Rawleigh House

Rawleigh House is a residential care home for up to 6 people who are autistic and / or who have a learning disability. The home is laid out over 3 floors with stairs and a lift for accessibility. At the time of the inspection there were 5 people living there.

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:

Risks to people were assessed and regularly reviewed. People told us they felt safe and happy at the home. Relatives and a health professional agreed. People looked happy and content when spending time with staff. A familiar and consistent group of care staff meant they knew people well. Although agency staff were sometimes required to cover sickness these staff had a good understanding of people’s needs.

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.

Right Care:

Staff understood how to protect people from poor care and abuse. A health professional commented positively about the care people received and the way in which staff interacted with them. People received their medicines on time and had annual health reviews. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

There was an open and supportive culture at the home. Staff told us they felt supported and encouraged to take on new skills and qualifications. Relatives were encouraged to provide their views on the care family members received and felt listened to. The registered manager was held in high regard by relatives and staff. They also had a good rapport with the people living at Rawleigh House. The home worked well with other organisations and recognised the benefits to people of establishing and maintaining links with the wider community.

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 6 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rawleigh House is a ‘care 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. Rawleigh House is registered to provide accommodation and care for up to six people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living at the home.

The service had not had a registered manager in place since 08 January 2018. However, there was a new manager in position who had applied to the Care Quality Commission to become the registered manager of the service.

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.

At the last inspection carried out in September and October 2017 we found concerns relating to the care and support people received. We asked the provider to complete an action plan to show what they would do, and by when to improve the key questions safe, effective, caring, responsive and well led. We found during this inspection the action plan had been followed and improvements had been made.

Following the last inspection improvements had been learnt in regards the culture of the service. The manager informed us improved systems and process ensured people were protected from harm or abuse. They ensured staff received the appropriate mentoring and support to ensure safe practice was in place, which ensured there was an open culture.

Improvements had been made to people's welfare and safety. The provider had taken action to ensure quality monitoring systems were in place with greater emphasis on whistle blowing, safeguarding and training. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would feel confident to report safeguarding concerns, where previously they had not. Staff had received training in safeguarding vulnerable adults.

People, staff and relatives told us the culture of the home had improved and changed for the better. They all felt the home was now well-led. One member of staff told us, “I used to feel intimidated, and we could not express our opinions, whereas now with the new manager it is so easy to talk and share our thoughts.”

Improvement had been made to ensure systems were in place to assess, monitor, manage and mitigate risk. Risk assessments were in place which identified risks and listed measures in place to minimise risk to people. People, relatives, health professionals and staff told us that the service was safe.

Improvement had been made in regards to people’s right to be treated with dignity and respect. Staff demonstrated that they knew, understood and responded to each person’s diverse needs in a caring and compassionate way. When staff discussed people's care needs they did so in a confidential manner.

People, their relatives and professionals told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them. We asked one person if staff were kind, they said, “Yes staff are nice.”

People their relatives and friends had opportunities to feedback in regard their care by way of a complaints procedure and suggestion box. Where complaints and suggestions had been made the provider had acted upon them.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment of capacity assessments and best interest decisions.

Systems were in place to ensure people received their medicines safely. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines. When errors occurred staff were supported to reflect and learn from their mistake.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred. The provider used an on line system to record and monitor the daily support people received.

Improvements had been made in regards supporting people with their communication needs. A rota board had been placed in the hall to ensure people were aware of who would be coming on duty to support them. Staff were aware of people’s communication needs and we observed staff communicating with people in a personalised way to give them information verbally and visually.

People were supported by sufficient numbers of staff to meet their needs in a relaxed and unhurried manner. Safe recruitment practices were followed.

People were supported by staff who had undergone an induction programme which gave them the skills to care for people effectively. Staff were positive about their training opportunities. Staff told us they received regular supervisions which were carried out by the management team. We reviewed records which confirmed this.

Improvements had been made to quality monitoring systems within the home. Audits and additional daily checks were completed by the manager and senior managers. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate.

