This inspection took place on the 28 June 2016 and was unannounced.

Harbour Rise Rest Home is a long established care home without nursing, accommodating up to 44 people. People living at the home were older people, some of whom were living with dementia, or physical frailty. The home also provides day care for people, but this was not under a regulated activity regulated by the Care Quality Commission, so did not form a part of this inspection. The home had been undergoing a programme of expansion following the purchase of the adjacent property, and this was almost complete. The programme had involved extensive remodelling of the interior to provide wider corridors and doorways, en-suite facilities for all rooms and improved service and communal areas.

There was 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’s care were being assessed and mitigated, however, some risks in the environment had not been identified. Some of these were addressed at the time of the inspection. We have made a recommendation about this. People were being protected from the risks associated with medicines and a new medicines management system had been implemented.

Staff understood how to safeguard people from abuse. Staff told us they had no concerns over the quality of care or safety people were experiencing at the home, but would report them if they did. They had received training in how to identify abuse and what actions to take. The home had complaints policies and procedures for people to use to raise any concerns.

We saw that people’s needs were being met in a timely way on the day of the inspection, and records showed that call bells were responded to quickly. The provider told us they had recently increased staffing levels. Although we received some conflicting information about whether there were enough staff on duty to meet people’s needs, the provider told us that members of the management team would always provide additional cover if it were needed and the home would not be short of staff.

A clear recruitment process was in place to identify risks in relation to staff employment. This was reflected in the staff files we saw. There was not a system in place for the recording of decision making in relation to risks identified during the staff recruitment process, however we saw that where risks had been identified they had been assessed. The registered manager agreed to record this in future.

Staff told us they had the skills and training they needed for their job role and we saw they were knowledgeable about people’s care needs. Spot checks were carried out on their performance, and they told us they felt supported. The registered manager told us that systems for recording training, learning and competency were under further development.

Care files and plans reflected people’s needs or wishes about their care and how this was to be delivered. Plans were updated regularly, and contained information about how people wanted to be supported and their life history where this was possible to obtain. Some plans would benefit from additional information being available to support people with behaviours that might be challenging. People received good support from community healthcare services, and referrals were made to appropriate agencies if people’s health deteriorated. Some people with long term health conditions found these had improved since being at the home. People were supported to make choices about meals and they told us they ate well.

The service was supporting people in line with the Mental Capacity Act, and protecting their rights. Assessments of people’s best interests were being carried ou

There were 34 people living at Harbour Rise at the time of our inspection. We spoke with eight people who lived at the home. We met others who were unable to give us their views in depth because of their mental or physical frailty. We looked around the home, and spoke with care staff, the registered manager, head of care and one of the providers.

We saw no evidence to confirm that people had been asked for their consent or how the provider acted in accordance with their wishes before they received any care or treatment.

People we spoke with were positive about the support they received. People who lived at the home told us they were well looked after and were happy. One person said “I can assure you we are all well looked after”.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The home did not operate a robust recruitment to ensure suitable and properly qualified people had been employed by the home.

People told us that they felt safe and knew what to do if they had concerns. One person said "If I was unhappy about anything I would speak to staff or the manager." A visitor told us they would feel comfortable making a complaint if they needed to.

Accurate and appropriate care records had not always been maintained. This meant that people were not always protected from the risks of unsafe or inappropriate care and treatment.

Many people living at this home had a diagnosed dementia or symptoms of dementia. Care workers demonstrated an excellent knowledge of how each person was affected and of the principles of person centred care. People enjoyed living at the home. One person said that moving there had been a good decision and another said “I am so lucky to be here”. We saw that people’s privacy, dignity and independence were respected. People were supported to maintain their abilities for example being supported to feed themselves and to remain continent. People were helped to remain healthy because their health care, health promotion and social and psychological needs had been assessed and actions had been taken to address these needs. People said they felt safe and were very complimentary about care workers. They said “they are so good and caring” and “they make sure I have everything”. We saw there were enough care workers and staff on duty with the right skills, to meet people’s needs. There were systems in place to manage risks and to monitor quality. There was a clear ethos of person centred care, and strong leadership in place. People were supported to be involved in the home through for example residents meetings and a quarterly newsletter. Some people were more actively involved, for example one person answered the front door, delivered the post to the office and welcomed visitors. The providers were making significant investments to restore, improve and extend the home.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We looked to see if the improvements identified as needing to be made following our inspection in January 2014 had been addressed. During this inspection we also followed up on information of concern we had received about the service. The information we had received related to staffing levels, care and welfare of people who used the service and meeting people’s dietary needs. We found that the home had made improvements in the areas we looked at.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe and comfortable.

There were enough staff on duty to meet the needs of the people living at the home and staff had the skills and knowledge to safely support people. Comments included, “The staff always check on me, I have a nice feeling of safety here”; “I come at varying times throughout the day to visit my Mum and there’s usually a lot of staff around” and “I feel since my Mum has been here she has improved a lot, she is safe and secure”. People’s care plans provided staff with sufficient information to safely manage people’s needs.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant the provider had taken steps to demonstrate that the staff employed to work at the home were suitable to work with vulnerable people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS aim is to ensure people are protected from the risk of inappropriate restraint in any form. The Registered Manager demonstrated that before our inspection was completed, all persons who used the service had been reviewed under DoLS and where necessary applications had been made.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was evident from what we observed and from conversations we had with staff that they understood people’s care and support needs and they knew them well. Comments included, “I can’t fault this place in anyway at all, I think it’s marvellous and I’m saying this from the bottom of my heart” and “All the staff know my mum well, when her dog needs walking, the staff really comfort her during this high period of anxiety”

We saw that care plans reflected people’s individual need and professional advice was sought and followed by staff to ensure people who used the service received effective and appropriate care that met their needs.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff were patient when supporting people and displayed compassion when offering support. Comments included, “The staff are cheerful, friendly and willing, they really care about you” and “Everything is amazing, they are all very caring, I think my Mum is very lucky to be here”.

Is the service responsive?

People’s needs had been assessed and monitored. Care plans were reviewed regularly when changes occurred and reflected people’s current needs.

The home had taken account of published research and guidance to reduce the risk of unsafe or inappropriate care. The home responded quickly where risk was identified and sought specialist advice where appropriate to meet people’s changing needs.

Is the service well-led?

Staff felt supported by the management structure. Comments included, “If I had any concerns about anything I would speak to the manager, she really listens and action gets taken” and “The management are very approachable and supportive.”

There was an effective quality assurance system in place. Staff and people who used the service were regularly consulted about the quality of care provided. Learning from incidents took place, complaints and concerns were taken account of and action was taken to improve the service.