Rushyfield Residential and Nursing Home 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. It provides personal and nursing care for 41 people some of whom are living with dementia. The home is on three floors serviced by a lift. People receive care on two of these floors and the kitchen, laundry and staff room are on the lower floor of the home. When we inspected there were 36 people living at the home.

This inspection took place on 23 August 2018 and was unannounced.

At our last inspection in August 2017 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. The home was meeting the requirements of the fundamental standards.

People, relatives and staff felt the service was a safe place. People were protected from the risk of abuse because staff understood how to identify and report it.

There were sufficient staff on duty to meet people’s needs. We received positive feedback about staff always being available when people needed them and staff were visible throughout our visit.

People received their medicine safely and were supported to access the support of health care professionals when needed.

Where risks were identified to people who used the service or to the environment these were assessed and plans put in place to reduce them. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed both before and after their admission to identify their care needs.

Staff were well supported and received the training they needed.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided home-made food and drinks which were adapted for different diets.

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 told us they thought the service was caring. We received some examples of the service being very caring in the way it supported people and their relatives.

People told us, and we observed, that care was delivered with dignity and respect and people were supported to be as independent as possible.

Care plans were detailed and reflected people’s needs and preferences. Care plans were evaluated regularly and included meaningful information about people’s needs.

People were actively engaged in a range of activities and had opportunities to access the wider community.

People told us they did not have any concerns about the service but knew how to raise a complaint if needed. Feedback on the service was encouraged in a range of ways and was positive.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.

This inspection took place on 22 and 23 August 2017. The first day of our inspection was unannounced. Rushyfield Care Centre provides accommodation for up to 41 people who require nursing and/or personal care. At the time of inspection there were 31 people in receipt of care from the service.

At the last inspection in March 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-

Regulation 12 Safe care and treatment

Regulation 14 Nutrition

Regulation 17 Good governance

Regulation 18 Staffing

We also found at that time the provider was in breach of Regulation 18, Care Quality Commission (Registration) Regulations 2009, namely Notification of other incidents.

Following our last inspection we asked the provider to take action to make improvements. During this inspection we found improvements had been made and there were no continued or new breaches of regulations.

There was not 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. Since the last inspection the registered manager had left the service. A peripatetic manager had been managing the service. They told us a new manager had been appointed and was due to start working at the service in September 2017. A handover period had been agreed by the provider to ensure continuity of service.

Pre-employment checks were carried out on staff to ensure they were of suitable character and had the necessary skills to care for vulnerable people. Staff and relatives felt the new staff recruited by the manager were genuinely caring. We saw staff were kind and respectful towards people. They maintained people’s dignity and privacy.

A programme of checks was in place to ensure people were protected from living in an unsafe environment. These included, for example, fire safety and water temperature checks.

We checked people’s medicines and found they were administered by staff who had been trained to do this. Medicines were stored securely and there were regular audits to ensure medicine counts were correct. A system had been introduced by the provider to ensure the nurse on duty had oversight of the application of people’s topical medicines (creams or ointments applied to the skin).

People had care plan documents which were accurate, up to date and regularly reviewed. We found these described people’s individual needs. Where risks to people had been identified, for example, falls risks, actions had been put in place to mitigate these risks. Each person had a day allocated to them. The day involved staff with different roles in the home contributing to that person’s needs on the day. For example, housekeeping staff in the home deep cleaned their room, checks were carried out by maintenance staff and care staff reviewed the person’s care records.

The building had been adapted to support people with dementia related conditions. We found the walls had been decorated using brightly coloured pictures. Corridors were distinctive with themed areas. Signage was in place to assist people to orientate themselves around their environment, for example towards bathrooms and toilets. We found the home to be clean and tidy throughout.

There were enough staff on duty. The manager reviewed the staffing levels on a monthly basis and had listened to the staff about the times in the service where there was the greatest need. They had put in place a twilight shift so there was an extra pair of hands to support people to bed.

People had a positive meal time experience supported by staff who gave them choices and promptly responded to their requests. Staff completed food and fluid charts for people to monitor thei

This inspection took place on 8, 9, 10 and 15 March 2017 and was unannounced.

Rushyfield Care Centre provides accommodation for up to 41 people who require nursing and personal care. The home is split into two units. Upstairs is known as the Usher Moor unit and downstairs is the Langley Moor unit. At the time of our inspection 19 people were living upstairs and 18 people were living on the ground floor.

