Rutland Home provides nursing care for up eighteen people, including people who have dementia and mental health needs. At the time of our inspection 11 people lived here.

The inspection took place on 01 August 2017 and was unannounced. We had carried out an unannounced comprehensive inspection of this service on 30 April and 5 May 2015. At that inspection a breach of the regulations had been found with regards to records management. After that comprehensive inspection, the provider wrote to us to say what they would do to meet the regulations. The provider had taken appropriate action and addressed the concern we had raised.

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.

People were safe at Rutland. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

There were sufficient numbers of staff deployed to meet the needs and preferences of the people that lived there. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. They had also checked to ensure staff were eligible to work in the UK.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to support people if the building needed to be evacuated. Regular checks were completed around the home to ensure it was safe, such as testing fire detection systems, and maintenance of equipment.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and specialist diets either through medical requirements, or personal choices were provided. People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

There was positive feedback about the home and caring nature of staff from people who live here. The staff were seen to be kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection between staff and the people they cared for. People could have visitors from family and friends whenever they wanted.

Care plans gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details in the care plans matched with what we saw on the day of our inspection, and with what people told us.

People had access to a wide range of activities. People and relatives were positive about the choice of activities, and how there was always something interesting to

Our inspection of this care service helped answer our five 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, talking to people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff at most times. However we saw over lunch that staff were required to support two people at once. Staff were unable to give their full attention to the people they supported. This was not a dignified or relaxed experience for the people or the staff. We have asked the provider to make improvements in this area.

Systems were in place to make sure that the registered manager and staff learn from events such as accidents and incidents, concerns, whistleblowing and investigations. Risks to people’s welfare and safety had also been assessed. Appropriate action had been taken to minimise the risk of harm coming to people.

Is the service effective?

People's health and care needs were assessed with them or their family members, and they were involved in their care planning. We saw examples where reviews were held by the service to ensure that care plans reflected their current and changing needs.

Although there were procedures in place that said staff had regular one to one meetings and appraisals, the records we saw showed us this was not happening. We have asked the provider to make improvements in this area.

Is the service caring?

All of the people we spoke with said they were very happy with the care and support they received. One person told us that “I can’t fault the girls they are very good.”

We were told by the people who used the service and their families that their preferences and interests had been recorded and care and support had been provided in accordance with their wishes.

People using the service, their relatives, friends and other professionals involved with the service were asked to provide feedback on the service they received.

Is the service responsive?

At our last inspection in October 2013 we saw that people had given feedback to the service about the lack of activities at the home. During this visit we saw that no improvements had been made. People were seen to be left in lounge areas with no meaningful or appropriate activities. This meant that the service had not been responsive to people’s needs. We have asked the provider to make improvements in this area.

We looked at the complaints record and found there had been three complaints made to the provider. The complaints policy we looked at had been designed, written and developed to be user friendly. However where shortfalls or concerns were raised, people told us they felt that these were not always appropriately addressed by the provider. One family member stated that they were made to feel that they had “No right to make a complaint”. We have asked the provider to make improvements in this area.

Is the service well-led?

The staff and the registered manager worked well with the other professional bodies and authorities that had placed people with them. This ensured people received their care in a joined up way.

The registered manager carried out regular checks around the home to ensure people received a good standard of care. We saw audits had been completed of the care plans of people who used the service. These were carried out to ensure the information was complete and up to date, and that people had received care that met their needs. Other audits that had been carried out included appropriate checks in relation to the health and safety monitoring of equipment used at the service To ensure all equipment that was used was safe.

You can see our judgements on the front page of this report.

Systems had been put in place which evidenced that people’s care plans were reviewed to ensure they were up to date. We found that care plans provided detailed information and guidance for staff to be able to meet people’s needs. Care plans included risk assessments based on the persons emotional and health needs.

People who lived at the service were supported and enabled to eat and drink sufficient amounts to meet their needs. Most people ate their meal from lap tables while remaining seated in lounge chairs in the sitting room. We were told that this is because they have chosen to do so. We observed that some people were provided with support to eat their meal by staff and that people were given appropriate time to eat their meal.

We found that the general environment of the communal areas were cluttered and the decoration was compromised and in need of remedial works. Overall the service was in need of a firm maintenance program to be developed for both inside and in the garden.

We looked at the provider’s quality assurance (QA) system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk. We were told that the QA provided feedback on the quality of the services and if it is achieving its aims and objectives. This included: residents meetings and feedback questionnaires. We noted that changes to menus, activities, maintenance issues and care practices had been influenced by this

feedback.

People we spoke with told us they liked living in the home and that the staff were friendly and caring.

People told us that that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received. One person told us that "although I would rather live in my home, Rutland is the next best thing".

We saw that staff interacted well with the people who used the service. Staff interactions often resulted in positive outcomes for service users.

There were systems in place for maintaining a clean and hygenic environment although the staff did not always complete the relevant internal audit tools. We have since received assurances and information from the registered manager that internal audit tools and appropriate records of cleaning are now kept and are up to date.

