This inspection took place on 3 May 2018 and was unannounced.

Rushey Mead Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rushey Mead Manor provides nursing and residential care for up to 50 older people, some of whom are living with dementia and/or physical disabilities. The home caters for people from a range of cultural backgrounds. It was purpose built with accommodation on three floors and a passenger lift for access. The service has lounges, a dining room, and gardens. When we inspected there were 43 people living at the home.

The home had a registered manager. This 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 our inspection the registered manager was not at the home.

Improvements were needed to the way medicines were managed. Care plans and risk assessments were not always fit for person and people were not always receiving personalised care in line with their preferences and requirements. The oversight, monitoring, and day to day running of the home had been ineffective and failed to identify shortfall in the service provided.

People told us they felt safe living at the home and said they had confidence in the staff. They said the home had a happy and friendly atmosphere and the staff were caring and treated them with compassion and kindness. Staff encouraged people to make choices about their daily lives and communicated with them, where possible, in their preferred language. People said they could get up and go to bed when they wanted and follow their own routines.

The management team were in the process of updating and improving the home’s staff training programme. People told us the staff were well-trained and gave us examples of staff supporting them in a skilled and effective way. Staff helped to ensure people’s medical needs were met and accompanied them to appointments were necessary.

People said they were satisfied with the food served. Improvements were being made to the menu to help ensure the full range of people’s dietary needs was met on a daily basis. The premises were in need of redecoration and improvement to make them more suitable for people’s needs.

Staff understood the importance of people consenting to their care and support. Relatives said they could visit when they wanted and were made welcome by staff.

The home had an activities programme and we saw some group activities taking place. These included an indoor ball game, colouring pictures, and singing religious songs. Activities staff were being re-trained to help ensure they had the skills and knowledge they needed to provide suitable and accessible activities to everybody who wanted them.

People and relatives said they would speak to staff if they had any concerns about people’s care. The home’s complaints procedure, which was displayed in the reception area, was being improved and updated to make it more user-friendly and readable.

At the time of our inspection visit the home was undergoing a period of rapid change. A new management team was in place. They acknowledged the home needed to improve and had begun to make positive changes to the way it was run. People, relatives and staff were involved in making decisions about the home and the management team were approachable and easy to contact.

This inspection took place on 15 March 2017 and was unannounced.

Rushey Mead Manor provides nursing and residential care for up to 50 older people, some of whom are living with dementia and/or physical disabilities. The home caters for people from a range of cultural backgrounds. It was purpose built with accommodation on two floors and a passenger lift for access. The service has lounges, a dining room, and gardens. When we inspected there were 45 people living 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. At the time of our inspection the service did not have a registered manager, however the manager had submitted an application to register with CQC and this was being processed.

People and relatives told us the culture at the service was open and friendly. There was sense of community spirit and we saw that people, relatives and staff got on well with each other. People told us they were happy at the service and there was lots of laughter and positive comments when we discussed the service with them.

People told us the manager and staff were friendly and approachable. They said the manager often sat with them, shared sweets, and asked how they were and what they thought of the service. They said that if they had any concerns they would tell the manager or a staff member and they felt they would be listened to and action taken in response.

During our inspection visit we observed that staff kept people safe. We saw them assisting people to move about the service safely, have meals and drinks, and take their medicines on time. All the staff knew how to protect people from harm and who to go to if they had concerns about any person’s well-being.

People told us there were enough staff on duty to keep them safe and meet their needs. During our inspection staff were always available to assist people. Both nursing and care staff were employed at the service. Staff also worked closely with local healthcare professionals to ensure people’s needs were met.

The staff were well-trained and had the knowledge and skills they needed to work at the service. For example, they had recently attended a course in dementia care to help them work effectively with people diagnosed with this condition. Staff told us the manager was supportive, had an ‘open door’ policy, and they could approach her at any time for advice.

People told us they liked the food provided. The kitchen staff prepared a wide range of cuisine to ensure people’s dietary needs were met. They catered for Asian vegetarian, halal and non-halal, English, diabetic, and soft diets. We saw there were jugs of fresh water in all communal areas to encourage people to drink fluids to protect themselves from dehydration.

We observed many caring interactions between staff and the people they supported, and people and relatives said the staff were caring and kind. Relatives told us they were always made welcome when they visited the service.

People using the service spoke a range of languages including Gujarati, Hindi, English, Punjabi and Urdu. All staff spoke English and most spoke some Asian languages. During our inspection visit we observed staff talking with and reading to people in their first languages.

People told us the staff provided them with personalised care. Staff were familiar with the information in people’s care plans. They knew people well and this helped to ensure they provided them with responsive care and support. Care plans were regularly reviewed to take into account people’s changing needs.

The service had an activity co-ordinator and we observed an organised activity taking place in the afternoon when a group of people listened to Hindu music and then s

This inspection took place on 7 October 2014 and was unannounced.

Rushey Mead Manor provides nursing and residential care for up to 40 older people, some of whom are living with dementia and physical disabilities. The home caters for people from a range of cultural backgrounds. It was purpose built with accommodation on two floors and a passenger lift for access. The home has a range of lounges, a dining room, and gardens.

