Rendlesham Care Centre 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. Rendlesham Care Centre accommodates up to 60 older people in one adapted building. There were 49 people living in the service when we inspected on 29 and 31 January 2018, some people were living with dementia and some needed nursing care. This was an unannounced comprehensive inspection.

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.

Our unannounced focused inspection of 12 July 2016 was prompted in part by notification of an incident which a person had died. This incident, and previous incidents, are subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of choking. This inspection and the previous inspection of 26 and 27 October 2016 examined those risks.

At our last inspection of 26 and 27 October 2016 the service was rated overall Requires improvement. The key questions for Caring and Responsive were rated Good. The key questions for Safe, Effective and Well-led were rated Requires improvement. This was because the improvements made from our previous inspections needed to be embedded in practice and sustained over time to ensure that people were receiving good quality care at all times. During this inspection, we found that the improvements had been sustained and the service was now rated as Good overall.

You can read the reports from our previous inspection, by selecting the 'all reports' link for Rendlesham Care Centre on our website at www.cqc.org.uk.

There were systems in place to keep people safe from abuse. Staff were trained in safeguarding and understood their responsibilities. Risks to people were assessed and staff were provided with guidance on keeping people safe. Medicines were managed safely and people were provided with their medicines as prescribed.

The service was clean and hygienic and the policies and procedures in place supported good infection control processes. The environment was well maintained, accessible and suitable for the people who used the service.

The staffing levels in the service provided people with care and support when they needed it. Recruitment of staff was done safely and checks were undertaken to ensure they were suitable to care for the people using the service. Staff were trained and supported to meet people’s needs effectively.

People’s holistic needs were assessed, planned for and met. Care plans and risk assessments provided staff with guidance about how to meet the needs and preferences of people. People’s decisions about their end of life care were documented and respected. People were provided with the opportunity to participate in meaningful activities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s dietary needs were assessed and there were systems in place to meet them effectively. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were treated with respect and care by the staff working in the service.

The quality assurance systems in place supported the provider and management team to identify shortfalls, address and learn from them. There wa

Rendlesham Care Centre provides accommodation and care for up to 60 people, some living with dementia and some requiring nursing care.

There were 58 people living in the service when we inspected on 26 and 27 October 2016. This was an unannounced inspection. There are four units in the service, on the ground floor Oak 1 accommodates people living with dementia and Oak 2 which accommodates people living with dementia and who may also require nursing care. On the first floor Chestnut 1 and 2 provide both personal and nursing care.

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.

At our comprehensive inspection of 25 November 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 12 Safe care and treatment, Regulation 18 Staffing and Regulation 17 Good governance. We set requirement notices relating to these breaches, the provider wrote to us and told us how they were taking action to improve.

An unannounced focused inspection carried out on 12 July 2016 was prompted in part by notification of an incident following which a person had died. This incident, and previous incidents, are subject to an investigation and as a result this inspection did not examine the circumstances of the incident. We found that the provider had not taken appropriate and swift action to ensure that people were safeguarded following incidents of choking. We took enforcement action to ensure the provider took the necessary actions to protect people.

You can read the reports from our last comprehensive and focused inspection, by selecting the 'all reports' link for Rendlesham Care Centre on our website at www.cqc.org.uk.

This unannounced comprehensive inspection on 26 and 27 October 2016 found that improvements had been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were identified in our last comprehensive inspection of 25 November 2015 and the focused inspection of 12 July 2016.

Improvements had been made in relation to assessing and managing risk for people at risk choking and associated training for staff.

Improvements were needed in the staffing levels in the service. This had been identified by the registered manager and they were in the process of addressing it.

Improvements had been made in the quality assurance processes which were used to identify shortfalls and address them. The improvements made need to be sustained over time and embedded in practice to ensure that people are provided with good quality care at all times.

Improvements had been made to ensure that people were supported safely to eat and drink. Detailed risk assessments and care plans were in place for people who were at risk of choking. These improvements needed to be sustained over time. People’s fluid intake was monitored to reduce the risks associated with dehydration.

Improvements had been made in people’s care plans and risk assessments and these guided staff in how people were provided with person centred care which was tailored to meet their specific needs. People were provided with the opportunity to participate in meaningful activities. There had been recent changes in the activities staff in the service and they were in the process of seeking people’s preferences in preparation for developing an activities programme that would include people’s interests.

Improvements had been made in the systems in place to store, obtain, dispose of and administer medicines safely and maintaining records relating to medicines management.

However to improve the rating to 'Good' would require a longer term

We carried out this unannounced focused inspection on 12 July 2016 to look at new concerns raised following the death of three people as a result of choking.

This report only covers our findings in relation to this topic.

Rendlesham Care Centre is a residential home that provides care to up to 60 people who are elderly and frail with complex needs, including dementia and nursing related needs.

The service had 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.

During our comprehensive inspection of 25 November 2015 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 12, Safe care and treatment, Regulation 18(1) Staffing and Regulation 17 Good governance.

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

During this focused inspection we found continuing breaches of Regulation 12, 17 and 18. You can see what action we told the provider to take at the back of the full version of the report.

Arrangements were insufficient for managing risks and improving the safety of individuals who have swallowing/eating/drinking difficulties (dysphagia).

