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Rockville House Requires improvement

Reports


Inspection carried out on 3 April 2017

During a routine inspection

The inspection took place on 3 April 2017 and was unannounced. Rockville House provides a respite facility for people who have a physical disability, and accommodation is available for a maximum of three people at any one time. On the day of our visit two people were staying for respite care and were then attending the adjoining day service.

The service provided accommodation for people requiring nursing or personal care on a respite basis. This meant people stayed for different lengths of time depending on their respite needs. For example, some people stayed one night while others stayed for longer periods. We visited the attached Rockville day centre so we were able to meet people who had used Rockville House for respite care in the recent past.

Prior to our inspection the Commission had received information from the local authority’s quality assurance improvement team and safeguarding team. These concerns had been investigated and appropriate action taken. The local authority’s quality improvement team were still working within the service to support the new manager to update and improve care records and other systems including quality audits.

At the time of our inspection the service did not have a registered manager. A new manager had been appointed and would be registering with the Commission. 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. Since our visit to the service we have been informed the nominated individual had resigned from their post. The nominated individual (NI) is the person registered with us to account for the service at the provider level.

At this inspection we found improvements were needed to ensure the service was responsive and well-led. The provider did not have robust quality assurance processes in place to identify if records were up to date. Systems of auditing aspects of the service had lapsed for example individual care records. Care plans and risk assessments were in place with some already updated and completed to enable people to retain their independence and receive care with minimum risk to themselves or others. Others needed further reviewing to ensure they were up to date. The new manager had already started to incorporate these actions and updates into their plans for the service. One staff member said; “I think that they have drastically improved” while another said; “Some still need more work.” Relatives and staff told us the new manager was approachable. The manager was implementing monitoring systems to enable them to identify good practices and areas of improvement.

People remained safe at Rockville House. Some of the people who stayed for respite care were not able to fully verbalise their views. Relatives and staff felt people were safe. There were enough staff to support the number and needs of people. Some staff worked in both the respite service and the day service and this provided continuity in care. People were supported to take part in activities and trips out. People received their prescribed medicines safely. People responded positively when asked if they liked staying for respite care. A relative said; “We are very happy with the care [their relative] receives.”

People continued to receive care from a staff team that were skilled and knowledgeable to effectively support them. Staff were well trained and competent. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems within the service supported this practice. People's healthcare needs were monitored by the staff and people had access to healthcare professionals when required during their stay.

The staff were very caring and people had built strong relationships with the staff. During our observation in the day service we observed staff being patient and kind. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.

People were able to make choices about their day to day lives. Complaints and concerns were fully investigated, responded to, and appropriate action taken. People attended the day service if they wished during their respite stay and were assisted to take part in a wide range of activities and trips out according to their individual interests.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; you can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 21 October 2015

During a routine inspection

The inspection took place on 21 October 2015 and was unannounced. Rockville House provides a respite facility for people who have a physical disability, and accommodation is available for a maximum of three people at any one time. On the day of our visit two people had stayed for respite care. We visited the attached Rockville day centre so we were able to meet people who used Rockville House for respite care.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager is also the registered provider. Registered providers 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.

Rockville House only provides respite care, this means people stay for different lengths of time. For example people stayed one or two nights or for longer periods including weekends or for a week’s holiday. A relative said; “The care is outstanding.”

We met and spoke to people during our visits. We observed people and staff were relaxed in each other’s company and there was a calm atmosphere. Some of the people who stayed for respite care were not able to fully verbalise their views. People responded positively when asked if they liked staying for respite care. All staff agreed that they felt people were safe when they stayed. Staff knew people well and had the knowledge to be able to support people effectively. One relative said; “He is as happy their as he is at home!”

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. Staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge about how to report any concerns and described what action they would take to protect people against harm. Staff felt confident any allegations or concerns would be fully investigated.

People did not all have full capacity to make all decisions for themselves, therefore staff made sure people had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff were trained in the management and administration of medicines

When people were asked about the care and support they received, those able, responded positively while others were not able to respond. A relative said: “The care he gets is fantastic.” Care records were comprehensive and personalised to meet each person’s needs. Staff understood people’s individual complex care needs and responded quickly when people needed support. People were involved as much as possible with their care and records documented how people liked to be supported. People were offered choice and their preferences were respected.

People’s risks were well managed and documented. People were supported to try a range of activities while staying for respite care. Activities were planned with people’s interests in mind.

People enjoyed the meals provided and they had access to snacks and drinks at all times. People were involved in planning of menus and preparing meals.

Staff said the registered manager was very supportive and approachable and worked in the home regularly. Staff talked positively about their roles.

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities of their choice. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs.

People had access to healthcare if needed during their stay, for example GP services. Staff acted on the information provided by professionals to ensure people received the care they needed.

