This inspection took place on the 15 and 16 February 2017. The first day of our visit was unannounced.

Rearsby Home Limited is located in the small rural village of Rearsby, near Melton Mowbray in Leicestershire. The service provides care and accommodation for up to 27 older people with age related needs, including mental health needs, dementia and physical disability. On the day of our inspection there were 24 people living at the service.

People told us the meals served at Rearsby Home Limited were good. Their nutritional and dietary requirements had been identified and a balanced diet was being provided. However, people’s dining experience varied, with some people enjoying a more positive and inclusive experience than others. This was because the staff team did not always interact well with those they were supporting. We also observed care workers supporting two people to eat their meal at the same time. This did not promote either person’s dignity.

People told us they felt safe living at Rearsby Home Limited. Relatives we spoke with agreed and told us and that they felt their relation was safe with the staff team who supported them.

The staff team had received training on how to keep people staff and knew the procedure to follow if they were concerned that someone was at risk of abuse or avoidable harm.

People’s needs had been identified and the risks associated with their care and support had been assessed. These assessments provided the registered manager with the opportunity to reduce and properly manage the risks presented to both the people using the service and the staff team.

Plans of care had been developed when people had moved into the service. These provided the staff team with the information they needed to enable them to support the people using the service in a way they preferred.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to see that they were suitable and safe to work there.

People were supported by a staff team with the right skills and knowledge. Staff members were supported through Induction, training and supervision and were aware of their responsibilities under the Mental Capacity Act 2005.

People felt there were currently enough members of staff on duty each day because their care and support needs were being met. The registered manager monitored staffing levels to make sure appropriate numbers of staff were deployed.

People had been involved in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, these had been made for them in their best interest and in consultation with others. The staff team understood their responsibilities with regard to gaining people’s consent, though this was not always observed.

People received their medicines as prescribed by their doctor. Medicines were being appropriately stored and the necessary records were being kept. There were systems in place to audit the management of medicines and medicines were only administered by staff members who were competent and appropriately trained.

People using the service had access to the required healthcare services and they received on-going healthcare support.

People told us the staff team were kind and caring. Relatives we spoke with agreed with this and told us that the staff team treated their relative with kindness and respect. This was observed on the whole, with the staff team treating people with respect and when supporting them, doing so in a kind and friendly manner.

A complaints process was in place and a copy of this was displayed for people's information. Although not everyone we spoke with had seen this, they knew who to talk to if they had a concern of any kind.

People had the opportunity to be involved in how the service was run. They were asked for their opinions of the service on a regular basis. This was through daily dialogue and through the use of surveys.

The re

This inspection took place on 29 January 2015 and was unannounced.

At the last inspection on 2 June 2014 we found the service met all the regulations we looked at.

Rearsby Care Limited is a care home for up to 27. The home specialises in caring for older people including those with physical and sensory disabilities and people living with dementia. At the time of our inspection there were 25 people present and two people in hospital.

Rearsby Care Limited is required to have 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. At the time of the inspection a registered manager was in post.

People told us they felt safe with the staff that looked after them. People who used the service gave us positive feedback about how their care and support needs were met. Staff had a good understanding of their role in meeting people’s needs and the actions they should take if they had any concerns about people’s safety.

People also told us how they were involved in the development of their plans of care. Whilst people did not raise any concerns about the administration of medicines, we found two concerns that we brought to the attention of the manager.

People’s dependency needs had been assessed and the manager had identified that an additional care staff member was required for the mornings. The manager had been unsuccessful in recruiting but was pursuing this.

People told us they felt confident that staff were knowledgeable, competent and experienced and that consent was sought before care and support was provided. People gave examples of how the staff had supported them to maintain their general health by accessing healthcare services. They said that they felt staff listened to them and responded promptly and effectively if there were changes to their health and welfare needs.

Staff had received an appropriate induction and ongoing training and support. Staff supported people to access healthcare services and worked with healthcare professionals in meeting people’s needs.

People told us they had sufficient to eat and drink and that they were happy with the food choices. People’s dietary and nutritional needs had been assessed and planned for.

The manager was knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and the action required to ensure people were not unlawfully restricted.

People spoke positively about the staff’s approach and the care and support they provided. This included respecting their privacy and treating them with dignity. People had been asked about their preferences in the way they were cared for such as their routines and what was important to them. Staff were aware of people’s individual needs and preferences.

Throughout our inspection we saw people’s dignity and privacy was respected, which promoted their wellbeing. The atmosphere was calm and relaxed and people looked comfortable in the presence of staff.

Whilst people received some opportunities to engage in activities it was unclear if people were supported to peruse their interest and hobbies. The visual environment could have been improved upon to support people with memory loss to promote independence and maintain their sense of identity and find their way around.

People said they felt confident to raise any issues, concerns or complaints if they had any. They also spoke positively about the leadership and that they felt the communication was good within the service. Staff said they felt supported.

The provider had quality assurance systems and processes in place that showed how they were monitoring the quality and safety of the service.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with eight people who used the service for their views and experiences. We also used observation to understand people’s experience, as some people had communication needs and were unable to tell us their views and experiences.

