Rustington Hall

We found the following examples of good practice.

The service had appropriate procedures in place for visiting, including checking of COVID-19 passports for visiting professionals.

The registered manager has facilitated visits for people safely and regularly during the pandemic.

The service was clean and tidy throughout. There were robust cleaning schedules inclusive of high touch point areas, to promote safe infection control practices.

Staff had received all appropriate infection prevention and control training. This included the correct use of personal protective equipment (PPE), and donning and doffing safely. Staff were observed to be wearing PPE correctly.

The registered manager had managed risks to people from outbreaks through appropriate isolation and separation of areas within the service.

Rustington Hall is a residential care home providing personal and nursing care to 42 people at the time of the inspection. The service can support up to 62 people. People had a range of health and care needs, including physical disability and dementia care. The home is divided into three wings, each of which has separate adapted facilities. There is a decking area outside the main communal lounge with wheelchair access to the gardens.

People’s experience of using this service and what we found

Without exception, everyone we spoke with talked about the fantastic care they received at Rustington Hall. Everyone was happy to be living there and spoke positively about all aspects of the service. One person told us, “This is a great home, I enjoy living here. I've been in other homes, but I would recommend this one. The care is brilliant.” A relative said, “Rustington Hall just blew me away. It is more like a hotel than a nursing home. I would absolutely recommend.”

We noted gaps in recording and stock for some medicines. These issues had been picked up in the most recent audit and were already being addressed by the clinical lead. Although there was no evidence of harm to people from these recording and stock issues, it was an area requiring improvement.

Staff had excellent knowledge of people and there was a focus on the individual and on tailoring care and providing activities which were meaningful to them. Staff made one to one time a priority and had encouraged people to venture out or to participate in activities that interested them. Staff supported people to maintain contact with those important to them and had devised imaginative ways to celebrate special events with family members, in line with COVID-19 restrictions.

People's communication needs were identified and planned for. The provider had invested in technology to support people with communication and to maintain their independence. People had confidence that any concerns raised to staff or the management team would be quickly addressed.

People received high quality care that improved their wellbeing. Staff were highly motivated to provide positive outcomes for people and ensured their independence was maintained and developed.

People received outstanding and individualised care at the end of their lives. Staff were encouraged to talk about death and dying openly and sensitively with people and the service helped people plan the end of their lives with dignity. Relatives spoke of the incredible support they had received from staff and of the wonderful photos and videos they received of their loved one.

Strong relationships were formed between staff and people due to the continuity of staff and the very caring approach of staff members. There was a feeling of community at the service and we observed positive and caring relationships between people and staff. People were actively involved and in control of how their care was provided.

Care staff were well informed about risks to people's health or wellbeing and knew how to deliver their care safely. Staffing levels were enough to meet people's needs. The home was clean. Staff had been trained in infection prevention and control and there were rigorous safety precautions in place in relation to COVID-19. One person told us, “How the management have handled the last year has been incredible.” Lessons were learned if things went wrong.

People spoke positively about the staff who supported them and had confidence in their skills and experience. Staff had regular supervisions and an annual appraisal. People were enthusiastic about the food and were actively encouraged to make suggestions for additions or changes to the menu.

People had access to a range of healthcare professionals and support. Premises were suitable and comfortable and met people's needs. The provider was investing in improving the facilities for people and for staff.

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

There was strong and effective leadership and both people and staff said they would recommend the home. The service was well organised and had a range of systems in place to ensure its smooth operation and to support good communication. Feedback from health professionals who worked closely with the service consistently indicated that staff went the extra mile to deliver person centred care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published on 23 December 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about care practice, including with moving and handling, choice, modified diets and oral care. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

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

Rustington Hall is a residential care home providing personal and nursing care to 58 people at the time of the inspection. They support older people, people with physical disabilities and people living with dementia. The service can support up to 62 people across three units in one adapted building.