There were effective quality assurance systems in place. Any significant events were appropriately recorded, analysed and discussed at staff meetings. Evaluations of incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service. People attended meetings to enable them to raise concerns. Feedback was sought from people who stayed for respite care, relatives, professionals and staff.

Inspection carried out on 4 February 2014

During a routine inspection

We visited Rockville day centre so we were able to meet people who used Rockville House for respite care. We met 12 people, many who used the respite care service. We spoke to two people in detail about the care they received while staying for respite. We also looked at records relating to peoples care, spoke to staff on duty and also contacted a relative by telephone.

Rockville House only provides respite care, this means people stay for different lengths of time. For some people the respite stay maybe for one or two nights, others stay for longer periods, for example a weekend or for a weeks holiday. People who stayed at Rockville House have a wide range of care and support needs which meant they were not all able to tell us their experiences. Because of this we used a number of different methods to help us understand the experiences of people using the service, this included talking to parents or carers, and talking to staff.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We spoke to staff about the care given, looked at records related to them, and observed staff working with people who stayed for respite care. They took time to work at people's own pace. We saw that people's care records described their needs and how those needs were met.

We saw that medicines were administered by suitably trained staff. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to administer and record medication.

All the staff we spoke to said that they felt well supported by their colleagues and management. We saw staff received the training they required to carry out their roles.

We saw that Rockville House held all records securely to protect people’s confidentiality.

Inspection carried out on 19 November 2012

During a routine inspection

During our visit to Rockville House we met two people who used the service, talked with staff and checked records. We also spoke to two relatives by telephone.

Rockville only provides respite care, this means people stay for different lengths of time. For some people the respite stay maybe for one or two nights others stay for longer period, for example a weekend or for a weeks holiday. People who stay at Rockville have a wide range of care and support needs which meant they were not all able to tell us their experiences. Because of this we used a number of different methods to help us understand the experiences of people using the service, this included talking to parents or carers and talking to staff.

People were not always in the house during the day but could attend Rockville day centres which are joined to the respite home. Therefore we visited the day care service to meet two people who used the respite centre and spoke to one person via the telephone after our visit.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We spoke to staff about the care given, looked at records related to them, met with two of them, and observed staff working with people who stayed for respite care. They took time to work at people's own pace. We saw that people's care records described their needs and how those needs were met.

A survey returned to Rockville said, “Always ready to chat when we visit”.

Inspection carried out on 21 October 2011

During an inspection in response to concerns

People who stay at Rockville House for Respite Care have a wide range of care and support needs. Most of the people who use the service require some support to express their views and feelings about the service and the care and support they receive.

People stay at Rockville for different lengths of time. For some people the respite stay maybe one or two days each week or the stay could be over the weekend or for a week long holiday.

After concerns were raised to us we (the Commission) visited the service so that we could check that the service was compliant with the regulations and to see that people were happy during their stay at Rockville House. We visited the service on 21 October 2011 and we also took into account further information on incidents that we received until 02 November 2011.

We were satisfied that overall the service was taking care to minimise many areas of risk but we identified some issues for the service to address.

When we visited the service we were able to walk into the unit from outside the building through a lockable self closing fire door that was wedged open. We then walked through the unit without being challenged by any member of staff. During this time we had unsupervised access to both the medication storage in the unit and to the personal belongings of a person that was staying in the unit that night.

We found that the service had not told a persons family that they had suffered an injury while in the care of the unit.

Some of the medication that had been kept and administered by the unit had not been properly recorded.

During our visit we saw people being supported by the staff. We saw that staff were interacting with people positively and with empathy and respect. People were talking, laughing and smiling in response to the staff support.

Inspection carried out on 29 March 2011

During a routine inspection

People who stay at Rockville House for Respite Care have a wide range of care and support needs.

People stay at Rockville for different lengths of time. For some people the respite stay maybe one or two days each week or the stay could be over the weekend or for a weeks holiday.

Most of the people who use the service require some support to express their views and feelings about the service and the care and support they receive.

We visited the service so that we could spend time getting to know people and to see if people were happy during their stay at Rockville House.

We observed staff as they supported people, and spoke to them about their work and understanding of people’s needs.

We spoke to other professionals who have been involved with people who use the service, and also asked some relatives about their views and experiences of this service.

During our visit we observed people laughing and smiling and interacting positively with the staff supporting them. People who use the service said that they liked staying at Rockville and that the staff are “kind and friendly”

A representative from Plymouth Social Services said that she was very impressed by the support people receive during their respite stay and that the service helps people complete very good Person Centred Plans.

The parent of one person who uses the service said “There has been a lot of improvement in the service since the new manager started. I feel that the staff and manager genuinely care, and have a good understanding of my daughters needs”

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