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Inspection carried out on 4 October 2016

During a routine inspection

The inspection took place on 4 and 5 October 2016 and was unannounced. Renaissance Residential Home provides care and accommodation for up to 17 people. On the day of the inspection 15 people were living in the home. Renaissance Residential Home provides care for people with a learning disability.

Two registered managers managed the service; one of which was also the registered provider and delegated certain management responsibilities to the other 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.

People told us they felt safe using the service. There were risk assessments in place to identify any risks related to people’s care and support needs. People received support to maintain their health and any referrals to healthcare professionals were made in a timely fashion. Staff knew how to keep people safe understood the risks relating to people’s health needs, however, these were not always included in people’s risk assessments. When people sometimes felt anxious, staff supported people to feel better but how they did this was not included in guidance for staff to ensure consistency for the person. The registered provider confirmed these would be put in place as soon as possible.

Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. People told us staff provided information about staying safe and supported them to keep safe.

Some people were supported with their medicines. Staff had received training in the safe administration of medicines but had not received regular competency assessments which meant they may not be working in line with best practice. Staff understood people’s needs in relation to their medicines but there was no information recorded for medicines that were prescribed to be taken, ‘as required’, this meant there may be a risk of staff administering medicines incorrectly. The registered provider told us they would ensure these were put in place.

The recruitment process of new staff was robust. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “You can’t fault them. There’s nothing they could do better.”

Staff and the registered provider understood the requirements of the Mental Capacity Act 2005 (MCA) but no-one living at the service was currently assesses as lacking capacity.

There was a positive culture within the service. The registered provider had clear values about how they wished the service to be provided and these values were shared by the whole staff team. The registered provider and staff described trying to create a ‘family home’ for people, and people and relatives felt this had been achieved.

There was a management structure in the service which provided clear lines of responsibility and accountability. The registered provider and registered manager were supported by other senior staff who had designated management responsibilities. People told us they knew who to speak to and any changes or concerns were dealt with swiftly and efficiently.

The registered manager and registered provider monitored the quality of the service by regularly speaking with people to ensure they were happy with the service they received. However, audits that were in place to identify any improvements that could be made to the service had not been carried out effectively, so few actions had been taken as a result. The registered provider told us, they would improve the way audits were completed in the future.

People and their relatives told us the management team were approachable and included them in discussions about their care and the running of the service. Comments included, “The management are brilliant.”

Inspection carried out on 23 July 2014

During a routine inspection

Our inspection team was made up of a single inspector. We considered all the evidence we had gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask: 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, speaking to people using the service, 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 the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that the managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's healthcare needs were assessed with them and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said they had been involved in writing them and they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People commented, “The staff are always happy and helpful. They always listen to me which helps my confidence”.

People’s preferences, interests, aspirations and diverse needs had been recorded and care support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in the home. Only one person enjoyed having trips out, other people were offered the choice of outings but declined.

People knew how to make a complaint if they were unhappy. No one we spoke to felt the need to make a complaint as they were very happy with the service they received. We looked at how complaints had been dealt with and found that the responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure that people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continually improving. Staff told us they were clear about their roles and responsibilities.

Inspection carried out on 15 January 2014

During a routine inspection

Prior to this visit we received concerns about staff being unsuitable to work with vulnerable people. There were also concerns about the boiler and the cellar at the home. We found no evidence to corroborate the concerns about staffing. We found there were issues relating about the boiler and cellar, but that these were being addressed by the owner.

People living at the home told us that they had been involved in completing their care plans and were always asked by care workers what they wanted to do. One person told us that they knew everything that was in their care plan and that everything was discussed with them.

People told us that they felt well supported by care workers and that there was always someone around to help them if they needed anything. When we spoke to care workers they were able to tell us what they did to support people and knew what to do for them if they needed any additional support.

We saw the medication systems in use were safe and care workers were appropriately trained.

We saw evidence that the home had sought evidence of conduct where care workers had worked with vulnerable people before. For example, references had been obtained from previous employers.

