This inspection took place on 28 September 2017 and was unannounced. We last inspected the service in February 2017 when we rated the service as Good overall.

This inspection was prompted by information we received about an incident following which a person using the service later died. This incident was subject to an investigation under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These Regulations require employers and those in control of premises to report specified workplace incidents. This inspection did not examine the circumstances of the incident. However, the information shared with CQC indicated potential concerns about how the service managed risks within the homes garden and surrounding external grounds.

This report only covers our findings in relation to these concerns. The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Reinbek’ on our website at www.cqc.org.uk.

Reinbek is registered with the Care Quality Commission (CQC) to provide 24 hour care and accommodation for up to 46 older people with a wide variety of conditions and frailties and some people who are living with dementia. People who used the service were cared for in accommodation over two floors. All rooms are single and 27 rooms have en-suite facilities The home also provides short stay and day care services. At the time of the inspection 46 people were using the service.

A general manager was in place and an application to become registered as manager with the Care Quality Commission (CQC) had been submitted. 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.

The provider had taken prompt action to help prevent a similar incident occurring by carrying out external ground work that ensured any identified garden risks were mitigated.

Care records, individual risk assessments/ risk management plans and appropriate garden monitoring/checking systems were in place. These systems ensured that where people wanted to spend time in the garden they would be enabled to do so safely.

A ‘Garden Policy’ was in place to ensure the safety and wellbeing of people using the service, visitors and staff when using the garden and external grounds

The provider had taken prompt action to help prevent a similar incident occurring. They had commissioned an independent external health and safety advisor to identify existing control measures, hazards and severity of potential risks within the garden and external grounds.

The provider had followed the principles of the Duty of Candour, following the incident. The Duty of Candour sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, truthful information and an apology.

This was an unannounced inspection which took place on 13 and 14 February 2017.

We last inspected the service on 8 and 9 September 2015 where we rated the overall service as Requires Improvement. At that inspection we identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to the management of medicines the management of environmental risks, infection control and staff supervision.

This inspection was to check satisfactory improvements had been made and to review the ratings. We saw evidence to confirm that action required following our last inspection had been taken and the requirements of the regulations were being met.

Reinbek is registered with the Care Quality Commission (CQC) to provide 24 hour care and accommodation for up to 46 older people with a wide variety of conditions and frailties and some people who were living with dementia. People who used the service were cared for in accommodation over two floors. All rooms are single and 27 rooms have en-suite facilities The home also provides short stay and day care services.

A registered manager was in place at the home. 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 who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. They felt the overall care provided was good and their bedrooms were clean. People spoken with said, “The service is very good”, “The building is very clean; no complaints” and “Everything with the staff is perfect, they are very caring.”

During both days of the inspection we saw people were supported by sufficient numbers of staff. Care staff we spoke with told us they had undergone a thorough recruitment process. They told us they had undertaken an employee induction and training appropriate to the work they carried out was always available to them. Staff we spoke with had gained a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Staff confirmed they had received safeguarding and whistleblowing training, and knew who to report concerns to if they suspected or witnessed abuse or poor practice. We saw records to show staff received regular supervision to help make sure they were carrying out their duties safely and effectively.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review. Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act.

Care records were in place which reflected peoples identified health care and support needs. Information about how people wanted to be supported and their dietary requirements were also included in the care records we examined.

Systems to make sure the safekeeping and administration of medicines were followed and monitored were in place and reviewed regularly. Medicines were stored safely and administered by designated trained staff. Any specific requirements or risks in relation to people taking particular medicines were clearly documented.

Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives were addressed by the registered manager. People who used the service and their relatives told us they knew how to make a complaint and felt confident to approach any member o

During our inspection we spoke with the registered manager and three members of staff. We also spoke with three people who lived at the home and three visitors. We took a tour of the building and spent some time observing how people were cared for. We looked at a selection of the provider’s records, including a sample of people’s care records.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We spoke with people who lived at the home, visitors and staff. Everyone told us they though people cared for at Reinbek were safe and no one had concerns about the care people received. One visiting relative told us they had “peace of mind” and added “I feel she [their relative living at Reinbek] is safe and settled”. One member of staff commented “I’d be happy for my mum and dad to be looked after here”.

Although the people we spoke with told us they had no concerns about the way their medication was managed, we saw that medication was not always securely stored and the home did not keep appropriate records of controlled drug medication used by District Nurses.

We saw that people’s needs were met by the staff deployed within the home.

Is the service effective?

Care staff told us they were given enough information and guidance to deliver appropriate care. People were provided with balanced, nutritious meals, which the people we spoke with told us they enjoyed. People’s dietary preferences and needs were catered for.

Is the service caring?

We saw people were treated with respect. The care we observed was provided in a patient, warm and sensitive way and people were provided with reassurance by staff. One person commented “they [staff] don’t come into your room unless they ask”. Another person described staff as “very helpful” and “very understanding”, they also told us “I’m very comfortable here”.

Is the service responsive?

During our inspection we spoke with a visiting GP. They told us that the home was pro-active in referring people to them when needed and followed up on medical advice. They also told us communication with the home was good and staff “know what they are talking about”, and “they [staff] know the patients [people living at the home] well”.

Is the service well led?

Everyone we spoke with told us they thought the management team in place was approachable and people felt comfortable to raise any concerns they might have.

