We carried out an unannounced comprehensive inspection of this service in April 2016 and rated the service as ‘Good.’ However, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the providers website did not display the correct rating for the location. We checked that the provider was displaying the correct rating in October 2016 and found that they were compliant with the regulations.

Quenby 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 older people who may have dementia.

Quenby Rest Home is situated in a residential area. The premises is on two floors with each person having their own individual bedroom and access to communal areas within the service. At the time of our inspection, 23 people were using the service.

There was a registered manager in post. The registered manager was also the provider. 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.

At this inspection we identified 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.

Improvements were required regarding the storage, administration and auditing of medicines and to ensure that all risks to people's health, safety and welfare were effectively assessed. Care plans required further development to ensure records were complete, were legible and provided clear guidance of the support that people required. We have made a recommendation that the service consults guidance to further develop the Accessible Information Standard (AIS).

Staffing levels required review to ensure there were adequate numbers of staff on duty to support people and meet their needs and to ensure that care was provided at times to suit them. Staff had been recruited safely and were trained and supported to meet people’s needs, however some refresher training was required.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Processes were in place that encouraged feedback from people who used the service and relatives, however improvements were required to evidence that action was taken in response. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. Where people required further input, referrals were made promptly to other agencies and people were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Care and support was based on the assessed needs of each person. However, improvements could be made to ensure the environment was suited to people living with sensory impairment or dementia. We made a recommendation regarding the further development of a dementia friendly environment.

Staff demonstrated a basic understanding of the Mental Capacity Act (MCA) 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, however the completion of mental capacity assessments required improvement.

End of life planning required further improvement. We made a recommendation that the service consults a re

This focused inspection took place on the 13 October 2017 and was unannounced. We returned to this service, rated Good in all domains, because during the last inspection in April 2016, the provider had failed to ensure that the correct and most recent rating at the service was displayed on their website, nor in the home. This was a breach of regulation 20a of the Health and Social Care Act, 2008. Our return was to check that the provider was no longer in breach of this regulation.

Quenby rest home is a care home providing accommodation for up to 26 older people who may also have physical disabilities, dementia or sensory impairment.

At the time of inspection there was no registered manager at the service, however, a new manager was due to begin working at the home on the 16 October 2017.

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.

During this inspection we found that the provider was no longer in breach of Regulation 20a of the Health and Social Care Act.

Quenby Rest Home provides accommodation for up to 26 people older people. The service provides care and support to people with a range of needs which include; people living with dementia, those who have a physical disability, and/or a sensory impairment.

There were 20 people living in the service when we inspected on 13 April 2016. This was an unannounced inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring an accurate representation of the service provided at Quenby Rest Home was reflected on their website. You can see what action we told the provider to take at the back of the full version of this report.

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Care and support was based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. People were encouraged to pursue their hobbies and interests.

People or their representatives were supported to make decisions about how they led their lives and wanted to be supported. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date regarding the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities. Audits and quality assurance surveys were used to identify shortfalls and drive improvement in the service.

We carried out an unannounced inspection on the 3 June 2015. Quenby Rest Home provides care for up to 26 older people who may be elderly and or have a physical disability. Some people are living with dementia. There were 20 people living in the service when we inspected.

There was no 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. A new manager had recently been appointed and their paperwork was in the process of being submitted to CQC.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to protecting people by ensuring the premises was secure, well maintained, fit for purpose and safe. You can see what action we told the provider to take at the back of the full version of this report.

Staff were aware of the values of the service and understood their roles and responsibilities. Whilst there were sufficient numbers of staff, improvements were needed in the deployment and organisation of staff to ensure people’s needs were consistently met. Supervision arrangements to support staff were not robust.

Not everyone was encouraged to pursue their hobbies and interests and participated in a variety of personalised meaningful activities. People who remained in their bedrooms or were cared for in bed received little social attention and were at risk of isolation as staff interactions were task focused.

