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Inspection carried out on 15 August 2018

During a routine inspection

This unannounced inspection took place on 15 and 20 August 2018. The Rise is a residential care home on the outskirts of Dawlish. It is registered to provide accommodation and personal care for up to 26 older people. At the time of our inspection there were 24 people living at the 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.

At our last inspection we rated the home good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

The home continued to provide safe care to people. The registered manager and staff understood their role and responsibilities to keep people safe from harm and ensure people's rights were protected. Risks had been appropriately assessed and staff had been provided with information on how to support people safely. There were enough staff to meet people's needs and checks were carried out on staff before they started work to assess their suitability.

People received effective care because staff had the skills and knowledge required to support them. People’s health and wellbeing were promoted and protected as the home recognised the importance of seeking advice from community health and social care professionals. People were supported to eat a healthy balanced diet. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. However, not all records we saw were clear or reflected the same level of understanding.

We have made a recommendation in relation to how the home records people’s consent.

People received a service that was caring and they were supported by staff who knew them well. People were actively involved in making decisions about their care and support. Staff were passionate about their role and treated people with dignity and respect.

The home was responsive to people's needs. Care and support was personalised and people were supported to take part in meaningful activities. People were confident any complaint they might have would be responded to promptly. No one we spoke with had any complaints about the home.

People benefitted from a home that was well led. People, relatives and staff were positive about the leadership of the home and told us the home was well managed. The provider had systems in place to review, monitor and improve the quality of service provided. This included a programme of audits and checks, reviewing medicines management, quality of care records, support to staff and environmental health and safety checks. Regular meetings provided the opportunity to share information, review how well the service was supporting people and discuss how the service could be improved.

The registered manager was aware of their responsibilities in relation to duty of candour, that is, their duty to be honest and open about any accident or incident that had caused, or placed a person at risk of harm. They had notified the Care Quality Commission of all significant events, which had occurred in line with their legal responsibilities. We found the provider had displayed their rating in the home and on their web site.

Further information is in the detailed findings below.

Inspection carried out on 7 January 2016

During a routine inspection

The Rise is a residential care home on the outskirts of Dawlish. It is registered to provide accommodation and personal care for up to 26 older people. At the time of our inspection there were 24 people living at the home.

At the time of our inspection there were two managers at the service who worked on a job-share basis. One was a registered manager and the other was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

This inspection took place on 07 and 15 January 2016 and was unannounced.

People expressed a high level of confidence in home. They told us they felt safe and happy living at The Rise. Relatives were also confident in the care provided at home and believed their loved ones were safe and well looked after. The atmosphere of the home was calm and relaxed throughout our inspection. Staff were happy in their demeanour and they spoke respectfully and warmly to people. People were supported to continue with their interests and hobbies and encouraged to maintain their independence.

Staff had received training in safeguarding adults and knew how to raise concerns if they were worried about anybody being harmed or neglected. They felt confident that if they had any concerns they could raise them with the managers and they would be acted upon quickly and effectively.

People said there were enough staff on duty to meet their needs and spoke very highly of the care they received. One person said “The staff are very helpful and attentive” and another said “the staff are splendid”. We saw that staff met people’s care needs in an unhurried way and that people responded warmly to staff. Staff told us they had enough time to effectively meet people’s care needs. Staffing levels were increased when necessary in recognition of particularly busy times of the day or people’s changing care needs. Staff told us they were a happy team and committed to the well being and care of the people they supported.

We observed medicines being administered and this was done safely and unhurriedly. Medicines were stored safely and all stock entering and leaving the home was accounted for. Staff received regular training in medicines and medicines audits were completed regularly to ensure consistent safe practice.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were well supported by managers through regular supervision and appraisals. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relating to people’s care needs such as medicines management, skin care and dementia care. The provider was a member of ‘Dignity in Care’, a national initiative to encourage good practice and high standards of care.

Staff were knowledgeable and confident when they spoke about people’s care needs. Staff had received training in, and understood the principles of the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. We found that managers were not completely up to date with changes in the law regarding the Deprivation of Liberty Safeguards (DoLS). However this was quickly remedied for the small number of people affected and appropriate actions were taken to make DoLs applications and quickly access appropriate training. There was no detrimental effect on people living at the service.

Care plans showed each person had been assessed before they moved into the home and any potential risks were identified. Where risks were identified there were detailed measures in place to reduce these. In some records we found th

Inspection carried out on 21 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who lived in the home told us they felt safe and were well treated by staff. When asked if they had ever been treated badly or witnessed anyone else being treated badly, one person said "No nothing further from the truth, all the staff are lovely." They added "There isn't one problem at all. If there was I can approach the manager or any of the care staff." We observed the Registered Manager and staff talked to people in a patient, friendly and supportive manner throughout our inspection.

Another person told us "I feel so safe here, it's so lovely and it makes me happy to have this as my home." They added "My family don't worry so much now I'm here. They say I look different now I'm happy and content."

We saw that care plans had been regularly updated and were reviewed monthly. This included risk assessments relating to the risk of falls, pressure sores, nutrition, weight and moving and handling. This meant that people could be sure that their records were up to date and care had been planned and reviewed to ensure their safety.

There were arrangements in place to deal with foreseeable emergencies. We saw that there was a detailed plan in place for dealing with emergencies that could affect the entire house, for example a fire. The provider had an emergency plan in place which included contact numbers for the emergency services and other staff. All staff we spoke with demonstrated a good understanding of the policy and pathway. This meant that the disruptions to people's care and welfare would be minimised.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's human rights. The manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and knew where to go if an application was required.