People living at Rawleigh House were not receiving end of life care. However Information about people’s preferences following death had been clearly recorded in their plan of care.

There were effective quality assurance systems in place to monitor care and plan on going improvements. There were audits and checks in place to monitor safety and quality of care. Where shortfalls in the service had been identified action had been taken to improve practice.

The service is registered to provide care and accommodation for up to six people who have a learning disability. At the time of our inspection six people were living at the service.

Although there was a registered manager in post at the time of the inspection they were unavailable. At the time of the inspection the home was being overseen by an interim manager and interim deputy 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.

At the last inspection carried out in November 2015 no concerns relating to the care and support people received had been identified. At this inspection we found the service required improvement.

People had not been fully protected from the risk of abuse because staff told us they were not always confident in raising concerns. Risks to people's welfare and safety had not always been assessed and managed appropriately Allegations of abuse had been raised by staff with the provider. One member of staff told us, “There has been a culture of bullying, but it feels much better now”.

Prior to our inspection we received information of concern in relation to the safeguarding of people from harm and improper treatment. These concerns included safeguarding concerns around the unsafe treatment of people living in the home. The concerns continued to be investigated whilst this inspection took place. Staff told us they had been dissatisfied and concerned in their work before changes to the management of the service had taken place.

On receiving these concerns the provider had acted to ensure people were safe and protected from immediate harm and abuse.

Systems in place to assess, monitor, manage and mitigate risk were not always effective. This meant people were at risk of receiving unsafe care and treatment. There was not a culture of openness that ensured staff had the confidence to speak out about concerns in regards protection of vulnerable adults.

People were supported by staff who knew them well, however, people’s privacy was not always respected. When staff discussed people’s care needs they did not do so in a confidential manner. People did not have access to communication aids that would promote the knowledge and independence.

Staff did not respect people’s communal areas and stored their own personal items around the home and took their breaks in communal areas.

We recommended to the provider they reviewed their methods of communication in regards decision making and choice, and to look at accessible information standards.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met Where people had restriction on their choices, best interest decision making process were not in place. People were not always consulted in decision in regards restriction on their movements.

People received help with their medicines from staff who were trained to safely support them and who made sure they had their medicine when they needed it. The provider undertook regular competency checks on staff to ensure they followed safe practice when supporting people.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people effectively. Staff were positive about their training opportunities. Staff had attended training in safeguarding people and had access to the organisation’s policies on safeguarding people and whistle blowing.

Training certificates in staff files confirmed the training staff had undertaken, which included safeguarding of vulnerable adults, manual handling, infection control and the Mental Capacity Act 2005 (MCA).

The service had a complaints policy and procedure which was available for people and visitors to view in the home.

To ensure the environment for people was kept safe specialist contractors were commissioned to carry out fire, gas, water and electrical safety checks.

We have made recommendations to the provider they seek guidance from the accessible information standards in relation to supporting people’s communication needs

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.

The service is registered to provide care and accommodation for up to six people who have a learning disability. At the time of our inspection six people were living at the service. There was a registered manager in post. 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 were relaxed and comfortable in the Rawleigh House and we saw people freely approached staff for support and reassurance throughout our inspection. People told us, “They [the staff] are good, they look after me” and “I like living here.” We observed that staff and managers knew people well and were able to communicate effectively with each person they supported.

Staff spoke warmly of the people they supported and told us, “[People] are great, easy to get on with” and, “I enjoy it here. We have a good set of people, they are a nice bunch.” People’s relatives said, “[my relative] is happy there” and, “It’s a really nice house with a good atmosphere.” Staff understood local procedures for the safeguarding of vulnerable adults and their responsibilities in relation to protecting people from possible abuse.

People’s care plans were detailed, informative and up to date. Each person’s care plan provided staff with detailed guidance on how to meet their individual care needs. This including information on the level of support the person normally required with specific activities as well as guidance on the individuals specific likes and preferences. Risks had been clearly identified and people’s care plans provided staff with guidance on the actions staff must take to protect people from identified risks.