People’s experience of using this service and what we found

People told us they felt safe when staff supported them but we found inconsistencies in records relating to risk and topical medicines. People spoke positively about the staff who supported them but we made two observations on the day that showed people’s dignity was not always promoted through staff practice. Care records were not always personalised and we found shortfalls in governance and auditing at the service.

People told us there were enough staff but they sometimes had to wait for support, the provider was about to introduce a new call bell system in response to this. Feedback about food was mixed and work was underway to involve people in changes to the menu. People’s dietary needs were met and we saw evidence of an assessment of people’s needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice, because we found some records relating to consent were inconsistent. People received an assessment of their needs before coming to live at the service. The environment was adapted to people’s needs and we saw examples of innovative practice to make areas of the home more accessible to people.

People’s healthcare needs were met and staff supported people to access healthcare appointments where necessary. Aside from the issues with topical creams people’s medicines were managed and administered in line with best practice. Staff had received training and support for their roles and had regular meetings. People and relatives had regular surveys and meetings to involve them in the running of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 18 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk, dignity, care planning and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rustington Hall provides accommodation for up to 62 older people who require nursing and personal care. At the time of our inspection there were 51 people staying there.

The service had a 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 2008 and associated Regulations about how the service is run.

The registered manager was dedicated to providing the best possible standard of care and inspired the staff to provide care which focussed on the individual. Staff were well supported and encouraged to continually develop their skills and knowledge to deliver excellent person centred care. People were treated as individuals and their wishes and preferences respected.

The provider was committed to making Rustington Hall as ‘homely’ as possible in order to meet people’s individual needs; they had invested in their staff and environment. The home had been decorated and furnished in a way which helped people living with dementia remain as independent as possible and there was up to date, well maintained equipment available to support people’s personal care needs effectively.

People received care from staff that knew them very well and who were kind, compassionate and respectful. People received care that was person centred and there was an ethos of ‘how can we’ not ‘why we can’t’. Staff strived to enable people to continue to live rewarding and fulfilling lives. People’s needs were assessed prior to coming to the home and care plans were written in a person centred way ensuring people had choices and opportunities to receive their care in line with their personal preferences. Care plans were kept under constant review and every effort was made to ensure people and their families stayed involved with the planning of people’s care. People participated in a range of activities and received the support they needed to help them do this.

Staff supported people in a manner that ensured that their health and well-being was maintained and actively promoted. The service provided very good end of life care. People experienced a comfortable, dignified death in line with their wishes.

Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people's rights. There was guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, registered provider and staff ensured that people were supported in ways that did not restrict their freedom and were supported appropriately to uphold their rights.

There were sufficient staff to meet people's needs; staffing levels were kept under review and adjusted to meet people’s changing needs. Staff were not rushed in their duties and had time to talk with people. Throughout the inspection there was a friendly and calm atmosphere; staff responded promptly to people who needed support. The service had appropriate recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. Care plans contained risk assessments which gave detailed instructions to staff as to how to mitigate risks; these enabled and empowered people to live as independent a life as possible safely.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had. People felt listened to and knew how to make a complaint if they needed to.

A quality assurance system was in place and people could be assured that action would be taken to address any shortfalls. People’s feedback was actively sought and there was commitment within the management team to strive to continuously improve and be the best they could be.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

Everyone that we spoke with told us that they were happy living at the service and that they felt that their care needs were being met. One person said, 'The staff are lovely, they are more friends than members of staff'. Another person said, 'I am well looked after here, I have nothing but praise for the place'.

We found that people had planned care that met with their needs, and that people had been consulted about their care needs and preferences. People also told us that staff treated them with respect and promoted their privacy.

We found that the service had systems in place to administer medications safely. We also found that the service had followed safe recruitment processes, and had systems in place to ensure that people living at their received a safe and good quality service.

We spoke to two staff who informed us that they knew how to report abuse. The home had procedures in place to report any allegations of abuse.

We examined the recruitment process and found all relevant checks had been carried out, ensuring the staff had the right qualifications and experience to provide care to older people.

During our inspection we were able to confirm the home had systems in place to evaluate and monitor the quality of the service given.