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Inspection carried out on 20 August 2018

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

The inspection took place on 20 August 2018 and was unannounced.

Ribston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ribston House accommodates nine people in one shared house and provides a service for people with a learning disability. At the time of our inspection visit there were seven people using the service.

At our previous inspection in July 2017 we found the service was rated ‘Good’ overall. In July 2018 we received concerns in relation to staff not respecting people’s dignity, lack of activities and the management of the service. As a result, we undertook a focused inspection on 20 August 2018 to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ribston House on our website at www.cqc.org.uk

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At this inspection we found the service remained ‘Good’.

Ribston House had 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 received support from caring staff who treated people with respect and upheld their privacy and dignity.

People were supported to take part in a range of suitable activities of their choice.

The registered manager was visible and accessible to people and staff. Quality checks were made with the aim of improving the service in response to people's needs.

Inspection carried out on 3 July 2017

During a routine inspection

Ribston House is a residential care home for nine adults. People living at the home have a range of needs including learning disabilities. At the time of our inspection visit there were six people using the service. At the last inspection on 17 March 2015, the service was rated Good. At this inspection we found the service remained Good.

Staff and management understood how to protect people from harm and abuse. Risks to people's safety were identified, assessed and appropriate action taken. People were supported by sufficient staff who had been recruited using thorough checks. People’s medicines were safely managed.

People were supported by staff who had training and support to maintain their skills and knowledge to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support from caring staff who respected their privacy, dignity and the importance of independence. There was regular consultation about how the service was provided to capture people’s views.

People received personalised support that enabled them to pursue their interests at the home and in the community. People were supported to maintain contact with their relatives. There were arrangements in place for people to raise concerns about the service.

People using the service and staff were kept informed about developments in the service. Checks had been completed as a way of ensuring the quality of the service provided including questionnaires sent to people using the service, their representatives and staff.

Further information is in the detailed findings below.

Inspection carried out on 17 March 2015

During a routine inspection

The inspection took place on the 17 March 2015 and was unannounced.

Ribston House is a purpose built home for up to nine adults. People living at the home have a range of needs including learning disabilities. At the time of our inspection there were seven people living at the home.

The home had a 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.

Medicines were stored securely and people were given their medicines as prescribed and on time.

People were protected from abuse by staff who understood safeguarding procedures. Robust recruitment procedures were applied ensuring that people were protected from the employment of unsuitable staff. There were enough staff with the right skills and knowledge to keep people safe and meet their needs.

People were supported by staff who received appropriate training and had the right knowledge and skills to carry out their role. People’s rights were protected by the correct use of the Mental Capacity Act (MCA) 2005. People were supported to eat and drink a balanced diet.

People received personalised support that enabled them to take part in activities in the home and the community. People’s privacy, dignity and independence was respected and promoted. There were arrangements in place for people to raise concerns about the service.

Management encouraged open communication in the interests of people using the service.

Quality assurance checks on the service including the views of people and stakeholders had been completed as a way of ensuring the quality of the service provided.

Inspection carried out on 10 April 2013

During a routine inspection

We spoke to two of the nine people who were using the service. They told us that they received regular health checks and we found that health action plans were in place for them. They also confirmed that their rooms were kept clean and we found that the service had carried out work in relation to infection control. People told us that they were given their medicines on time and we found that suitable arrangements were in place for storing and administering medicines.

Staff were receiving appropriate support through training and supervision and the people we spoke to indicted that they were happy with how the staff supported them.

We also found that quality monitoring systems were in place that included seeking the views of people using the service.

Inspection carried out on 4 October 2012

During a routine inspection

We spoke to one person using the service who told us that Ribston House was "alright". They told us about the service user meetings they attended and about activities they took part in.

They confirmed that they were looked after by the staff at Ribston House and felt safe there.

They commented on how their room was kept clean and that the environment of the home was "good enough".

Inspection carried out on 23 April 2011

During a routine inspection

Comments from staff and people living in the home included;

“I like everything here. The staff are fine and the food’s okay. It’s better here than in the other places I’ve lived. It’s wider”. “Nothing to improve.”

“It’s okay here but not all that wonderful. I don’t do much, I watch the TV. The food’s okay, my favourite is beef.”

“We have parties, play games, and go bowling. I like going to the café, I like the food, I like it when we have pasties.”

“I like working here very much. The manager listens and is very approachable. She is open to new ideas and listens to us. That makes a real difference to the house.”

“Having an activities coordinator is her (the manager’s) experiment. She provided the money to develop activities. That was a real highpoint - the trust she placed in us.”

“People living at Ribston House have as much choice in their lives as you and I do.”

“It’s a nice house. We have a really good manager who does her best for everyone.”

“I really enjoy my job. I love working with the people here. A bad day is when the washing machine doesn’t work or if someone is ill.”

“The best thing is when you make a difference for the service user – something that makes them happy.”

“The people here can do whatever they choose – what food to eat, when to get up, what to do in the day. They have a nice life”

The activities coordinator talked very enthusiastically about her work. There is a wide range of activities within the community and the household. On a regular week people are likely to have the opportunity to go to the pub, go bowling, attend college, go for a drive, or attend performance arts at a local community facility (the Kingfisher Centre). In house there is likely to be bingo, music therapy, arts and crafts, and use of the sensory room. All of the people in the house have the opportunity to undertake the activities of their choice, be that in a group or as an individual.

The activities coordinator works with each person to find out what they like to do and tries to, as far as possible, meet their needs. Each person has an activities plan. An evaluation sheet regularly considers their participation, engagement, and interaction with the activities, and activity choices may be changed or adjusted in the light of these evaluations. A three monthly report is completed on each person. The activities coordinator encourages each person to make choices about how they spend their time. For example, one person likes to go to the pub or for a drive in the afternoon. Another person likes to go shopping with a member of staff.

People have a choice about the food they eat and have a say in how the menu is developed at residents’ meetings. At these residents’ meetings, choices about holidays, activities, and other aspects of daily life are discussed. People also choose how their rooms are decorated. For example one person’s room was pink but is now half pink and half cream because she wanted a change recently. Staff recognise that it is sometimes more difficult to understand the choices of those people who are non-verbal but offer examples where they have been successful in doing this.

If a person is having a problem or has a complaint, the key worker would initially talk it through with the person. That member of staff would then talk with the manager. Staff say that all complaints are fully documented. At the residents’ meetings staff emphasis to people how to complain if they are not happy with anything. Staff take the view that the manager is very open and approachable, and they would not hesitate to share a problem or difficulty with her. Staff are very clear what they would do if they witnessed poor practice. People who live in the house are clear about what to do if they have a complaint or a problem.

Some members of staff feel that the level of staffing is adequate. Others think that with another member of staff it would be possible to do more with the residents, possibly to join them on activities.

Staff spoke very positively about training and access to training. They feel that they are very encouraged to undertake training courses and time is made available for their development, this includes; NVQs (National Vocational Qualification), conflict management, medication training, leadership training, and an activities course.

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