About the service: Rayner House is a residential care home, providing personal care to 37 people aged 65 and over at the time of the inspection. The home also has a registration for personal care, however at the time of inspection this was not being carried out.

People’s experience of using this service:

¿ Staff knew how to recognise potential abuse and who they should report any concerns to.

¿ People had access to equipment that reduced the risk of harm.

¿ There were sufficient staff on duty to meet people’s needs.

¿ Staff supported people to get their medication.

¿ People had a choice of food and were supported to maintain a healthy diet in line with their needs and preferences.

¿ Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

¿ People enjoyed positive and caring relationships with the staff team and were treated with kindness and respect.

¿ People’s independence was promoted as staff were careful not to do things for people they could do for themselves.

¿ People were supported by staff who knew about their needs and routines and ensured these were met and respected.

¿ Staff and relatives knew how to complain and were confident that their concerns would be listened to.

¿ People and staff were happy with the way the service was led and managed and the provider worked well with partners to ensured people’s needs were met.

We found the service met the characteristics of a “Good” rating

More information is available in the full report.

Rating at last inspection: Good (Published May 2016)

Why we inspected:

This was a planned inspection based on previous rating.

Follow up:

There will be ongoing monitoring and routine inspections of the location.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on Monday 18 April 2016 and was unannounced.

Rayner House provides personal care and accommodation for up to 26 people. They also provide a personal care service to some people who live in the flats within the Yew Trees housing complex next to the home. On the day of our visit, 26 people received care at the home, and two people from the Yew Trees Housing Complex received personal care.

At our last inspection on 16 and 23 December 2014 we identified concerns with quality monitoring in the home. We also identified concerns with the delivery of care to people to ensure they were safe. We asked the provider to take action to make improvements. At this inspection we found improvements had been made.

The registered manager had recently cancelled their registration as manager at the home, and the new manager had applied to the CQC to be registered with us. The new manager had worked at the home since June 2015 in a management capacity to support the previous 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.

People at the home were supported by staff who were kind, caring and who understood people’s needs, wants and preferences. People’s privacy and dignity were upheld by staff.

Sufficient staff were on duty to meet people’s needs. The provider’s recruitment practice provided assurance that all measures had been taken to recruit staff who were safe to work with people. Staff received training and management support to help them effectively meet people’s needs and to keep people safe.

People were supported in line with the principles of the Mental Capacity Act. The manager understood the importance applying for Deprivation of Liberty Safeguards (DoLS) when there was a need for restrictions to be placed on people’s care to keep them safe. No-one who lived at the home was under a DoLS at the time of our visit.

People enjoyed the food provided and the choice of meals available to them. Timely referrals to the relevant healthcare professional were made when staff had concerns about people’s health. People also received healthcare support to maintain their well-being. People received their medicines as prescribed.

Group and individual activities were provided for people’s enjoyment. Staff supported people, where possible, to continue to pursue their individual interests and hobbies.

People knew how to make a complaint if they needed to, although no formal complaints had been made since the new manager started at the service. The manager encouraged open communication with people, relatives and staff, and they in turn, confirmed this was the case.

Quality assurance systems were used effectively to drive improvements in the home. The board of trustees provided good support to the manager in ensuring the home met the needs of people who lived there.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?”

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service and one of their relatives, four care staff supporting them and looking at four care records and four staff records

.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us they felt safe. Safeguarding vulnerable adult procedures were in place and staff understood their role in safeguarding the people they supported.

We found that the provider had policies and processes in place to ensure that people rights were protected in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that staff had training in how to protect people's rights and gain their consent.

We found that people's care records showed that risks to individuals had been assessed but did not have appropriate plans in place to prevent harm to people. We found care staff were not aware of the risks associated with delivering care and support.

The registered manager ensured that staff rotas were planned in advance to maintain the required staffing numbers. The provider had recruitment systems in place to ensure that staff were of good character and had the necessary skills.

Robust systems were not in place to make sure managers and staff learned from events such as accidents, incidents and complaints. This increased the risk to people and failed to ensure that lessons are learned from mistakes.

Is the service effective?

People's care needs had been assessed but appropriate plans to meet their identified needs were not always in place. Some of the care plans had not been regularly reviewed and staff could not support people’s needs as required.

People told us they were able to see their visitors in private if they wished and that visiting times were flexible.

Care staff received the appropriate training to meet the diverse needs of people who used the service.

Is the service caring?

People were supported by staff that were kind and caring. We saw that care staff gave people encouragement and were patient with them. One relative told us, "The staff are very calm and have patience".

People using the service had completed an annual satisfaction survey. There were some shortfalls and concerns that had been raised. The registered manager was unable to tell us what actions had been taken to address these shortfalls.

People's preferences, interests, aspirations and diverse needs had not always been recorded. This meant that care and support was not always provided in accordance with people's wishes.

Is the service responsive?

Care staff told us they had raised concerns about people's changing needs with the registered manager but that they were not always responded to. We found that staff had raised concerns in staff meetings. The registered manager was not able to tell us what actions they had taken to resolve these concerns.

People who used the service had made requests for changes to the service provided. These requests had been recorded but no action had been taken to meet those requests.

Is the service well led?