At the last inspection in October and November 2015, we asked the registered provider to take action to make improvements to the administration of topical medicines (creams applied to the skin). We found the home had failed to make improvements.

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.

Visitors expressed concerns to us about the levels of staff on duty and the availability of staff to keep people safe. During this inspection we visited the home on a nightshift and found where staff were required to attend to one person this left the remainder of people unattended on the floor.

We saw staff were supported to carry out their duties through induction, supervision and training. However we found there were a number of incidents where people had not been protected and staff had not given due regard to people’s well-being.

Regular checks were carried out on the building included fire-fighting equipment, fire alarms and fire drills. Water temperatures and window restrictors were also checked to make sure people were safe in their environment.

We found concerns about three people not having in place equipment to keep people safe and the maintenance of that equipment including sensor mats. During the inspection we asked the registered manager to conduct a review of everyone with equipment to ensure people were safe. The registered manager provided us with a list of 16 people for whom the service used bed or floor sensor mats, seat sensors, door sensors, crash mats and bed rails. With the exception of one person whose bed sensor was on order the registered manager gave us assurances the equipment was in place and in working order.

We also found processes to review and analyse people’s accidents in the home to be ineffective in looking at people’s personal safety.

Food and fluid charts were not completed appropriately in the home. There were no target fluid levels in place so staff were not aware how much people needed to drink to remain hydrated, and we found records to indicate people had drinks after 4.30pm were not in place. The charts failed to reflect adequate food intake for people.

People and their relatives were involved in assessments of people prior to their admission to the home. Care plans have guidance to staff on how to meet people’s care needs, however we found some of these care plans were missing. A resident of the day was chosen which meant their care was to be reviewed that day. We found these were incomplete and their care plans had not been reviewed. Staff were unable to provide us with audits on people’s plans to ensure they were up to date and accurate.

Relatives told us about their mixed experiences of making a complaint. We saw staff had documented complaints raised by relatives but these had not been documented with outcomes by the registered manager

Activities were provided in the home by two recently employed activities coordinators. The registered manager explained the coordinators were finding out what works in the home and as yet there was no current activities programme in place.

Staff had learned the best ways to distract people at times when they became distressed. We found they engaged people in activities including singing. Staff welcomed visitors into the h

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The new manager has submitted an application to become the registered manager.

During our inspection we asked the provider, staff and people who used the service specific questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service caring?

During out inspection we saw people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were treated with dignity and were supported to make choices and remain independent. A relative told us she felt her parent was much better cared for now and always appeared clean and tidy. She attributed the better care to having a new manager in post.

Is the service responsive?

We found a daily reporting system in place from the night staff to the manager to allow the manager to quickly address issues.

People using the service, their relatives, friends and other professionals involved with the service completed a satisfaction survey. Where shortfalls or concerns were raised, we saw these had been addressed by the provider.

Relatives told us the staff had responded to their needs in helping them to care for their family members

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that as far as possible anyone who was unsafe to work with people was not offered employment.

The service was safe, clean and hygienic. Equipment was regularly checked to make ensure people were not put at unnecessary risk.

People told us they felt their relatives were safely cared for at Rushyfield

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw these had been followed correctly.

Is the service effective?

People’s health and care needs were assessed with them, and their representatives. Specialist dietary, social, mobility, equipment and dementia needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.

People completed a range of activities in and outside the service regularly.

Is the service well led?

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People told us the service had improved since the new manager came into post.

Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

On the day of our inspection visit we found 14 people were living at Rushyfield Care Centre. We saw the building had two floors but the upper floor was closed due to the home’s low occupancy level.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us however we were able to speak with two people who told us, “I’ve lived in the village all my life so I know a lot of the carers, which is lovely. Everyone is so kind and helpful here,” and “I really like the place; it’s cosy and friendly and I have some good friends for company.”

We spoke with a visiting relative who said, “I cannot speak highly enough about this home. The staff are amazing. They are so caring with Dad. They spend time with him and engage with him. On every possible level this place is first class.”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with a visiting relative who said, “I am aware of safeguarding from my own job and I can tell you the staff are fully aware of safeguarding. I also know for a fact Dad feels safe here; it shows in his body language.”

We found medicines were managed in a safe way.