The provider’s complaints system was not robust. Not everyone knew how to make a complaint or report a concern. There were inconsistencies in how issues were reported; records did not always show that feedback had been acted on promptly and appropriately.

Systems in place to monitor the quality and safety of the service required further development to drive the service forward.

Staff interacted with people in a caring and compassionate manner. The atmosphere in the service was friendly and welcoming. Staff listened to people and acted on what they said. Staff understood how to minimise risks and provide people with safe care. Care and support was individual and based on the assessed needs of each person.

Appropriate recruitment checks on staff were carried out. Staff understood their responsibilities to protect people from harm and report any concerns about people’s welfare. People were provided with their medicines when they needed them and in a safe manner.

People were encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

People voiced their opinions and had their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests.

People were provided with a variety of meals and supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

During our previous inspection on 6 November 2013 we found shortfalls with the safety and suitability of premises. The provider submitted an action plan 30 December 2013 telling us how they would address these shortfalls.

As part of our inspection on 1 May 2014 we followed up on the non-compliance found at the last inspection. We found that improvements had been made to address our concerns.

During this inspection we spoke with seven of the twenty two people currently living in the service and two visitors to the service. We also spoke with four members of staff including the registered manager.

We looked at four people’s care records and three staff files. Other records seen included: care plans and risk assessment reviews, complaints log, resident meeting minutes, staff meeting minutes, relatives meeting minutes, accidents and incidents log, medication audits, staff rota, fire safety checks, maintenance logs, water temperatures, and safety checks on equipment.

We considered the evidence we had gathered under the outcomes we inspected. 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?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor’s book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the service.

People told us they felt safe, protected and their needs were met.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, we saw that policies and procedures were in place. The registered manager confirmed that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded.

Records seen confirmed that staff were booked onto upcoming or had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

There were effective policies and procedures for managing risk. Staff understood and consistently followed them to protect people.

Records seen confirmed health and safety was checked in the service and equipment was maintained and serviced.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Records showed that staffing levels were based on the level of dependency and needs of the people who used the service.

Support for staff was provided through effective training, supervision and appraisal.

People especially those with complex needs, were protected from the risk of poor nutrition, dehydration, swallowing problems and other medical conditions that impact on their intake.

Is the service caring?

Care was individualised and centred on each person.

Staff had a good understanding of the people’s care and support needs and knew them well.

Staff interacted with people who used the service in a caring, respectful and professional manner. People told us they were happy with the care they received and their needs were met. One person told us, “The staff are kind, caring and compassionate, it’s very good here”.

People who used the service, their relatives and other professionals involved with Quenby Rest Home completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, community matron and chiropodists.

People told us they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate actions had been taken to address them.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities and were supported and trained to meet people’s needs.

People's care records and risk assessments were accurate and up to date.

The provider had systems and procedures in place to monitor and assess the quality of the service provided. There were records to identify shortfalls in the service and how they had been addressed.

Feedback from people who used the service about their experiences was valued, taken into account and influenced the running of the service.

People were complimentary about the care and support that they received from the staff at Quenby. They told us that staff were very nice and supportive. They also told us that staff understood their care needs very well and always supported them in ways that were respectful and polite.

People received care that met their individual needs. Staff were provided with training and support to ensure they had the knowledge and skills to care for people safely.

People were comfortable in the home but improvements were needed in the way the home was maintained to ensure people were not put at risk from living in an unsafe environment.

There were effective processes in place to monitor the quality of the service. The provider consulted with people and took their views into account to make improvements.

We saw that staff received appropriate training some of which was specific to the needs of people using the service. Measures were in place to assess the standard of care provided.

People that we spoke with told us that care staff understood their care needs well. They also told us that staff were very supportive and understanding when supporting them. One person told us 'the staff are lovely, always respectful and polite. A relative spoken with told us that people living in Quenby were treated with dignity and respect and they were involved in making decisions about their care and support.

Relatives who completed surveys as part of the home's own quality assurance system

made positive comments about the service provided at Quenby.