When we inspected there were 34 people living at the home.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safe at the home and staff knew what to do if they had any concerns about their welfare. Records showed staff had thought about people’s safety and how to reduce risk. They also knew how to protect people under the Mental Capacity Act 2005.

There were enough staff on duty to meet people’s needs and to spend time socialising with them. Staff had the skills and knowledge they needed to provide effective care. Medication was kept and administered safely and in the way people wanted it.

Most people said they were happy with the food which met their dietary preferences and needs. Dieticians were involved if people needed extra help with nutrition and hydration.

People were satisfied with the care and support the home provided. They had access to a wide range of health and social care professionals. Records showed the home took prompt action if there were concerns about the health of any of the people who used the service. If people needed extra support to meet their health care needs this was provided.

The staff were caring and we saw many examples of them working with people in a kind and sensitive way. They listened attentively to what people were asking for or wishing to do and helped them accordingly. The staff team was multicultural, as were the people who used the service, and if particular language skills were needed certain staff members were able to provide these.

People told us they were listened to when they raised concerns or complaints. The registered manager told us the she had an ‘open door policy’ and the people who used the service, relatives, and others were welcome to approach her at any time if they had concerns. She also walked round the home several times a day to chat with people and give them the opportunity to raise concerns with her directly.

The registered manager was helpful and approachable and knew the people who used the service and their relatives well. She listened and acted when people made suggestions about improving the service. The quality of the service was monitored and the people who used the service, relatives, and staff were central to that process.

We found the provider had taken appropriate action to remedy our earlier concerns and was continuing to work with local authority commissioners to ensure care was delivered to a consistently high standard in order to meet the needs of the people using the service.

We reviewed the care records of five people and found them to be comprehensive and up to date. The staff ensured they completely understood the needs of people. The provider had taken steps to ensure all staff understood the requirement to ensure appropriate action took place in order to make judgements in the best interest of any person who lacked the capacity to make their own decisions regarding their care.

The physical environment has been significantly improved and as a result is safer for people and staff. This programme of improvement is planned to continue in order to ensure all area's within the location are both safe and welcoming spaces for those using the service and the staff who care for them.

We found that some improvement in two outcomes had been achieved. People are now involved in the planning and delivery of their care and the care and support they receive is now accurately assessed and delivered in a person centred way. Care records are now adequate and appropriately maintained but still contained discrepencies between planned care and that delivered.

We still have concerns that the number of nurses employed is not sufficient to meet the needs of people, the majority of who require complex nursing support. On duty nurses spend a disproportionate majority of their time administering medication. This limits their delivery of appropriate nursing support, the supervision of non nursing staff and the expected reviews and maintenance of care plans.

During our visit we expanded the scope as a result of earlier assurances by the provider not being fulfilled. We found the environment to be potentially hazardous and the expected standards of maintenance and repair had not been carried out. We also discovered the security and safety of people using the service, staff and others could not be guaranteed. The rear entrance to the location was not effectively secured and as a result any unauthorised person would be able to gain easy access to the home and its immediate surrounds.

People who used the service told us that they liked the staff and the home. They told us the staff were respectful and helpful, but some people using the service thought that there weren't enough staff. We found staff on duty to be very busy and the complex needs of some people required the care of two staff members. At times, this ratio of staff to people resulted in other people using the service being required to wait for lengthy periods of time before they were assisted.

We also found care plans did not include the choices and wishes of people using the service. In some care plans we could find no evidence of people using the service being involved.

The staff on duty during our visit were busy and some appeared overwhelmed during key periods such as meal times. We spoke to some staff and they told us that they thought the home needed more staff for each shift because more people with nursing needs now lived at the home.

The interim manager had raised concerns with the provider. This manager but had not felt sufficiently well supported in their role and so had decided to resign from the post and not take on the role permanently.

An expert by experience accompanied us on our visit to the service. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service.

People who live at the home spoke with the expert by experience. They told them they were happy with the service the home provided and they had their health and care needs met. People said their religious and cultural needs were met through the food which is provided and by people being able to visit local places of worship. Visitors spoke with the expert by experience and said they were happy the care and support their relatives received. Staff are able to speak with people in their preferred language.

People who use the service and visitors told us that improvements to the environment through decorating and the purchasing of new furniture had made the home more welcoming and pleasant.

People were supported by staff who in recent months had received training which enabled them to understand and meet the needs of people. Staff told us that they were confident in their role and that they enjoyed spending time with people and taking them out into the community.

One relative told us that they were involved in the quality assurance panel, which meets to look at how the service can be improved for those in residence. We asked them whether any changes had occurred since the group was set up they told us: - "Residents are now going out it's one of the things we wanted to change."

Relatives we spoke with told us that they had noticed recent improvements in the way in which staff support people. One relative said "staff are able to spend more time talking and looking after people as there are now more staff."

Relatives who were visiting friends and family told us: - “It’s much better now, the rooms are being painted and many of the rooms have new carpets and curtains and furniture.” Whilst another relative told us: - “It’s a lot brighter and more cheerful.”

We spoke with one person who told us that "I visit the local shops, Temple and library, and sometimes I have something to eat whilst I'm out."

We were told by someone who lives at the home "staff are very friendly, and they help me when I need it."

One person we spoke with said "I really like the food here".

One person we spoke with said "I prefer to sit in the quieter lounge, I don't like noise and the sun shines more in this room."