Rutland Manor 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.

Rutland Manor Nursing Home is registered to accommodate 41 people. At the time of our inspection 26 people were using the service. The service accommodates people in one adapted building over two floors. The ground floor has a lounge and dining area. A garden and enclosed patio were also available that people could access.

The service did not have a registered manager in post at the time of the inspection. 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. A manager was in post and they had completed the process to register with us. At the time of the inspection they were awaiting their registration certificate.

Our last comprehensive inspection was undertaken on the 3 March 2017 and although the service was meeting the regulations that we checked, we identified improvements were needed. This was to ensure safeguarding procedures were followed consistently and that staff supported people consistently when they demonstrated behaviours that put themselves or others at risk. At the last inspection some staff did not feel they were supported effectively or worked well as a team in meeting people’s needs. We asked the provider to address this. At this inspection all areas for improvement had been addressed. The service continued to meet the regulations and was rated as good.

There was sufficient staff to support people and people told us they felt safe at the home. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were undertaken that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. Plans were in place to respond to emergencies; to ensure people were supported in accordance with their needs. People had the equipment they needed to enable staff to assist them safely and staff understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use.

Staff supported people to make their own decisions whenever possible and where people were unable to do this, decisions were made in their best interests. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to take part in activities to promote their wellbeing and their dignity and privacy was respected by the staff team. People were supported to maintain relationships and visitors were made welcome by staff.

There were processes in place for people and their relatives to express their views and opinions about the service provided and raise any concerns they had. People’s representatives felt the service was well managed and they were involved in reviews of care. Staff felt supported and confirmed they worked well as a team. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

This inspection took place on the 3 March 2017 and was unannounced. At our previous inspection on the 4 May 2016 the service was meeting the regulations however we asked the provider to make some improvements. This was because there were times during the day where additional staff support was needed to ensure people were supported in a timely way and supervised. Improvements were also needed to ensure informal complaints were addressed promptly and areas identified for improvement were addressed in a timely way. We saw that improvements had been made in these areas. At this inspection the service continued to meet the regulations that we checked but we identified that other improvements were needed.

Rutland Manor Nursing Home is registered to provide accommodation, personal care and nursing care for up to 41 older people including people living with dementia. There were 27 people using the service at the time of our inspection.

There was no 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. The previous registered manager had deregistered in November 2016 and a new manager was recruited. However they had recently stepped down and were employed as the clinical lead at the time of this inspection. The operations manager confirmed they were in the process of advertising the registered manager’s post, in the interim the operations manager was overseeing the management of the service.

Some staff did not feel they were supported effectively or worked well as a team in meeting people’s needs. Improvements were needed in the guidance for staff when supporting people who may demonstrate behaviours that put themselves or others at risk. Safeguarding procedures had not been followed consistently by the management team.

People felt safe and staff understood their role in protecting them from the risk of harm. People received their medicines at the right time and medicines were managed safely. People were supported by staff who had the knowledge and skills to provide safe care and support and there was sufficient staff available to meet their identified needs. Checks were carried out prior to staff starting work to ensure their suitability to work with people

People were supported to eat and drink what they liked according to their dietary needs and preferences. Where concerns were identified, people received support from health care professionals to ensure their well-being was maintained. Health concerns were monitored and people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew people’s likes and dislikes. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People were supported to participate in social activities. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. The staff and management team made visitors feel welcome and were approachable.

Quality monitoring checks were completed by the provider and when needed action was taken to make improvements. The provider sought the opinions from people and their representatives to bring about changes. The provider understood their responsibilities around registration with us. People knew how to complain and we saw when complaints were made these were addressed.

This inspection took place on the 4 May 2016 and was unannounced. At our previous inspection on the 6 and 7 May 2015 the service was meeting the regulations that we checked but we did ask the provider to make some improvements. This was because improvements were needed to; the staffing levels, the housekeeping standards, the support people received with their meals and drinks and promoting their dignity, the complaints, staff support and the quality monitoring systems in place. At this inspection we saw that improvements had been made in most areas but further improvements were required.

Rutland Manor Nursing Home is registered to provide accommodation, personal care and nursing care for up to 41 older people including people living with dementia. There were 33 people using the service at the time of our inspection.

There was a registered manager in post at the time of our inspection. 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.

Although staff understood people’s needs and preferences and were responsive to them, we saw there were times during the day where additional staff support would have ensured that everyone was supported in a timely way and supervised as needed. People’s representatives knew how to raise a concern and formal complaints were responded to but the provider’s procedure was not followed when informal complaints were made.

There were systems in place to monitor the quality of the service. However there was not a proactive approach to implement the improvements required. This led to external monitoring teams raising concerns and identifying the improvements which had not been made swiftly to reduce the risk to people using the service.

We saw that staff treated people in a caring and respectful way. People were offered refreshments throughout the day and their nutritional needs were monitored and actions taken as needed, to promote their health and well-being needs. Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs.Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks.