There had been a period of absence within the management team at Reinbek prior to our inspection. Although resolved there had been some impact on the systems in place to monitor the quality of the service provided by Reinbek. Regular quality checks (audits) across the service, in areas such as medication, care plan records and infection control had not been effectively completed over recent months. Although we did not identify any concerns with the care that people received, we found that the quality of people’s care records were not monitored as effectively they could have been.

We visited Reinbek on 17 October 2013. In the absence of the registered manager the inspection was assisted by the two senior carers on duty.

On arrival at the home we found most people were up, dressed and having breakfast. We were told some people were still in bed having a lie in.

We found the home to be warm, clean and tidy. We looked on all four units and found the home to be sufficiently staffed.

We saw people who used the service were well presented and we observed staff interacting with them in a friendly, polite manner and respecting their dignity and privacy.

We spoke with four people who used the service and with three relatives. One person told us, “I can’t remember how long I have been here but it’s very good”. Another said, “I am happy here”. A relative told us, “My X has not been here very long but they seem to have settled well”. Another told us, “It’s very good. I can visit at any time, everything is very open and the staff always make you welcome”.

We saw staff had access to relevant policies and procedures including safeguarding procedures and contact details.

We saw a number of compliment cards from relatives displayed on the units. Some of the comments included: ‘To all the staff for the care provided. X certainly enjoyed her time with you’. Another read, ’We are delighted with the level of care my X received. We can’t praise the staff enough’. The home offers respite care and one relative wrote, ‘Thanks for looking after X she felt she had lost something when she came home and they missed your company’.

We spoke with a range of people about the home. They included, the registered and deputy managers, staff, people who lived at the home and two visitors. We also had responses from external agencies including social services in order to gain a balanced overview of what people experienced.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives where possible to ensure people received the right care and support. This was confirmed when we spoke to two visiting relatives. One told us, "The staff are always keeping me up to date with mums care and what she needs."

When asked about routines in the home residents told us it was relaxed and one said, "staff are very attentive."

We spent time in various parts of the home throughout the inspection where we witnessed staff talking to people in a respectful mannner. We saw staff spent time with people on an individual basis. One staff member told us, "It's important for us to spend time with people, they like the attention."

This was an unannounced comprehensive inspection which took place on 8 and 9 September 2015.

We had previously carried out a scheduled inspection on 2 July 2014 when we found the service had not complied with all the regulations we reviewed. We found breaches in the regulations relating to the management of medicines and assessing and monitoring the quality of service provision. We returned to the service on 28 August 2014 and found that action had been taken to achieve compliance with the regulations in both areas.

In August 2015 we received concerns that medicines were not being administered and monitored effectively.

Reinbek provides residential care for up to 44 people. The home is a large extended, two storey, detached

property set in mature grounds in the Stockport area. The home is divided into four units, named Blueberry, Lemon Tree, Greenacre and Strawberry Fields. All units provide accommodation, bathrooms and communal areas. All bedrooms have single occupancy and some have en-suite facilities. There is a passenger lift providing access to the first floor. There is large enclosed garden area and car parking is available within the grounds.

There was a registered manager in place at the home. 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 found four breaches of regulations relating to arrangements for staff supervision, and safe working practices including the administration of medicines, control of infection practices and environmental and nutritional risks. For example, we saw staff leave medicines in pots close by each user, but did not ensure that they had taken their medicines; doors to rooms and cupboards which should have been kept locked were not locked, and clinical waste procedures were not always followed. Staff were not always provided with supervision or appraisal.

You can see what action we told the provider to take at the back of the full version of the report.

We also made a recommendation relating to the provision of food. See the comments in the main body of the report.

People told us they felt safe. We were told “Its home. I definitely feel safe here” and “I know the staff very well. I’m very comfortable here.” Visitors told us they were reassured that their loved ones were safe; we were told by one relative that, “I like what I see. If there was anything untoward I know I can speak to the manager, and it would be sorted out.”

Systems were in place to reduce the risk of harm and potential abuse. The provider’s safeguarding adults and whistle blowing procedures provided guidance to staff on their responsibilities to protect vulnerable adults from abuse.

Recruitment and selection procedures were in place to help ensure that the staff employed at the home were suitable to work with vulnerable adults. There were sufficient numbers of staff available to support people, with the exception of lunchtime on the day of our visit, due to medication training and attending to a visiting doctor.

The people we spoke with were complimentary about the staff. One person told us, “The staff here are very kind. I have no complaints, and if I did I would be able to speak to [the registered manager].” Another told us, “We are well looked after here. It was a wrench to leave my bungalow, but I made the right decision to come here.”

We saw that people were often left to find their own stimulation and there was little sign of any organised activities taking place. People told us that the level and quality of activities had declined whilst they had been there.

The registered manager was able to demonstrate a good understanding of the Deprivation of Liberty Safeguards procedure (DoLS) and Mental Capacity Act MCA (2005) and the staff we spoke with also had an understanding of capacity and consent issues relating to people who used the service.

Reinbek had a comfortable calm and relaxed atmosphere. It was undergoing extensive refurbishment when we inspected, but this was unobtrusive and caused little obvious inconvenience to the people who lived there

The staff had developed good relationships with all the people who used the service. We observed good social interactions and people were treated with kindness and respect by staff who knew them well.

We saw that the home had a complaints procedure, with the policy on display in the entrance hall. In addition there was a locked box for people who lived there and their visitors to post any comments, and ‘your views are important’ comment cards were available.

The registered manager was respected by the staff we spoke with, who told us that they were confident that she would resolve any issues if they approached her. One staff member told us that she thought morale had improved since the new manager had taken over, and that she looked forward to coming into work.