Russets

Russets provides full time residential care for up to 7 people and respite care for up to 11 people with learning disabilities, in one adapted building. There are 2 flats within the building, one accommodates 4 people and the other accommodates 3 people. The rest of the building provides support to those people receiving respite care. Respite care is short term. At the time of our inspection 6 people were living at Russets.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Although the service is larger than current best practice guidance, this was mitigated by the building design. People lived within smaller flats in part of the building and had privacy for themselves and their visitors. We identified some environmental safety risks and we made a recommendation about this. The service was located so people could participate in the local community.

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. However, records relating to consent and capacity needed improving and we have made a recommendation about this.

Right Care: People received support from staff who knew them well, understood their needs and considered their preferences. Staff understood how to protect people from poor care and abuse. Healthcare professionals had been referred to appropriately and staff ensured their advice was followed. People's support plans reflected their range of needs and this promoted their wellbeing. Risks associated with people’s needs were understood by staff.

Right Culture: Quality assurance processes had not identified all the concerns in the service and where they had, enough improvement had not taken place. Records were not always complete. It was not always clear how people were involved in making decisions about how they wanted to achieve their goals. We have made a recommendation about this.

The culture at Russets had improved since the last inspection and was positive. People and their families told us they felt the management team was supportive. Complaints were listened to and acted upon. Staff received the training, support and information they needed to provide effective 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 15 June 2019) and there was a breach of regulation.

At this inspection we found the provider remained in breach of regulation. The service remains rated requires improvement and has been rated requires improvement for the last three consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 7 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Russets on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to Governance at this inspection.

At our last inspection we recommended that the provider sought reputable guidance to support people to maximise their skills to their full potential. At this inspection we found improvement was still needed. We have made a recommendation about the management of environmental risks in the service and records relating to consent and capacity.

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 from the provider, and meet with them 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Russets had not previously been fully developed and designed in line with the values that underpin the Registering the Right Support guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Further work was needed to fully meet these values.

People’s experience of using this service

Governance systems had been improved but shortfalls in the service remained. This meant the quality assurance systems were not fully effective in identifying concerns in the service and driving the necessary improvements in a timely way. At times there was a lack of clear and accurate records regarding people’s medicines, mental capacity, support and any potential risks to them.

The management team were in the process of improving the service, however, more time was needed to fully embed improvements and changes in culture. They understood their regulatory responsibility and were working hard to provide an effective service to people.

Feedback about the management team demonstrated they listened and took any feedback as an opportunity to make improvements for people. Staff felt the management team were open, approachable and supportive.

Improvements were needed to the management of risk associated with people’s conditions.

Medicines were managed safely, and the service was clean and well maintained. There were enough staff to meet people’s needs and the provider was actively working to deploy more staff for the service.

Assessments had taken place for people at the beginning of their stay, but re-assessments did not always take place when people returned for respite. This meant staff may not have up to date information about people. Following the inspection, the registered manager told us they had improved this process.

People were supported to access health professionals to ensure they lived healthy lives and had good health outcomes.

People were supported by kind and caring staff and people were treated with dignity and respect.

There was limited evidence that people were involved in meaningful activity in the service which may develop their life skills. We have made a recommendation about this. Improvements were being made to ensure people received personalised care.

People were supported by staff who felt valued and listened to and who felt the training opportunities available to them were good.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations relating to the governance and records in the service. Details of the action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires Improvement (Report published 26 May 2018)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Requires Improvement.

Follow up: The service has breached legal requirements and have been rated Requires Improvement for the last three consecutive inspections. Because of this, we will request a clear action plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

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

Russets is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Russets provides full time residential care to up to seven people and respite care to up to 11 people, in one adapted building. There are two flats within the building, one accommodates four people and the other accommodates three people. The rest of the building provides support to those people receiving respite care. Respite care is short term.

A registered manager was in post. A registered manager is a person who has registered with 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. The registered manager was due to leave employment at Russets and the provider had recruited a new manager to take over this role. This person was due to start before the current registered manager left in order to ensure a comprehensive handover.

The registered persons had not always notified CQC of significant events that had occurred in the service. There were systems in place to monitor quality and safety of the service provided, however, these were not always effective and did not identify concerns with records and incident analysis that we had.

People, relatives and staff were positive about the registered manager who was described as open, approachable and easy to talk to. Staff were committed to meeting the needs of people and providing a service people wanted. People and their families were encouraged to provide feedback on the service through meetings and an annual survey. They were also supported to raise complaints should they wish to.

Improvements had been made to the assessment and management of risk. Environment risks had been assessed and measures taken to reduce these. Risks associated with people’s care and support were well known by staff. The management of medicines had improved and was safe. Infection control measures had improved and Russets was clean and tidy throughout. There were enough safely recruited staff deployed to meet people's needs. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with others to ensure decisions made in people’s best interests were reached, although improvements to the documenting of this was needed and we made a recommendation about this. People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the deprivation of liberty safeguards (DoLS) in place for people.

Prior to people moving into the home, assessments were undertaken to ensure the service could meet the person’s needs. People told us that staff knew them well and this was apparent throughout our discussion with staff about people. Care plans were in place, which reflected individual preferences and support needs. Activities were delivered based on individual needs at the time of the inspection.

