What life is like for people using this service:

People told us they felt safe and well cared for. They told us they felt safe when staff supported them with transfers.

People had a personal emergency evacuation plan to be used in the event of an emergency, such as a fire. Fire safety arrangements for people were safe. A fire exit for staff in a cellar was not easily accessible. This was addressed by the provider on the day of our inspection.

Care plans had risk assessments that included information for staff about how to support people safely with their care. We saw staff do this.

The premises were clean. Staff followed infection control and prevention procedures, they wore personal protective equipment when they supported people with their personal care.

We saw there were enough suitably recruited staff to meet people’s needs.

People received their medicines when they needed them. Arrangements for the storage of medicines were safe.

The registered manager and senior care worker’s assessed people’s needs and developed care plans. People, if they were able, were involved in developing their care plans and their relative’s views were sought and listened to.

People told us that staff understood their needs and appeared to be well trained. Staff told us their training equipped them with the skills and knowledge they needed.

Staff supported people to have enough to eat and drink. People told us they liked their meals. However, not all people had a positive meal time experience.

Staff supported people to access health services when they needed them.

The premises provided a homely and comfortable setting for people.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us that staff were kind and caring. We saw that staff were attentive to people’s needs. People were supported to express their views.

People received care that was responsive to their needs. Care plans were detailed and included information for staff about how to support people.

People and relatives knew how to raise concerns or make a complaint using the provider’s complaints procedure.

Care plans included information about people wanted to be cared for towards the end of their life

People told us the registered manager was friendly and approachable and often seen.

The provider’s quality assurance included seeking feedback from people, their relatives, staff and health and social care professionals who visited the home.

About the service: The Rookery Care Home is a residential care home for up to 30 older people, some of whom may be living with dementia. At the time of the inspection 12 people lived in the service.

Rating at last inspection: Good (published 2 August 2016).

Why we inspected: This was a planned inspection based on the rating of Good at the last inspection. The overall rating at this inspection is Requires Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected The Rookery on 10 June 2016. The Inspection was unannounced.

The Rookery is a care home in the Eastwood area of Nottingham, owned by Dual Care Limited. The accommodation consists of a large Georgian building which has been extended to provide additional bedrooms. Care is provided over two floors of the building and a lift was available. The service is registered to accommodate up to 30 older people who require nursing or personal care. The service does not provide nursing care. At the time of our visit 14 people were living at the Rookery.

The service had a registered manager in place at the time of our visit. 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.

We found that people were safe at The Rookery and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began working at The Rookery.

People received their prescribed medicines when required and these were stored and administered safely.

People received effective care from staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for care staff was scheduled to help staff maintain their knowledge.

Where they were able to, people provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities.

Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities. They knew how to raise an issue and were confident these would be listened to and acted on.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

We inspected this service on 13 October 2015. The inspection was unannounced.

The Rookery is a care home in the Eastwood area of Nottingham, owned by Dual Care Limited. The accommodation consists of a large Georgian building which has been extended to provide additional bedrooms. Care is provided over two floors of the building and a lift was available. The service is registered to accommodate up to 30 people who require nursing or personal care. At the time of our visit 16 people were living at the Rookery.

The service had a registered manager in place at the time of our visit. 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.

We found the provider was not meeting the requirement to keep people safe as there were not always sufficient numbers of staff available to meet people’s needs which meant people were left unattended for long periods of time. We saw people were left in soiled clothing due to incontinence and staff did not assist them to change their clothing. The system to call for assistance was not adequate and not all people had access to a call button. This meant that people would experience delay in accessing assistance when required.

Risks to people were not always assessed and monitored to protect them from the risk of harm. Risk assessments that were in place were not reviewed or updated and did not give instruction for how to reduce risk of injury. Measures to reduce risk were not always used, for example sensor mats to alert staff that a person at risk of falls was moving were not always used.

A number of people who used the service had dementia and were not always able to communicate their wishes clearly. We saw that staff understood the needs of people and were able to communicate with them effectively.

People were not supported to engage in any meaningful activities.

The service was not meeting the requirement to ensure that fit and proper persons were employed as appropriate pre-employment checks were not always carried out. References or conduct in previous health and social care roles were not checked.

The service was not meeting the requirement to ensure the environment was clean and properly maintained. The environment was dirty and had a strong smell of urine. Furniture and flooring was clearly soiled and chairs were unclean and in need of repair or replacement. Infection control audits and training had not been carried out.

People’s records were not always updated to reflect the person’s current need and information was sometimes contradictory.

People received their medicines as prescribed. However medicines were not always being stored safely to ensure they were still effective.

People were protected from the risk of abuse in the service and the manager knew what information should be shared with the local authority when needed. Staff knew how to respond to incidents and when to share information with the safeguarding team. This meant there were systems in place to protect people from the risk of abuse.

We saw good examples of staff supporting people to maintain their nutrition. Staff were involving a range of health professionals when people’s needs changed and they needed extra support.

Where people lacked capacity to make a decision, mental capacity act assessment guidance was followed. We noted good examples and understanding of deprivation of liberty safeguards guidance.

People were supported to maintain their nutrition and staff were involving a range of health professionals when people’s needs changed and they needed extra support.

People were mostly treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people and supported them to develop their independence.

Systems were in place to allow people, their relatives and staff the opportunity to give feedback about the service. However we found this feedback was not acted on. The service was not meeting the requirement to ensure good governance as the systems in place to monitor the quality of the service were not robust.

You can see what action we told the provider to take at the back of the full version of the report.