During our inspection we spoke with the registered manager, deputy manager and two care staff. We looked at some of the records held in the service, including the care files for three people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People told us that they felt safe and that staff supported them appropriately.

We saw the provider had internal systems and processes in place that monitored the quality and safety of the service. This reduced the risks to people and enabled the service to continually improve.

We saw people had received a pre-assessment, and care plans and risk assessments were in place and reviewed regularly. This meant risks that had been identified, had measures in place to reduce risks and keep people safe.

People had their dependency needs assessed which informed the level of staff required to meet people’s needs and keep people safe. We saw the staff roster showed there was sufficient staff employed and deployed appropriately.

We, the Care Quality Commission (CQC) monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to nursing and care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. We saw an authorisation was in place for one person. This showed the provider had acted appropriately and within the legislation.

Is the service effective?

We saw people’s preferences, routines, health and welfare needs had been assessed. We saw examples of referrals and joint working with health professionals in meeting people’s needs. This showed person centred approaches to care delivery.

People who used the service were provided with information about the service. The provider had sought information about local advocacy services and had made this available for people. People were supported to know what their rights, choices and options were.

Staff received appropriate training, development and support to enable them to do their job effectively.

People received balanced and nutritional meals that met their dietary requirements. People received sufficient food and fluid that kept them hydrated.

Is the service responsive?

We saw activities were provided by the staff and external entertainers visited the home. Daily newspapers were provided for people to read. One person told us how they had been encouraged and supported to organise a fund raising activity.

The provider had a complaints policy and procedure that supported people to know their rights, and what action to take should they wish to complain about the service.

Is the service caring?

We found staff knowledgeable about people’s needs, preferences and routines.

We found staff were kind and attentive. We observed people who used the service appeared relaxed and at ease with the staff supporting them.

Is the service well-led?

Staff were aware of their roles and responsibilities, this showed good leadership and accountability.

We saw the provider had quality assurance processes in place to monitor the quality of services provided to people.

Because some people who live at Rearsby Residential home have cognitive disability or communication difficulties, we were unable to ask people directly about their experiences. We spent time and observed people’s daily routines and interactions with others from a distance. We saw that people’s needs were attended to promptly by staff, and that people were relaxed throughout our visit.

We observed staff talking with people this was done with their privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs. We also looked at how people’s individual care, support and dietary needs are organised planned. We looked at how staff compile care and other supporting records and documents, and how the staff were supported with training on both an individual and group basis.

We spoke to a number of relatives and staff during our visit. The relatives we spoke to were very happy with the home, the cleanliness and attitude of staff. One of the relatives stated they had been recommended by a nurse to move their mother to the home following an unsettled time at their previous residential home. They said, “Now that mum’s moved from (the other residential home) I am happy with her stay here, this one is much better.” They added “She is always well dressed and her hair is done regularly, I visit regularly and we are able to go out to church together.” We returned to the home to ensure staff had made improvements to two outcome areas. We noted improvements in both and staff showed a greater awareness of how to protect people using the service from the effects of cross infection and cross contamination.

We also looked at how complaints and compliments are handled by the staff. We found that the provider included a clear commitment to dealing with complaints in their Statement of Purpose and had a ‘Comments Box’ available for the use of relatives and visitors. The provider had also issued a quality assurance which they call a ‘Family Questionnaire’ we saw evidence where the provider dealt with a concern which had been raised by a relative.

Some of the people we spoke with have limited and specialised communication. We were unable to directly ascertain what people felt about their experiences in this outcome area.

People looked relaxed and were enjoying breakfast at the time of our visit. We saw staff assisting people to eat their meal. This was done at a pace individual to each person, in a dignified manner and staff had good eye contact with people throughout the process.

We spoke to staff that were aware of the needs of individual people, and were able to explain the different levels of intervention and support people required.

Peoples care plans have improved and the local authority continues to support the staff with this exercise. Staff have shown a greater awareness of how to safeguard people, and have undergone training to assist them understand the importance of this.

Quality assurance is evident in many areas of the home and systems in the home, though more evidence could be obtained from relatives and visiting professionals. There is confusion amongst staff as to the finer details in dealing with infection control and preventing cross infection and cross contamination within the environment of the home. We will make a further visit to ensure this has improved.

There were eighteen people living in the home during our visit. We spoke with three people who use services, three visitors and four staff. People who use services told us,

“My bedroom is delicious and comfortable and I have a toilet in my room.”

“There is nothing to do here.”

One person who uses services told us she attends a religious ceremony in the home on Sunday and enjoyed this.

Visitors told us overall they were happy with the service and had confidence in the staff.

People’s care plans need improvement together with how staff deliver care and support. Systems to manage the prevention and control of infection are not fully implemented. We found parts of the home were not clean and presented with unpleasant odours.

Staff training around safeguarding adults to be actioned, and the quality monitoring systems improved. This would ensure people who use service benefit from safe quality care, treatment and support due to effective management decisions.