We found that there were sufficient levels of staff with the appropriate skills and qualifications to meet the needs of the people living at the home. One person we spoke to told us that the staff were "simply excellent... we can always have a laugh and a joke with the nurses and carers which helps cheer me up".

There was a complaints procedure available to all people living at the service and additional information was available in large print format for those with sight problems.

Our inspection visit took place between 11am and 3.30pm and was unannounced. This means that the service did not know beforehand that we would be visiting. During our visit we spoke to five people who live at the service and six staff. We also spoke to three carers (relatives) either on the day of our site visit or via telephone following our visit. There were 13 people living at the service at the time of our visit.

We observed that the people living at the service were again given time to express their needs, were involved in making some day to day decisions and were supported in a way that was mindful of their rights to respect and dignity.

A person who lives at the service told us how they had the freedom in their daily routines which included going to bed and getting up whenever they wanted.

All people who live at the service were involved in the review of the service through either their feedback or our observations of their interactions with the service and staff. We spoke with five carers (relatives) either on the day of our site visit or via telephone following our visit. We also consulted with five staff members. The site visit was in part facilitated by the provider. On the day of our site visit there were eleven people living at the service including people who have dementia, mental health needs and behaviour which can be challenging.

In February 2011 the service became registered as a nursing home, prior to this they provided residential care. The service has gradually increased in occupancy in the previous five months with most of the people living at the service having been admitted in this period. Some people have been admitted for short term care.

All people we consulted who live at the service told us that they liked living at the service. This was because it had a relaxed, friendly atmosphere and it was a comfortable place to live with a person telling us “I am well looked after”. Carers consistently told us that the relaxed pace of life suited their relative and that they were happy with the standards of care their relative received. A carer also told us “ the environment is always very clean and tidy her bedroom has everything she needs”. A carer told us “that the only thing that I feel they could improve is providing more activities and things to do”.

A person told us how they felt unwell on the morning of our site visit and how the doctor had been called immediately.

A carer said about the food “generally not bad there are plenty of hot drinks”. Another carer told us how they stay for meals with their relative and how nice the food has been. Another carer said that usually the meals are very good but they had noticed of late that their relative had started to complain about some meals. We received variable comments from people about the meal on the day of our visit, which included. “not warm enough” and several people told us that the meat was extremely tough

People who use the service who all told us that they felt they were living in a safe and secure environment. People and carers told us that they felt confident to raise any concerns they had with management and felt that this would be dealt with promptly.

People we consulted all told us about the kindness of staff and how they always got the help they needed when they wanted it. Carers we spoke to told us how polite and hard working staff were. A carer said “all the staff seem friendly and helpful”. Several carers noted that there had been some turnover of staff in the last few months, with one carer commenting “there are always new people around when we visit which can be a bit frustrating but this has slowed down now, the manager always around to answer any questions”.

Carers and people living at the service told us that they are regularly asked for their views about the service and if there was anything that could be improved upon. They said that in response their views had been listened to and they felt that they had some influence over what happened at the service.

This inspection took place on 30 April and 05 May 2015 and was unannounced on both days.

Rutland Home provides nursing care for up eighteen older people, including people who have dementia and mental health needs. At the time of our visit nine people lived here. Rooms are arranged over two floors and there is a stair lift. Communal facilities include two lounges, one on each floor and a secluded rear garden. Ramps have been placed by stairs to help people mobilise around upstairs. There is parking to the front of the property. The home is an adapted building with bedrooms on the ground and first floor. The home has no lift although it has two stair lifts. There are specialist bathing aids and baths to assist people.

A relative told us, “Overall the service is very, very good, all the staff are caring and compassionate.”

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was not present during the inspection.

Documentation to enable staff to support people and record the care and support given were not consistently completed. Records such as care plans, risk assessments and medicine records had gaps, or no recorded recent review. People did receive the care and support they needed during our inspection.

People were positive about the staff saying they were kind and caring. People generally thought there was enough staff to meet their needs.

Medicines were managed in a safe way and people received them when they needed them. Apart from a few minor issues with recording they were managed well in the home. People also received appropriate treatment to keep them healthy, or if their health needs changed.

Activities were available that were of interest to the people that live here. People were seen to enjoy the activities, and everyone who wanted to be involved was. Work was being carried out to further improve the activities on offer to make them more individual to people.

Food and drink was readily available throughout the day. The food was freshly prepared and looked appetising. Those people on specialist diets received the food in the form they needed it.

A complaints procedure was available for any concerns and relatives and people were encouraged to feedback their views and ideas about the running of the home.

The provider and staff carried out a number of quality assurance checks to make sure the home was safe and people received a good quality of care.

Appropriate checks were carried out to help ensure only suitable staff worked in the home.

We have identified one of breach in the regulations. You can see what action we told the provider to take at the back of the full version of this report.

Good interactions were seen between the staff and the people who live here. They were friendly, caring and supportive.