This inspection took place on 14 and 16 November 2017 and the first day was unannounced.

At our comprehensive inspection on 11 October 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment and good governance. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well led, to at least good. We undertook a focused inspection on 8 March 2017 to check the provider had followed their action plan and to confirm that they now met legal requirements. We found the provider had taken all the necessary action to make the necessary improvements and improved the overall rating to good.

Rutland House 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.

Rutland House care home accommodates 20 people in one adapted building. Accommodation is provided on two floors with stair lift access. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 17 people living at the home.

At this inspection we found the service remained Good. The registered provider demonstrated they continued to meet the regulations and fundamental standards.

People continued to feel safe and well cared for at Rutland House. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. Risks to people’s health and safety were managed and staff took action to minimise these and keep people safe.

Appropriate recruitment checks were completed to make sure staff were suitable to work at the home. The staff were given ongoing training that enabled them to meet people’s different needs and keep up to date with best practice. Staff were supported appropriately through regular supervision and reviews of their performance.

People's needs were fully assessed and kept under review. Care records were person centred and clearly described people's needs and risks and how these were to be managed. Care plans provided important information about people, their background histories and preferences. Staff had a good knowledge of people's care needs and personalities. People’s wishes, choices and beliefs were reflected in their care plans. People were supported to make decisions and staff encouraged their independence as far as possible.

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. Staff showed understanding, patience and treated people with compassion.

There were enough staff on duty day and night to make sure people’s needs were met in a safe and timely way. People experienced care and support which was respectful, dignified and took into account their right to privacy and confidentiality.

People lived in a safe, clean environment that was designed and equipped to meet their needs. The provider planned to refurbish and decorate areas of the home and provide a more stimulating environment for people living with dementia.

Activities were arranged according to people’s needs and interests and were meaningful for people living with dementia. Activities were organised by care staff and entertainers visited from outside the home. Staff understood the importance of social interaction and ensured they offered people support and companionship when needed.

People were supported to maintain relationships with family and friends who were important to them. Relatives and friends were welcome to visit when they wished and invited to join in with social events at the home.

People received the assistance they needed with eating and drinking and to maintain

This inspection took place on 8 March 2017 and was unannounced. At our last focused inspection on 11 October 2016 we found the provider was not meeting legal requirements in relation to safe care and treatment and good governance. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check the provider had followed their action plan and to confirm that they now met legal requirements. We found the provider had taken all the necessary action to make the necessary improvements which meant they were no longer in breach of regulations. We are changing the rating for the two key questions ‘Is the service safe’ and ‘Is the service well led’ to Good, and we are therefore changing the overall rating to Good.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rutland House on our website at www.cqc.org.uk

Rutland House Care Home provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 17 people living at the home.

The service had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had made improvements to medicines management systems which meant they had taken action to protect people against the risks associated with medicines. The registered manager had put necessary guidance in place for staff to follow in administering some medicines to people and medicines administration was now recorded clearly. Our stock checks indicated people received medicines as prescribed and that records the provider made regarding medicines were accurate.

The provider had reviewed the audits in place to assess, monitor and improve the service. The registered manager had introduced effective medicines audits so they regularly checked that people received their medicines as prescribed. In addition the registered manager had also introduced monthly audits of care plans as well as of other aspects of service provision including accidents and incidents, pressure ulcers and falls. The registered manager had reviewed the medicines and complaints policies which we found to be lacking key details at our previous inspection.

This inspection took place on 11 October 2016 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in October 2014. At that time we gave the service an overall rating of ‘Good’ although we imposed one requirement notice which we checked during a focused inspection in August 2015. We found the provider was meeting the regulations we looked at that inspection.

Rutland House Care Home provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 16 people living at the home.

The service had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we identified a lack of clear, accessible guidance for staff as to how, when and why some medicines should be administered. Some medicines administration records (MAR) were poorly maintained which did not allow for a clear audit trail and increased the risk of mistakes being made when medicines were administered. We also found the provider’s policy and procedure for homely remedies did not comply with national good practice in this area. A homely remedy is a non-prescription medicine that is available over the counter and can be used in a care home for the short-term management of minor, self-limiting conditions.

The issues we found with the management of medicines did not give us full assurance that the provider’s quality assurance systems were fully effective. Although managers carried out medicines audits they did not check that current arrangements reflected best practice so there was a risk that people would not always experience the best care and support they needed to keep them safe and promoted their wellbeing.

We also found some of the information contained in records or policies and procedures was out of date or inaccurate. We found on one care record two different versions of a person’s support plan, which could have been confusing for staff unfamiliar with their needs. People were also not correctly informed about how they could take their concerns or complaints further if they were dissatisfied with the service.

We found two breaches of regulations during the inspection. These were in regards to safe care and treatment and good governance. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

The home manager acknowledged that more thorough checks and audits of key aspects of the service were needed and had employed a member of staff to specifically support them with this. The home manager had been proactive in making improvements when shortfalls in the service had been identified. Following an inspection of the home by London Fire Brigade this year, they made considerable investment in making the required improvements to bring the home up to the required standard.

Relatives told us their family members were safe at Rutland House Care Home. Staff were clear about their duty and responsibility to safeguard people from abuse. Managers worked proactively with other agencies to ensure action was taken to sufficiently protect people. This included taking action when allegations were made about the inappropriate conduct of staff towards people they supported. Staff knew how to minimise identified risks in order to keep people safe from injury or harm. Managers ensured maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of obstacles so that people could move freely and safely around.