Staff received training and support that enabled them to meet the needs of the people they supported and deliver effective care. Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services. Where people required support to eat their meals this was provided in a manner which enabled them to eat at the pace they wanted and not feel rushed. They were supported to ensure they received adequate nutrition and hydration. The environment had been adapted to meet the diverse needs of people through use of furnishings and equipment.

People and their relatives provided positive feedback about staff. Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. Their privacy and dignity was respected and they were encouraged to be involved in making decisions about their care. Information about people was stored confidentially.

In line with CQC's enforcement policy, the overall rating for a service cannot be better than requires improvement if there is a breach of regulations. We found one breach of the Care Quality Commission (Registration) Regulations 2009 and 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.

Russets provided accommodation for up to 18 people who have personal care needs and have a diagnosis of a learning disability. The service provided support to people on a residential basis and also offered a respite service. On the day of our inspection there were seven people using the residential service and 11 people using the respite service. We were not able to speak to many people who used the service to ask them questions due to the nature of their diagnosis and lack of capacity. We therefore spoke with a relative, visiting professional and staff members and undertook observations around the service.

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

During this inspection we found breaches 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.

Risk assessments that were in place for people who used the service had not been subjected to reviews as stipulated by the service. This meant that staff would not know if they had access to up to date information in order to keep people safe and minimise risks. There were no risk assessments in place in relation to the environment such as kitchens and bathrooms. Therefore no consideration had been made to the health and safety of people using the service.

Keys to the medicines cabinet in one unit had been left in an unlocked room and unattended and therefore accessible to unauthorised persons, placing people at risk. Medicines that were to be stored in a fridge were being store in the main fridge and therefore accessible to unauthorised persons, again placing people at risk.

We found a number of infection control issues; in one bedroom the washbowl had been placed in the bowl of the toilet and a drinking bottle was being stored on the top of a toilet cistern. A tambourine and some plastic balls were stored in another bathroom. In one communal bathroom we found a number of commode lids were being store on the floor behind the bath; when these were moved there was a large amount of dust and dirt underneath. The laundry was disorganised and sinks contained cleaning products and a mop bucket; rather than being clean for hand washing. We also observed a staff member and service user enter the kitchen and were cooking for a person who lived at Russets, without wearing any personal protective equipment (PPE) or washing their hands.

We recommend the service considers suitable training for all staff members in relation to food hygiene and safety.

All staff members we spoke with knew how to keep people safe and were able to recognise the different types of abuse and how to respond to any concerns.

Fire guidelines were in place for each person who used the service. These should ensure that people are safely evacuated in an emergency situation.

Robust recruitment processes and systems were in place to ensure staff members were safe to work with vulnerable people. Checks had been carried out with the Disclosure and Barring Service (DBS).The DBS identifies people who are barred from working with children and vulnerable adults and informs the service provider of any criminal convictions noted against the applicant.

We recommend the service considers current best practice guidance on meeting the end of life wishes of people who use the service.

Staff members told us and records we looked at confirmed that staff received regular supervisions and appraisals.

We saw there was adequate equipment throughout the service to meet the physical needs of people who used the service such as specialist baths, hoists (including ceiling track hoists), moveable sinks and shower trolleys.

People who used the service had access to healthcare as and when they required it. We saw hospital passports were in place which used the traffic light system; red to represent important information about the person, amber to represent things that were important and green to represent likes and dislikes.

We saw people had hospital passports in place which used the traffic light system. Red contained important information that the hospital must know about the person, amber contained information about things that were important to the person and green contained information about the person’s likes and dislikes. This should ensure that if a person was admitted to hospital that all their needs were met.

The service had a sensory room which provided a relaxing and therapeutic atmosphere for people who used the service. There was also an activities room which contained a number of musical instruments such as drums and a keyboard. Many people who used the service attended day services throughout the week.

Care plans were person centred and contained detailed information about the person. The supported staff members to meet the needs of people who used the service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and 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.

This is a summary of what we found:

Is the service safe?

People only moved into this service once they had undergone a thorough assessment. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. People spoken with confirmed that they had access to medical support as necessary. A relative said, 'They contact the GP if they have any concerns'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People had been cared for in an environment that was safe, and well maintained. People who used the service were protected by the service's recruitment and selection process.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people's care and support needs and that they knew them well. Staff had been well trained, and were provided with support so they could provide the appropriate level of care to people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. One relative commented, 'I am very happy with the way '.is looked after'.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them. People were supported to maintain and increase their independence.

Is the service well-led?

People were able to contribute to decision making within the service. Their views were listened to. Staff received appropriate support and guidance from the manager and they were consulted regularly.

We spoke with two people who use the service, four relatives, six staff and two health professionals. The people who used the service told us they were happy with the care and support they received. One said 'I love it here they [staff] are all nice to me'.

A relative told us; "I would recommend here. This place is perfect'. Another relative said; 'They are brilliant. They have a dedicated team that keeps the place going as if it's home'.

We found that people's views and experiences were taken into account in the way that the service was provided; their care was assessed and delivered. A visiting health professional told us; 'Russets go out of their way to be supportive and meet service user's needs'. Another health professional said; 'Staff take looking after people very seriously. I would recommend the service'.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.