About the service: Rock House Residential Care Home provides personal care for up to 38 older people, who may also live with dementia or mental health issues. At the time of the inspection 34 people were living there.

People’s experience of using this service:

• People and their relatives spoke positively about the service. Improvements had been made in some areas since our last inspection, for example a television had been placed in reception and a new family room had been adapted from a bedroom. However, we found several breaches of regulations.

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was breached because medicines were not always correctly recorded or administered. The medicines fridge and trolley temperature checks had gaps in the records. Records related to people’s challenging behaviour was not clear in how staff should have supported the person.

• Records related to incidents involving people’s behaviour had not been reviewed to identify themes. This may have helped people identify useful strategies and help relieve people’s distress.

• We found information related to people’s nutritional and hydration needs were not always available. We observed one person struggling to eat with little help, and information about people’s dietary needs was not always understood by staff.

• People were not always treated with dignity and respect. Records about people and the way staff spoke with them was not always respectful. People were not allowed to leave the dining room at meal times until they had received their medicines. As a result, we found the service had breached Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This also meant people were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• The registered manager had breached Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. because they had not sent to CQC the required notifications. Furthermore, the registered manager and the provider had not identified the areas requiring improvement that we had found. This meant they had not achieved a clear overview of the service, which was required to ensure they assessed, monitored and improved the quality and safety of the service provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• Activities were available to people, however at the time of the inspection they were not always person centred. We have made a recommendation about training staff in this area.

• Staff had received training in how to identify and report concerns of abuse. Information was readily available to guide staff on how to report concerns to the local authority safeguarding team.

• Safeguarding concerns were dealt with appropriately by the senior staff.

• Checks were made on the utilities and equipment to ensure they were safe to use.

• The premises were kept clean and hygienic, people were protected from infections that could affect both staff and people using services through regular cleaning.

• People spoke positively about the staff describing them as “Caring and Professional”.

• Records showed where people required support from external medical professionals this was sourced.

• Staff received support to carry out their role through training, supervision and staff meetings.

• Both staff and people living in the home were treated as equals, there was anti discriminatory policy in place which was adhered to by staff.

Rating at last inspection:

At our last inspection the service was rated Good. (Report published 31 March 2016)

Why we inspected: We inspected the service as part of our scheduled inspection plan.

Follow up: We will continue to monitor the service to ensure that people receiv

This unannounced inspection took place on the 22, 23, 25 February 2016. During our previous inspection in August 2014 we had concerns about the cleanliness of some parts of the home. We also recommended the provider carried out minor enhancements to the building to ensure people’s needs were met. During this inspection we found improvements had been made in both areas.

Rock house is a residential care home registered to care for up to 38 older people including people who live with dementia or mental health problems. At the time of our inspection 29 people were living permanently in the home and one person was receiving respite care. The home 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 previous inspection in August 2014 we had concerns about the cleanliness of some parts of the home. During this inspection we found cleaning schedules were in place and the level of cleanliness had improved.

People told us they felt safe living in the home and staff knew how to identify signs of abuse and responded appropriately. On the first day of the inspection we raised some concerns about how people’s medicines were recorded. We found on the third day of the inspection improvements had been made. We have made a recommendation about how the home manages medicines.

People told us they felt safe living in the home. They told us their needs were met, and when they needed help from staff their requests were responded to quickly. People’s needs were assessed and care plans reflected how staff would meet their needs. Risk assessments were in place to ensure the risk of injury to staff and to people was minimised.

Records were frequently updated in relation to the care provided, and information about people was shared in the changeover meetings which took place each day.

The systems used for recruiting staff included making checks on candidate’s backgrounds. This was to ensure they were safe to work with people.

The provider had an assessment tool in place to gauge the staffing levels required to meet the needs of people at any one time. People, staff and relatives told us they thought there were enough staff in place to meet people’s needs, and our observations confirmed this.

Staff told us and documentation verified they were being supported by the provider through regular supervision, annual appraisals and training. Staff meetings were held where discussions took place on how the service could be improved through improved performance by staff and management.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant where people were unable to make decisions for themselves, staff acted in a way that was agreed was in the person’s best interest.

People’s health was maintained and where professional advice was required to assist people to remain healthy this was sought by staff. For example, dietician and GP.

People told us and we observed staff caring for people in a sensitive and appropriate way. They demonstrated a kind and caring nature and they were knowledgeable about people’s needs and how to meet them. Care plans recorded people’s choices and preferences and these were respected by staff.