Risk assessments were not personalised and relevant to the individual. They did not consider associated signs and symptoms specific to the person that could indicate potential or actual risk of choking. Plans in place for managing risk were not detailed, informative or specific to the individual. Therefore staff did not have sufficient information to guide them on how to monitor and review those people, recognise when symptoms were worsening and identify emerging increase to their risk of choking.

The service did not have a pro-active approach to staff learning and development in line with the home's stated purpose and the needs of people using the service. Staff had not received training in the wider risks related to dementia, including dysphagia. They therefore did not understand how difficulties associated with dysphagia are caused, exacerbated or how to recognise any change or deterioration in swallowing difficulties.

People’s safety and welfare were compromised because the provider did not have a robust and effective system in place for identifying and remedying deficits in care to improve the safety of individuals who have or are susceptible to swallowing difficulties, and prevent recurrence of serious untoward events.

We inspected this service on 17 November 2014 and this was an unannounced inspection. Rendlesham Care Centre provides accommodation and personal and nursing care for up to 60 older people. Some people are living with dementia. There were 40 people living in the service when we inspected.

At our last inspection on 23 and 25 June 2014, we asked the provider to take action to make improvements in respecting and involving people who use services, consent to care and treatment, care and welfare of people, cleanliness and infection control and assessing and monitoring the quality of the service provision. The provider wrote to us to tell us how they had implemented these improvements. During this inspection we checked on their improvement plan and found that this action has been completed.

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. There was an acting manager in post at the time of our inspection and the provider had employed a permanent manager who was due to start in December 2014.

There were systems in place which guided staff on how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Procedures and processes were in place to guide 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 the risks to people were minimised. There were systems in place to provide people with a clean and hygienic environment to live in.

Appropriate arrangements were in place to provide people with their medication at the prescribed times. Medication was obtained and stored safely.

People were supported by sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People or their representatives, where appropriate, were involved in making decisions about their care and support. The service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards and at the time of our inspection they were working with the local authority to make sure people’s legal rights were protected.

Staff in the service were trained and knowledgeable about the Mental Capacity Act (MCA) 2005. The MCA sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People were supported to have sufficient to eat, drink and maintain a balanced diet. Their nutritional needs were being assessed and met.

A complaints procedure was in place. People’s complaints were listened to, addressed and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people. The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service continued to improve.

We spoke with seven people who used the service. They told us that they were happy with the service they were provided with. One person said, "It is very good, we are all well looked after." Another person said, "I am happy here, I did not know what to expect, but it is quite good."

People told us that the staff treated them with respect. One person said, "They (staff) always call me by my name, which shows they know who I am." Another person said, "They (staff) are all very kind, always pleasant." This was confirmed in what we saw during our inspection, staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of five people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff training records showed that they were provided with the training that they needed to meet the needs of the people who used the service.

We found that people were provided with their medication at the prescribed times and in a safe manner. However, we suggested areas for the provider to consider and develop this area of medicine management further to enhance safety.

Rendlesham Care Centre provides accommodation and personal and nursing care for up to 60 older people. Some people are living with dementia.

There were 56 people living in the service when we inspected on 4, 10, 15 and 25 November 2014. There are four units in the service, on the ground floor Oak 1 accommodates people living with dementia and Oak 2 which accommodates people living with dementia and who may also require nursing care. On the first floor Chestnut 1 and 2 provide both personal and nursing care.

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. There was a manager in post at the time of our inspection and they told us that they were in the process of completing their registered manager application.

Prior to our inspection we had received a number of concerns about the service being provided. This included relatives, staff and visitors to the service. For some of these we made referrals to the local authority who are responsible for looking at safeguarding matters. Once we have received the outcomes for all of these we will make a view on a regulatory response. The Commission is aware of an incident that took place in the service in August 2015. We will report on this once our enquiries are complete.

There were systems in place which guided staff on how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to report any concerns to. When concerns had arisen actions had been taken to improve the service. However not all concerns had been appropriately reported to us.

There were not sufficient numbers of staff to meet people’s needs safely and ensure their needs are met in a timely way. In addition some people wanted more social contact with staff. Staff were provided with training and support to meet people’s needs and had good relationships with people. However these relationships were hindered due to the staffing numbers.

People or their representatives, where appropriate, were involved in making decisions about their care and support. Improvements were needed in how people’s needs were assessed, planned for and met to ensure that they are provided with personalised care which meets their needs at all times.

The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards and referrals had been made to the local authority where needed. However, the arrangements in place to ensure that the right safeguards were in place where people needed to have thier medicines given covertly, for example within food were not always in place.

People were supported to have sufficient food to maintain a balanced diet. Their nutritional needs were being assessed and met. Improvements were needed to ensure that records of people’s fluid intake are accurately documented to demonstrate they were being supported to be hydrated which also helps support wellbeing overall.

Procedures and processes were in place to guide 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 the risks to people were minimised.

A quality assurance system had been recently introduced but was not yet embedded in practice or fully developed. Systems had not yet enabled the service to independently identify the shortfalls seen at this inspection and improvements seen at our last inspection in November 2014 had not been sustained.