Staff told us they felt supported by the management team and were provided with training to enhance their knowledge and understanding. People and their visitors told us the staff were able to meet their needs and felt safe with the support provided to them. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse. Recruitment checks were carried out prior to staff starting work to ensure their suitability to work and people were supported to take their medicine as and when needed.

Capacity assessments had been completed to show how people were supported to make decisions. When people were being unlawfully restricted this had been considered and applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions. There were processes in place for people and their relatives to express their views and opinions about the service provided. People’s representatives were asked to express their views and be involved in decisions related to the planning of their care.

A relative we spoke with told us they were satisfied with the care and support their family member received and told us they were kept informed about important events and incidents.

Our previous inspection visit in October 2013 found that the service was not obtaining people’s consent to their care consistently or completing documentation for advanced decision making with regard to resuscitation in an emergency. We saw this had improved and people’s representatives were now giving their consent to the care and treatment provided. We observed the care and support provided and saw this was offered in a timely manner.

Our previous visit in October 2013 found that there were occasions when the service did not have a sufficient number of staff to meet people’s needs. We also received information in March 2014 that suggested there was an insufficient number of staff available and that they were working long hours. We found that an additional member of staff had been employed to cover the evening shift and staff rotas showed us staff were not working excessive hours. This meant the provider had taken action to ensure there were a sufficient number of staff to meet people’s needs.

One person told us “I’m glad I came here” and a relative described the service as “nice and friendly”.

A relative told us they were "quite happy" with the support given to the person they were involved with and described staff as "caring". Another told us the person they were concerned with was “kept safe”.

Our observation showed us that staff showed warmth and encouragement towards people and maintained their dignity. Overall, people had positive experiences. The staff present knew what support individuals needed and respected the individuality of the people using the service. It showed us that people using the service responded well to the staff interactions and the approach by staff was positive and encouraging.

A relative told us they were satisfied with the service and said the person they were concerned with was “happy and settled”. They described the food as “good”.

Our observation showed us that people were treated respectfully and that their individual needs were catered for.

One relative said they were "particularly pleased" with the level of activities offered and said the service "try to get people involved". They told us they were "pleased with everything" about their relative's care.

A visiting professional told us the service had put a lot in place to manage end of life care and that there had been a "vast improvement". They told us staff were "keen" and wanted "to be involved".

Staff told us they “enjoyed work”’ and that they were well supported.

This inspection took place on the 6 and 7 May 2015 and was unannounced.

Rutland Manor Nursing Home is registered to provide accommodation, personal care and nursing care for up to 41 older people including people living with dementia. There were 41 people using the service at the time of our inspection.

The person managing the service [the acting manager] was in the process of applying to be the registered manager. 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 and associated Regulations about how the service is run.

People who were able to told us they felt safe living at Rutland Manor Nursing Home and felt safe with the staff who looked after them. The relatives we spoke with agreed.

Management were aware of their responsibilities around the safeguarding of people and staff had received training on how to keep people safe. Staff we spoke with were all aware of the actions to take if they were presented with a safeguarding concern.

People’s needs had been assessed before they moved into the service and plans of care had been developed from these assessments. Risk assessments had also been completed. Not everyone’s plan of care or their risk assessments had been reviewed on a monthly basis as expected by the management team and not all had been completed fully.

People told us there were not always enough staff around to meet people’s needs and staff members agreed. Our observations showed that staff were extremely busy throughout the day and only limited time was available to spend with the people who used the service when tasks were not being carried out.

We have made a recommendation about staffing levels at the service.

People received their medicines as prescribed by their doctor. Their medicines were being handled in line with national guidance and the required records were being kept.

Checks had been carried out when new staff had been employed to make sure they were suitable to work at the service. An induction into the service had been provided for all new staff and ongoing training was being delivered. This enabled the staff to provide the care and support people needed.

People’s nutritional and dietary requirements had been assessed and a balanced diet was provided, though a limited choice was provided at lunch time. Staff were not always recording when they were providing people with food and fluids. This meant they could not demonstrate that people had received the nourishment they needed to keep them well.

Not all the areas of the service were found to be clean or tidy. This was brought to the management’s attention during our visit and the areas of concern identified were addressed before we left.

Communication between the people who used the service and the staff was not always effective. Some members of staff took time to explain things to people, whilst others did not and carried on with the task in hand without speaking to the people they were supporting.

People’s privacy and dignity was on the whole maintained and staff knew what to do to promote this. People were encouraged to follow interests that they enjoyed and relatives and friends were able to visit the service at any time.

People knew how to raise a concern and these were responded to in line with the provider's policy and procedure. 

Systems were in place to monitor the service being provided, though these were not always effective in identifying shortfalls, particularly within people’s care records.

People felt that the service was appropriately managed but felt at times communication could be improved. Staff told us that if they had a concern of any kind, they would not hesitate to raise it with the management team.