There was a range of activities in the home to minimise the risk of social isolation. People told us they enjoyed the activities on offer.

People told us the service was well managed. Staff commented on how supportive and approachable the management were. Quality assurance checks had been completed and were on going alongside feedback from people which was used to improve the quality of the service to people.

When we visited there were 29 people living in the home and seven care staff on duty, including the deputy manager. The home seemed lively with an activities co-ordinator playing board games with people in the lounge and everyone engaging in a birthday celebration. We saw that the staff were helping people take part in the celebration and saving cake for those who were having a lie down in their own rooms. A number of the staff we spoke with described the home as having a 'family atmosphere' and one member of staff said that it was their 'second home'. We observed the warm, friendly and caring approach of the staff.

We spoke to one person living in the home who said that the staff 'had the patience of Job' and another said 'they look after us so well and nothing is too much trouble, no matter how silly I am'.

The deputy manager showed us the paperwork which was well maintained and organised. The home had recently transferred all the care plans to an electronic system and we saw how well that was being used to record and monitor progress. The managers at the home had a strong commitment to providing a high quality of care. We saw evidence of this in the diligent way in which they recorded even tiny suggestions and comments, what they called 'niggles and moans'. We saw that they considered and responded constructively to each one of them and used them to improve the service.

We looked at how people who used the service and their relatives were involved in the care process, and how their dignity and independence was respected. We found that people were involved in the planning and management of their care, and that they were able to exercise a degree of choice in terms of things such as menus and activities.

We looked at how people’s care was planned and managed and found that there was a comprehesive system of care planning in place. We also found that generally people were happy with their level of care.

We looked at safeguarding people from abuse and found that staff had done safeguarding training and were able to identify different types of abuse. We also found that staff felt comfortable in being able to report abuse if necessary.

We looked at staffing levels and found that there were sufficient numbers of qualified staff to cover all the rotas. However, we also found that for a brief period there appeared to be a shortage of staff in the two lounge areas.

We looked at how the provider monitored and assessd the quality of the service and found that there were effective systems and processes in place including regular reviews of the whole service and feedback from staff and people who used the service.

We spoke to three people using the service. They told us that staff had talked to them before they moved in about the service and the support they could expect to receive. They also said they had been able to visit the home before they made a decision to move in.

One person told us they were well looked after by staff, who were very helpful. They said they were happy living in the home and said they had settled in well thanks to the kindness of the staff.

We were informed by people that they felt safe in the home and people said if they were unhappy they would talk to one of the staff or the manager.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. The home had previously been inspected on 4 February 2014 when it was found to be meeting the requirements of the law in the areas inspected.

Rock House provides care and support to up to 38 older people, some of whom were living with dementia. Others were living with dementia and physical disabilities. At the time of our inspection 34 people lived in the home. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

During our inspection we found areas that required improvement. Whilst most bedrooms were spacious and personalised, one was not large enough to accommodate the person’s personal belongings. We have recommended the provider finds out more about current best practice, in relation to adapting living environments for people living with dementia. Some areas of the home were not clean, because systems in place to ensure all areas were clean had not been followed. Other areas of the home were clean and comfortable.

We found aspects of the service were good. Staff interacted with people in a gentle and supportive way. Where people may have been anxious about certain activities, for example being transferred in a hoist, staff were reassuring and supportive. Care plans and risk assessments were in place to ensure people received safe and appropriate care. Where possible people or their representatives had reviewed their care with staff to ensure it met their needs.

People were consistently having their care needs met and told us they were happy with the support they were receiving. The provider had identified the specific needs of individuals and had equipped staff through training, supervision and appraisal with the relevant skills and expertise to meet their needs.

The provider had clear plans of how they would improve the service to people over the next two years. The provider based the care on a clear set of values which were shared with the staff team.

Because many people living in the home had some form of dementia, the provider organised training for people’s families to help them understand the illness. They also encouraged families to share information about the person’s past life so they could enhance their present life.

Audits were undertaken to ensure the environment and the way care was delivered were safe. Feedback was obtained from people, staff, relatives and an independent organisation to assist the provider in driving forward improvements. Complaints were taken seriously and responded to appropriately in line with the provider’s policy. People who were unable to make verbal complaints were monitored for changes in behaviour, body language or facial expression. Where it was deemed a person was unhappy with a situation, this was investigated.

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