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We carried out an unannounced comprehensive inspection of this service on 28 October 2014 and a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to submitting notifications about events and incidents in the home to the Care Quality Commission (CQC), in a timely manner.

We undertook this focused inspection to check the provider had followed their plan and to confirm they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rutland House on our website at www.cqc.org.uk

We undertook this unannounced focused inspection of Rutland House on 12 August 2015. Rutland House is a care home that provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 16 people living at the home.

The service has a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During this inspection we found the provider had taken appropriate action to ensure notifications they are legally required to submit to CQC were done so and in a timely manner.

The registered manager had ensured all staff at Rutland House were aware of the service’s legal obligations about notifying CQC of events and incidents and how and when this should be done.

Information about the process for submitting notifications was displayed in the home and easily accessible to staff.

The provider through quality assurance checks, ensured notifications were submitted to CQC in a timely manner when there had been an event or incident at the home.

Our own records showed the provider had fulfilled their legal obligations to submit notifications in a timely manner, following the last inspection.

At our last inspection of this service we had not been able to see that all of the appropriate checks had been undertaken prior to staff beginning to work in the service. We undertook this visit to check that the provider had made improvements in this process.

We were able to see that there were now procedures in place to ensure that people were being supported by staff who were appropriately experienced, skilled and fit to support people using the service.

Rutland House provides care and support for people with dementia. One person living at the home was able to contribute to the inspection process and he told us it was a “good home." We spoke with four care workers and three relatives (one relative after the inspection) and the registered manager.

Three relatives told us they thought staff were “patient,” “calm,” and “really kind and caring.” The atmosphere was relaxed on the day of the inspection and in the afternoon we observed an activity of “reminiscent therapy (people discussed past events).”

We reviewed the care files of four people who used the service. We observed that staff respected and involved people in their care. People received the care and support that met their needs. We saw that medicines were managed in a safe way.

We found that insufficient checks were made on staff before working at the home. We saw that there was adequate information about how to complain and complaints were managed in a robust manner.

This home provides personal care and support for people with dementia and the majority of them were not able to contribute to the inspection process. Through our observations we saw that they showed signs of positive wellbeing and engagement with the staff and their environment. All of them were free to walk around the home as they wished and staff chatted to them and tried to encourage them to join in with activities. Some were singing and others helping to fold laundry.

Visitors were free to come in whenever they wanted to. They told us that they were always welcomed warmly and they were kept informed about any changes in people’s health. One relative liked the fact that they could come and help their loved one at lunch time. They told us “that’s what I like about it here the homeliness”. Another relative commented “I just want to tell you its fantastic here”.

Staff we spoke with displayed an understanding about the people that they were supporting and we saw that they were able to attend training to help them in their role. Supervision and appraisal procedures ensured that their performance was monitored and any individual training needs were identified.

All of the people who live in the home have dementia and for some communication is limited.

Those who were able to talk with us told us "it's nice here"," I'm quite happy" and "I like the food here".

Everyone appeared to be happy and showed signs of positive engagement, both with their surroundings and with the staff who were caring for them.

This inspection took place on 28 October 2014 and was unannounced. At the last inspection on 16 December 2013 we found the service was meeting the regulations we looked at.

Rutland House is a care home that provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. Accommodation is arranged over two floors and there is a stair lift to assist people to access the upper floor. The home has 12 single bedrooms and four double rooms. None of the bedrooms have en-suite facilities. Communal areas include a lounge and dining area on the ground floor and a number of smaller sitting rooms on the first floor.

There were 19 people living at Rutland House when we visited.

The service had a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

They provider had failed to notify the CQC without delay about incidents that had affected the health, safety and welfare of people living at Rutland House such as allegations of abuse and applications made to the local authority to deprive people of their liberty. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at Rutland House. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage identified hazards in order to keep people safe from harm or injury.

People receive their medicines as prescribed and staff know how to manage medicines safely.

There were enough properly trained and well supported staff working in the care home to meet people’s needs. People told us, and we saw for ourselves, that staff had built up good working relationships with people who lived at the home. Staff were also familiar with people’s individual needs and the choices they had made about the care they wanted to receive.

People told us they were happy living at Rutland House. They also told us staff were kind and caring, and our observations and discussions with relatives supported this. We saw staff treated people with dignity, respect and compassion.

Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing. Where there were any issues or concerns about a person’s health or wellbeing staff ensured they received prompt care and attention from appropriate health and social care professionals.

People had a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

People told us Rutland House was a comfortable place to live. We saw the environment was well maintained.

Care plans were in place which reflected people’s specific needs and their individual choices and beliefs for how they lived their lives. People were involved in developing and regularly reviewing their care plans and we saw people were supported to make decisions about their care and support.

People had access to their local community and could choose to participate in a variety of interesting and fulfilling in-house and community based social activities. We also saw staff encouraged and supported people to be as independent as they could and wanted to be.

People were encouraged to maintain relationships that were important to them. There were no restrictions on when people could visit the home and staff made all visitors feel welcome.

The service had a clear management structure and people who lived there, relatives and staff felt comfortable about sharing their views and talking to the manager and co-owner if they had any concerns or ideas to make Rutland House at better place for people to live. The manager and co-owner demonstrated a good understanding of their role and responsibilities and staff told us the manager was competent, supportive and fair.

There were effective systems in place to monitor the safety and quality of the service provided at Rutland House. The provider regularly sought people’s views about how the care and support they received could be improved.

The manager had sufficient training in Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.