Rutland House Community Trust

Rutland Community Trust is a residential care home providing accommodation and personal care to 9 people at the time of the inspection. The service can support up to 10 people.

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.

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

Right Support:

Staff supported people to achieve good outcomes. There were clear communication systems within the service to support this.

People were supported to have maximum choice and control of their life 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:

The care people received was tailored to their individual needs. Staff treated the person with dignity and respect and promoted their right to privacy.

Right Culture:

The culture within the home empowered people who used the service. The staff team promoted inclusive practices which supported people to live a full life, their rights and aspirations were promoted.

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 08 December 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and good governance.

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 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 changed from requires improvement to good based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. However, we found no evidence during this inspection that people were at risk of harm from this concern. Please see the Well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rutland Community Trust 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.

Rutland House Community Trust is a residential care home registered to provide personal care for up to 10 people with a physical disability, learning disability, or autistic spectrum disorder.

Not everyone who lived at Rutland House Community Trust received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were eight people living at the home at the time of the inspection, seven received personal care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The home was in a local residential area. However, it was at the end of a side road on a separate gated area.

The home was bigger than most domestic style properties. Yet the size did not have a negative impact on people. We believe this was because the home was under occupied. An increase in the number of people living at the home may impact on the provider’s ability to provide personalised care.

The care home was spacious and had two communal areas people could use. There was an additional seating area in the foyer.

The provider had identified the need to refurbish and redecorate the home and were reviewing options available to them at the time of inspection, to ensure this met the requirements of Right support, right care and right culture.

Quality assurance systems and processes had not always been undertaken or identified concerns we found on inspection. We observed occasions where staff wore face masks below their chin in close proximity to people. Improvements were needed to systems and processes to check visitors and staff entering the building did not have symptoms of COVID-19 or had been a close contact of someone with COVID-19.

Staffing levels had not been regularly reviewed to ensure they met the needs of the service. There were not enough staff employed or deployed to meet the needs of the service. This put additional pressure on care staff and meant they did not always have time to spend with people to support them with their social and recreational needs. The provider was experiencing challenges in fulfilling staffing vacancies at the time of the inspection.

Improvements were needed to the providers medicines recording keeping systems. People received their medicines from staff that had been trained in medicines management.

People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager was passionate about providing person-centred care and knew people well as they were involved in care delivery. People received support from staff that knew them well. They had positive behaviour support plans in place, which were person-centred. Staff were discouraged from wearing anything that suggested they were care staff, other than the PPE required to keep people safe.

People were supported by staff that knew how to keep them safe from harm or abuse and had been safely recruited. Staff had a good knowledge of risks associated with providing people’s care and had received training relevant to people’s needs.

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 02 March 2019).

Why we inspected

We received concerns in relation to the management of people’s falls risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to the governance of the service and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿People were supported to have the 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.

¿There were enough suitably skilled and experienced staff to support people to be safe and to spend their time the way they wanted to. Staff respected people’s privacy and dignity.

¿ Staff supported people to have their medicines at the right times and to access health services when they needed to.

¿ People had a choice of healthy food and were supported to have enough to eat and drink. People with special dietary requirements had those needs met.

¿Staff were caring and supported people in ways to make people feel they mattered to them. Staff respected people’s privacy. People were involved in decisions about their care and support.

¿ Staff supported people to participate in activities and to follow their interests and hobbies.

¿ People and relatives knew how to raise concerns if they had any and they were confident they would be listened to.

¿ The provider sought people’s views and feedback about the service and acted on what they said.

¿ The service was well-led; management and staff shared the same vision to deliver high quality care and support. The provider had effective arrangements for monitoring the quality of the service and was committed to continuous improvement.

Rating at last inspection:

At the last inspection we rated the service Good (Report published 17 August 2016).

Why we inspected:

This was a planned inspection to check that the service remained Good. At this inspection we found the service remained Good overall and had improved from Requires Improvement to Good in the key question Effective.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Rutland House Community Trust provides accommodation for up to 10 people with learning difficulties and sensory impairments. The home is also sometimes referred to as Willowbrook. There were 10 people using the service on the day of our inspection.

The person who was the registered manager had left 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. The current manager intends to apply to the Care Quality Commission to become the registered manager.

People were protected from harm and staff were clear of their role to keep people safe and protect them from abuse. People told us they felt safe. There was a recruitment policy in place which the manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were managed and administered safely.

People were supported to make decisions about the care they received. People’s opinions were sought and respected. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). However we found that the way that mental capacity assessments were recorded was not in line with the MCA. The manager was clear of their role in ensuring decisions were made in people’s best interest.

Nutritious meals were provided and where people had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff had a clear understanding of their role and how to support people who used the service as individuals. Staff knew people well and treated them with kindness and compassion. People’s dignity was maintained and promoted.

People’s independence was promoted and staff treated people with dignity and respect. People were supported to follow their interests and engage in activities. We observed times of inactivity for some people. Staff told us that there were times when more activities could be promoted.

Staff felt supported by the manager. The manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the manager and were confident that they would address issues if required. Relatives found the manager to be approachable.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made.

People received a well balanced and nutritious diet. Staff knew about healthy eating and encouraged people to make healthy choices. Appropriate referrals were made to healthcare professional where risk was identified.

There were robust systems in place to assess and monitor the quality of service provision. This included seeking the views of people who used the service. Risk was assessed and managed appropriately.