People and their staff got on well together and were able to communicate effectively. We saw that staff varied their approach in accordance with each person’s individual preferences and needs. When one person became anxious at lunch time staff appropriately supported this person to manage their anxiety using techniques described in the individuals care plan.

People were supported to lead full and varied lives and staff supported people to engage in a wide variety of activities they enjoyed. People told us they enjoyed living at Rawleigh House and one person said, “One day we went to Longleat (safari park), it was good. We also go to the Swannary, beach park, fun fair and that.” Relatives told us, “I know [my relative] has a busy schedule.” Staff said, “We try to encourage people to do lots of activities.” We saw individual activities schedules were in place for each person living at Rawleigh house and that the service employed personal assistants to support people on an individual basis with activities both within the service and in the local community.

Staff supported people to maintain relationships with people who were important to them. Wi Fi internet access was available throughout the service and staff supported one person to contact one of their relatives using video conferencing technology during our inspection. Staff regularly supported people to go on holiday and records showed one person had recently enjoyed a family cruise trips while another person had been supported on a holiday to Disney Land Paris.

There were enough well trained staff on duty on the day of our inspection to meet people’s care and support needs. The services recruitment processes were safe and robust. All new staff received appropriate induction training designed to ensure staff understood their new role and felt confident they could meet people’s needs before they provided care and support independently. Staff told us “It’s [the training] been really good actually”, “I feel I have had a lot of support while I was learning here” and “I have learned a lot.”

The staff team were well motivated and focused on enabling the people they supported to be as independent as possible. Staff told us their managers were “brilliant” and commented, “Everyone is a team, it’s really good here” and, “They [managers] are lovely, very approachable and very easy to talk to.” Records showed staff received regular supervision, annual performance appraisals and staff meetings were held regularly at Rawleigh House.

Weekly menu planning meetings were held at Rawleigh House and people were involved in both the planning of the service’s menu and shopping for ingredients. We observed that people and staff shared meals together in the dining room. Staff sat with the person they were supporting and provided appropriate equipment and encouragement to enable people to eat as independently as possible.

Accidents and incidents were appropriately recorded and had been fully investigated by the service’s registered manager. These records were reviewed regularly as part of the service’s quality assurance processes to identify any areas of increased risk or where any improvements could be made to systems to further protect people from harm.

The service had not received any formal complaints but did regularly received positive feedback and compliments form people’s relatives. People’s relative told us; I have absolutely no concerns” and “We have no complaints, [our relative] is happy.”

We saw regular audits were completed by the registered manager to assess the service performance and identify any areas where improvements could be made.

We saw that staff spoke in a kindly and respectful way. People could choose what they did during the day as well as choosing menus and how their rooms were furnished.

Staff told us that they knew the people they worked with very well, through spending one-to-one time with them each week. One of them said, 'Everyone has different care needs: we are here to support them." We saw that care plans were up-to-date and detailed.

We looked at how medicines were managed, and were satisfied that this was done safely and securely. Although there was a recent error, no-one was harmed and practice was changed to reduce the chance of it happening again.

We also looked at how staff were recruited, and were satisfied that this was done with all the necessary checks. Staff received mandatory training before working unsupervised, and were supported by more experienced members of staff.

Finally, we looked at how the home monitored quality. We found that the manager and staff conducted regular audits and reviews and fed this information back to the provider, Dorset Residential Homes, each month.

Some of the people who lived in this service were unable to talk with us. Because of this we looked at records, talked with staff and observed the way that the care was provided.

However, some people were able to tell us that they were well looked after. They said that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect.

Many people were able to make it clear to us that they liked living at Rawleigh House. Some said such things as 'I like it' and 'It's nice'.

People told us that they felt able to raise any issues with the managers or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw that staff were always available when people needed help. People told us that staff were friendly and always acted professionally.

The service's management held regular meetings with the people who live in the home to find out what they thought about how their care was delivered.