The provider identified, assessed and managed risks to the health, safety and welfare of people. In addition to the individual risk assessments in people's care plans, the provider had a range of health and safety policies and procedures in place.

Is the service effective?

Relatives told us that they had visited the service before their family member had come to stay. They were shown around and were able to ask questions and given information about care choices that were available.

They told us "Our family member now looks happy and content here, not as distressed as when in their own home." They added "You can tell they are happy here and we are relaxed now they have the constant care needed should a situation arise."

We saw people walked around the home with no restrictions and their right to privacy and time alone was upheld. Several people told us staff listened to them and treated them respectfully. Staff called people by their preferred names, as recorded in care plans. Staff were heard to explain to people about what they were doing when providing care. For example, while helping a person to sit down, the staff member explained why they needed to sit down, how they were going to do it and asked if it was alright for them to do it.

One person said "The staff are wonderful nothing is too much trouble, they help me just do whatever makes me happy." They added "I've got to know everyone here, I feel I belong it's just like a family."

We reviewed four care plans all of which identified what people were able to do for themselves and showed an individual programme of their needs. Records showed that people or their representatives had been involved in developing the care plans. This showed that people were enabled and supported to make decisions relating to their own personalised care. Staff we spoke with were aware of what people liked or disliked.

Is the service caring?

We spoke with four people who used the service. One person told us the staff "Look after us all well, they listen and I am happy here". People who used the service told us they received care and support that met their needs. When asked if they could think of anything that could be improved, no one was able to identify any areas for improvement.

The Registered Manager said people's relatives and other professionals were consulted, where appropriate, when important decisions needed to be made about their care and treatment. We saw evidence in people's care plans of appointees to act in people's best interests.

People who lived at the home were very complimentary about the management and staff. One person said "I can't speak too highly about the manager and staff. They are all very caring." Another person said "The staff are excellent. They are lovely people and very good at caring for us."

The Registered Manager told us that most of the staff had worked at the home for a number of years. This meant people were supported by a small experienced team providing a consistent level of care.

Is the service responsive?

In our discussions with a relative, they told us that staff were approachable and there was good communication links between themselves and the home. The relative was not able to identify any areas for improvement in respect of how care was provided to their family member. But was confident any suggestions they raised would always be considered and acted on if appropriate.

We saw evidence that the individual care and support provided to people was subject to formal review. People who lived in the home and their representatives were asked for their views about care and treatment and these views were acted on.

One person who lived in the home said "You only need to have a word with the manager and they always fit in with your request." Another person said "It's a very nice, clean and comfortable home. I have no problems at all. But if something did go wrong I can always talk to the manager or the other staff."

Is the service well led?

People who lived at the home were very complimentary about the management and staff. One person said "I can't speak too highly about the manager and staff. They are all very caring."

One member of staff told us "The manager is very approachable and supportive. We have a really nice team and we all get on very well together. With handovers and daily communications we are fully aware of everything within the home." They added "The continuity of staff has helped build up good working relationships and trust."

People told us they could talk to the Registered Manager or the other staff about any issues and they always did their best to meet their needs. People said "I would give the home 10 out of 10, the manager is absolutely first class." They added "The owners are extremely nice and caring, they are here often."

Inspection carried out on 16 April 2013

During a routine inspection

We spoke with five of the twenty two people who lived at The Rise on the day of our inspection. We also spoke to two care workers, two ancillary staff and the Manager. People we spoke with were satisfied with the service. One person told us �It�s lovely here when the sun�s out. The gardens are beautiful and the staff are very good�.

The people we spoke with had lived at The Rise for some time and knew each other and the care workers well. Strategies were in place to meet people�s care needs. People�s care plans had been reviewed on a monthly basis or more regularly when required.

We saw that care workers interacted with people in a friendly and respectful manner. People had made friendships within the home and had access to social activities.

During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life. People told us �I enjoy it here, I�m happy here�.

Care workers were skilled and experienced and had worked at the home for many years. We saw that a safeguarding policy was in place. Care workers had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

We saw evidence that a staff recruitment procedure was in place. We found that the provider dealt with complaints within reasonable timescales and to the satisfaction of the people raising concerns.

Inspection carried out on 28 November 2012

During a routine inspection

We spoke with five people receiving care at the home. People told us �We are all very well looked after here�, �This is a lovely place to live� and �All the staff go that extra mile�.

Each person had a clear and updated care plan, which indicated their needs and how they were to be met.

People told us that there were usually enough staff on duty. We observed staff in their interactions around the home, including answering the call bells and in their dealings with individuals in their rooms. They were at all times respectful, caring and patient.

People told us they felt safe receiving support from the staff at the home. People said that staff were always very kind and helpful. Staff told us they were very happy in their workplace and felt very much part of a team. Comments from staff we spoke with included "This is the first time I have had a job when I really love coming to work�, "What I love is that we really help people�, and "It doesn�t matter what age the people are as long as they all have a reason for waking up and I feel we make that happen�.

The manager told us that systems for assessing quality assurance were kept under review and were reassessed regularly.

We saw that people at the home were given opportunities during the day to influence the way services were provided to them. As an example we saw people exercising choices in where and how they spend time, activities and what they ate.