We saw the manager undertook audits of the services provided. There were also arrangements in place to gain additional feedback about the services provided from survey data.

This inspection was carried out as follow up to an inspection in May 2012. At that time the provider was found not to have a statement of purpose in place to provide information on the service and the range of peoples needs which could be met. In addition the provider did not have adequate quality monitoring mechanisms which ensured the health, safety and welfare of people who used the service and others.

During this inspection visit we focused on these two areas.

We found the provider had introduced a comprehensive statement of purpose which clearly set out the aims and objectives of the service, the kinds of services it provided and a broad range of additional information.

We saw the provider had begun to modify the facilities within the home to provide an improved environment for people with dementia conditions. We also found the provider had introduced a wide range of audits to scrutinise all aspects of care from facilities management through to individual care and support of people.

In addition we found the manager had improved communication with people who use the service and their relatives.

We spoke with three people living in the home and spent time on both floors of the home. Those able to express an opinion told us they were happy and were well cared for, although due to their needs some comments were not directly relevant with the service received. People appeared generally content, at ease in the home and with the staff on duty.

People said they were not happy/thought their relatives privacy was not protected.

People told us "my relative stays in their room as they don't like to mix" and "people come into their room and move things or urinate and this is very distressing".

People said they received enough to eat and drink. They said, "the food is nice", "I really enjoy the food" and "we get a good variety".

People told us their home was clean, comfortable and warm. They said, "I have my things around me and how I like them in my room" and "the place is spotless".

They said their visitors were made to feel welcome but information sharing between relatives and the provider was not good.

This inspection took place on 27 and 29 October, 3 November 2015 and was unannounced. This meant the registered provider and the manager did not know we would be carrying out the inspection.

During our last inspection in November 2014 we found the registered provider had not met the requirements of three regulations. We found the registered provider did not at times have sufficient staff on duty to ensure people were safe; the registered provider had not maintained appropriate standards of cleanliness and hygiene and had not maintained accurate records in respect of each service user. The registered manager submitted an action plan to show how the service planned to improve. We found improvements had been carried out.

Rushyfield Care Centre is a purpose built facility that provides care for up to 41 people who require accommodation and have personal or nursing care needs.. People were accommodated on two units named Usher Moor and Langley Moor. At the time of our inspection there were 35 people living in 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 or our inspection the manager in post had applied to become the registered manager. An error had been found by the CQC on their application and returned to the manager. During our inspection this was brought to the attention of the manager who re-submitted the correct application.

We found the registered provider had considered risks to people in the home and had in place risk assessments to identify and mitigate possible causes of accidents or injuries to people.

Arrangements were not in place to ensure people’s topical medicines were administered appropriately.

The registered provider had a robust recruitment and selection procedure in place and carried out all relevant checks when they employed staff.

We saw that accidents and incidents were recorded and these were monitored by the manager to see if improvements could be made to reduce risks to people.

We found communication arrangements were established in the home to ensure staff were kept informed about people’s needs.

Staff had received training pertinent to their role, for example they had completed training in moving and handling, health and safety and safeguarding people.

We observed meaningful contacts between people who used the service and the staff. Staff engaged people in conversation and gave them choices so they could be assisted with their needs.

We saw people’s rooms were personalised with items they had brought from their own homes including ornaments and photographs. This meant people had familiar things around them to support them and make them feel at home.

We found people were supported to live the life they chose with full regard to their gender, age, race, religion or belief, and disability.

We observed staff in the home giving people hugs and kisses on the cheek and treating people with affection. People demonstrated these actions supported their well-being and responded with smiles and chatted to staff.

People were encouraged to be independent with eating and drinking.

The registered provider had on display a poster which said staff had been trained in ‘OOMPH’ which stood for ‘Our Organisation Makes People Happy’. Staff led a movement to music session where we saw people participated to various levels and enjoyed the activity.

We found the registered provider carried out monthly auditing visits, and looked at ways the service needed to improve as well as setting deadlines by which the improvements had to take place.

We found people chose when they wanted to get up and staff provided the support they required. Staff gave people an early morning drink and a biscuit.

The manager had introduced an ‘Employee of the Month Award’ which was aimed at recognising good practice and fostering a positive culture in the home.

Professional partners involved in the care of people in the home without exception spoke positively about working in partnership with the staff.

We found the manager had in place regular meetings with staff to look at various aspects of the home including health and safety and catering.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.