We saw that the provider identified, assessed and managed risks relating to the health, welfare and safety of people who used the service and others who may be at risk. For example, we saw that risk assessments had been completed in relation to the use of bed rails.

Inspection carried out on 11 December 2012

During an inspection to make sure that the improvements required had been made

Renaissance residential home was last inspected by the Care Quality Commission (CQC) in July 2012. Improvements were required relating to the management of medicines and the management of records.

During our follow up inspection we found that the home was meeting the required standards. New protocols had been introduced which improved the management of medicines. The introduction of new procedures in relation to care plans had improved the management of records.

In addition, some improvements had also been made to the safety and suitability of the premises. A higher balustrade on the staircase had been installed, which meant that the stairs were now much safer.

We observed that, as on our previous inspection, people were treated with kindness, courtesy and respect.

Inspection carried out on 6 July 2012

During a routine inspection

We (the Care Quality Commission) carried out an unannounced visit to the home on 06 July 2012.

The home was last visited by the Commission for Social Care Inspection (the predecessor organisation of the Care Quality Commission) in October 2007.

The current owners purchased Renaissance Care Services Limited in September 2011.

We saw that there was a relaxed atmosphere in the home and staff were observed to relate well to the people living in the home.

People we spoke with all told us that they were supported to make their own decisions and were able to make choices about how they spent their day. They told us about the different things that they did including going to clubs, visiting families and doing jobs in the community. People told us that they were able to take part in completing and reviewing their care plans, where they could talk about their care and make decisions about their daily lives. This meant that they could contribute and have their say about how they were supported. When we spoke to staff they were able to tell us what they did to support people and knew what to do for them if they needed any additional support.

People that we spoke with praised all the staff who worked at the home. One person told us that the staff treated them with respect and always told them "what they were doing". They also said staff treated them "like a normal person". Another person told us that staff "always spoke nicely" to them and helped them "in all sorts of ways".

Our observations showed that staff interacted well with the people in the home. They spoke to people in a respectful manner, responded to people's requests and listened to what they had to say. People told us that staff supported and helped them when they needed assistance. They said that they felt well supported by staff and that there was always someone around to help them if they needed anything. Everyone we spoke with was happy in the home. One person told us that they liked living at the home because every one was "very nice".

We saw two different types of care plans being used and the provider told us they were changing the documentation. The 'new' care plans were very detailed and contained much more information than the 'old' ones. They 'new' ones gave clear instructions to staff on how to meet people's assessed individual needs. However, not everyone had a 'new' care plan and the 'old' ones did not give staff such good information about meeting people's needs.

We saw that in some cases risk assessments relating to people's health care needs had not been fully completed. For example there was no assessment of the risk of people falling over one person who moved about on the floor. We also found that there were no daily records kept for each individual. Information about them was recorded either on 'handover' sheets or in a communication book. This meant that it was not easy to see where incidents had occurred or to find evidence that people's needs were being met. It also meant that people could not see information about themselves without seeing information about other people living at the home.

Staff that we spoke with told us that they had received training on safeguarding people and they were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. They told us that in the office there was a policy and list of telephone numbers of people to contact if they were needed.

We saw that staff who administered medications had received training and that the medications were stored securely. We also saw that where medications had been given to people that staff had signed the MAR (Medication Administration Records) sheets to say they had done so. However, when short term medications such as antibiotics were received into the home, the details were handwritten onto the MAR sheets. These entries were not signed by two staff, so there was the possibility that the wrong details would be written down. We also noted that when people had been prescribed medication 'to be taken when required' there were no guidelines for staff to follow as to when the medication should be administered. This meant that people might receive this medication inconsistently and this might affect their wellbeing.

We toured the communal areas of the home and looked in some of the bedrooms. We saw that many rooms in the home had been refurbished and that one was being decorated. The person whose room it was told us that they had chosen their colour scheme themselves and had been shopping with the owner to purchase bedding and soft furnishings.

Reports under our old system of regulation (including those from before CQC was created)