The registered manager was not able to provide us with any information on how they managed or identified risks. The quality assurance checks that were made contained no information about what was checked and what was found.

Where concerns had been raised by care staff and people who used the service, the registered manager had not investigated these concerns or resolved them.

At the last Care Quality Commission inspection of the service in August 2012 we found the provider to be non compliant in three areas, medicine management, staff training and record keeping.

We asked the provider to send us an action plan and documented evidence to show how they intended to become compliant and meet the outstanding regulations. The provider sent us a detailed action plan explaining what steps they had taken to achieve compliance and how they intended to maintain compliance with the regulations.

We then visited the service in July 2013 to check the service was now compliant. We found the service to be much improved. The medication system had been completely reviewed and updated. New policies and procedures were in place and staff who administered medication had received training and had been assessed as competent.

Training for staff had taken place in the mandatory areas such as fire safety, infection control, moving and handling and safeguarding. Training records were up to date and a central matrix identified when training was needed for each staff member. Staff supervision sessions now took place regularly and were formally documented.

Records had been reviewed and amended. All the records and documentation we saw was up to date and in good order.

We found the service to be compliant.

We spoke with four people living at Rayner House. People told us: “There are very good staff. Anything you ask them to do they will do it.” “They are very pleasant, they are very kind, if you ask them to do anything they will try.”

We saw that people were appropriately dressed with neat hair and nails. We observed that staff were friendly and respectful towards people and people told us there was a member of staff who they could approach if they had any concerns.

Some people told us they enjoyed the entertainment and some people told us they preferred to stay in their room and watch television or listen to the radio. One person told us: “The entertainment is good at holiday times. Someone sings and plays the piano, that’s quite nice. They do their best to entertain, I go around and chat to people.”

We observed people enjoying their meals and we saw that there were sufficient choices being made available. Most comments about the food were positive. These included: “The food is very good, they have a very good chef.” “The food is very good, the kitchen staff and servers are very nice. ”Sometimes I just don’t like it.”

We found that improvements were needed in some areas. This included the management of records, medicines and information about staff training and development..

We saw that people had an opportunity to voice their opinions about the care and services being provided within ‘resident’ meetings and provider visits.

We saw that following our last visit the service had applied for an extra regulatory activity to provide ‘personal care’ to people situated in the Yew Tree flats. We did not fully assess the service linked to this regulated activity during this visit.

We visited Rayner House on 23 February 2012. We did not tell the service provider that we were going to visit.

Some people living in Rayner House were not able to tell us about the care they received. We spoke to seven people who lived in the home and four visiting friends or relatives. We spoke with a health professional and three people that worked in the home. We observed how care workers spoke to and cared for people.

People told us that they were happy with the care they received they said:

"It is equal to any place I've been. I quite like it here."

"It is marvellous."

"On the whole it is very good."

"The girls (care workers) are ok, nothing I would say against them."

"I would like some more activities. I like it when we have barbecues and the cream teas."

"I like the exercise sessions."

People visiting people in the home were happy with the care provided. They said that the care workers and the management were friendly. They were informed about any changes in their relative's health needs. They said that if they raised any issues they were dealt with. Some thought that more activities that were of interest to people should be developed.

A health professional told us they visited the service regularly and had no concerns about the care given in the home.

The inspection took place on 16 December and 23 December 2014. It was an unannounced inspection.

Rayner House provides personal care and accommodation for up to 26 people. They also provide a personal care service to some people living within the Yew Trees housing complex adjoined to Rayner House.

At our last inspection in April 2014 we identified concerns with people’s care and welfare, the monitoring of the quality of service provision and record keeping. At this inspection we found improvements had been made but further improvements were still required.

This home has 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 and associated Regulations about how the service is run.

People who lived at the home and staff told us people were safe. There were systems and processes in place to protect people from the risk of harm. These included robust staff recruitment, staff training and systems for protecting people against risks of abuse. Risks to people were minimised because people received their care and support from suitably qualified staff in a safe environment that met their needs.

People told us staff were respectful towards them and we saw staff protected people’s privacy and dignity when they provided care. Staff were caring to people throughout our visit.

People told us there were enough suitably trained staff to meet their individual care needs. We saw staff spent time with people and provided assistance to people when they needed it.

Staff understood they needed to respect people’s choice and decisions if they had the capacity to do so. Assessments had been made and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were considered in ‘their best interests’ with the involvement of family and appropriate health care professionals.

The provider was meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, two applications had been authorised under DoLS for people’s liberties to be restricted. The registered manager was aware of the impact of a recent court judgement on the implementation of DoLS and had submitted applications to the appropriate bodies to make sure people continued to receive appropriate levels of support.

People’s health and social care needs had been appropriately assessed. Pre assessments were completed before people received care at the home. The manager told us this helped them to make sure people’s individual needs could be met before people moved to Rayner House.

Care plans provided information for staff to help them meet the individual care needs although we found these did not always reflect the levels of support people required.

Risks associated with people’s care needs had been assessed and plans were in place to minimise any potential risks to people. However some of these risks had not been managed appropriately which had potential to put people at increased risk of harm.

There was a procedure in place for managing medicines safely.

Systems were in place to monitor and improve the quality of service people received but these required further improvements. The manager had action plans in place but did not always follow these through to make sure the improvements had been made.