were suitable to work with people at the service.

Fire safety measures were not sufficiently robust to ensure people would be safely evacuated in the event of a fire. Adequate maintenance and infection control measures were not in place to ensure the environment was safe for people.

Staff had not completed a relevant induction or training to meet people’s individual care and treatment needs. Staff had not received training in the principles of the Mental Capacity Act (2005) to ensure they obtained people's consent lawfully. Staff had not received regular supervision or appraisals to address their training and development needs to ensure people received effective care.

People had not consistently had access to appropriate health professionals to effectively meet their health needs. People’s care and treatment was not routinely reviewed with the involvement of relevant health care professionals to ensure their health, safety and welfare.

Staff had not routinely reviewed people’s care plans and risk assessments regularly with their involvement. Staff followed care plans and provided care which did not consistently reflect people’s most current needs and preferences. People’s care plans were not personalised in all cases to enable staff to meet people’s individual preferences. There were insufficient activities available based on people’s needs and wishes available at the service.

The provider had not routinely consulted people or staff to obtain their feedback to influence how the service was developed. A robust quality assurance system was not in place to effectively identify all service shortfalls and to ensure service improvements were made.

The provider had not demonstrated they fully understood their regulatory obligations to share important information with us to keep people safe. The provider had not notified us of significant events at the service.

Medicines were administered and recorded safely and correctly. Medicines storage practices required improvements. We have made a recommendation about this.

The provider had not considered accessible ways to inform people about services available to them, to include advocacy. We have made a recommendation about this.

There was sufficient staffing level to meet people’s assessed needs.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

People told us staff treated them with kindness, compassion and respect. People’s privacy and dignity was respected by staff. Staff promoted people’s independence and encouraged them to be as independent as possible.

People were encouraged to make complaints where necessary. A complaints process was in place to ensure service improvements were made.

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 the report.

There were 15 people living at the home. One person had been admitted to hospital and was receiving care within a specialist unit.

We spoke with five people and five staff. One person told us, “The staff always do their best for us.”

We found that people were shown respect and dignity. We observed positive interaction between staff and people.

We looked at two care plans and saw that they reflected the care that was provided to people. The home had systems in place to ensure people’s individual needs were met.

We looked in five rooms, we found the home to be clean and tidy. One person told us, “Someone comes into my room every day to have a clean and tidy.”

The home had sufficient numbers of qualified staff on duty. One person told us, “There is always staff around to have a chat with.”

The home had an effective complaints system however it was not on display. People we spoke to were aware of how to make a complaint.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they did not all want to tell us their experiences. Those that did talk to us said they were well cared for and staff were kind. One person told us, "The staff are very good." Another told us, “We have very good food." People were supported to be independent and have choice with decision making.

Staff told us they had regular training and supervision. We saw records that showed that people were involved in decisions about their care and that people were treated with dignity and respect. We looked at training records that showed that staff received development to help them perform their roles safely and well. We found that the home was comfortable and the provider had effective quality assurance systems in place to monitor their service delivery.

We were told by people that they liked living in the home. Comments included “the staff always do what they can to help you”, “the foods good” “we are all good friends now”, “really helped me”.

Some people had lived in the home for 21 years.