The Rookery

We found the following examples of good practice.

¿ People were being kept informed about COVID-19, the vaccination programme and lockdown restrictions. Information was provided in accessible formats.

¿ People told us about the activities they have participated in to keep them busy and prevent them feeling socially isolated. People showed us the puzzles they were completing at the time of the visit, while enjoying a social coffee and snack.

¿ People told us about missing seeing their family and friends, but also about alternative ways of maintaining contact, for example through the use of social media to complete video calls.

¿ Staff demonstrated a detailed understanding and insight into people’s individual needs and risks in relation to COVID-19. Staff were familiar with the management plans in place in the event that there was an outbreak at the service.

¿ Staff supported and educated people on social distancing, use of personal protective equipment and hand hygiene to support safe access to the local community.

¿ Staff had implemented detailed risk management plans to support people while in isolation, while ensuring this did not have a detrimental impact on their mental health and wellbeing.

The Rookery is a residential care home providing personal care for up to 36 people aged 18 years and over. At the time of the inspection, 34 people were living at the service. The service comprised of one large converted house and separate self-contained units, called “cottages.”

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 36 people. This is larger than current best practice guidance stipulates for people with learning disabilities or autism. However, the size of the service was mitigated by the building design and layout. Also, as it was located in large grounds and adjacent to a working farm, people were able to spend time here to enhance their wellbeing. Other activities were provided in group and one to one sessions in the home and in separate buildings on the same site.

Thematic Review

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People living at The Rookery participated in one to one and group activities, including accessing the onsite working farm. Staff showed empathy, kindness and compassion. They placed value on their caring roles and involvement in people’s lives. The care provided was flexible to meet people’s needs and preferences.

The service worked with people and their families to complete end of life care planning to ensure people received high standards of care and support. People were involved in the planning of their care at that stage of their life. The service had good working relationships with the local GP practice and learning disability healthcare professionals.

The service worked in partnership with people and encouraged feedback on the care provided. We received positive feedback from people and their relatives about the service received. Staff told us they enjoyed working at The Rookery and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout. The service had governance arrangements in place and completed regular internal quality checks and audits. Findings from these were reviewed by the registered manager and provider and used to continually drive improvement within the service.

Rating at last inspection: The Rookery was previously inspected 30 and 31 August 2016, rated as Good in all key questions. The report was published 20 October 2016.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule for services rated as Good.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for services rated as Good.

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

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 supported by staff who understood safeguarding procedures and were able to recognise the signs of potential abuse.

Risks to people had been thoroughly assessed and plans put in place to manage these risks while enabling people to live their lives without unnecessary restriction.

Robust recruitment procedures had been employed to reduce the risks of employing staff unsuitable for their role. There were sufficient numbers of staff deployed to meet people’s needs. Staff received comprehensive training to enable them to meet people’s care and support requirements.

People were given support to take their medicines as prescribed. However, we identified that the medicines auditing procedure was not always effective.

People’s nutritional needs were met and they were supported to access healthcare if they needed it.

People were supported by staff who showed respect and cared for them as individuals whilst maintaining their dignity. People were encouraged to make their own decisions where possible and their consent was sought appropriately.

People and those important to them were involved in planning their care, how it was delivered and their independence was promoted. People’s care was delivered in the way they wished by staff who were knowledgeable about their needs.

People who used the service and staff who supported them were able to express their views on the service. People were supported to make complaints and were confident that these would be heard and acted upon. The service maintained good communication with people who used the service and their families.

The management didn’t always maintain a good overview of the service and systems in place to monitor the safety and quality of the service were not always effective. Staff were supported by the management and felt valued by the organisation.

The service was not providing personal care to anyone in their own home at the time of this inspection.

We considered our inspection findings to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found based on our observations during the inspection.

If you want to see the evidence supporting our summary, please read the full report.

Is the service caring?

We spoke with four people who used the service. One person said to us, "I like living here." Another person said, "I like it here as I can go out on the farm and look after the animals." Another person was excited because they were soon to be supported to do an activity they enjoyed. We observed the care and attention people received from staff. All interactions we saw were respectful and friendly and there was a relaxed atmosphere throughout the service.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements. Care plans and risk assessments were informative, up to date and regularly reviewed.

Staff told us that the manager and other senior staff were approachable and they would have no difficulty speaking to them if they had any concerns about the service. The manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary.

Is the service safe?

The accommodation was adapted to meet the needs of the people living there, was suited to caring for people with limited mobility and was properly maintained. The service was warm, clean and was personalised to the people who lived there.

People were protected by effective staff recruitment systems. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were proper process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with generally positive feedback from people reported in the provider's own annual quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care records.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

Some information in people's care plans was suitable and up to date. However the majority of the care plans were in need of updating and information improved upon. We could not be assured that the information in the care plans matched the needs of the individual people.

We found that people were safeguarded from potential abuse but that staff skills could be improved upon if they had more knowledge on the mental capacity act and deprivation of liberty safeguards.

The medication procedure at lunchtime was carried out correctly and safely. However, the home did not have accurate records for fridge temperatures for the month of October. Therefore we could not be certain that medication requiring fridge storage was kept at a safe.

We spoke with care workers, senior staff and administrators. Everyone told us they were supported and trained to do the job. Supervisions were regular and annual appraisals were completed. Training was recorded and there was a planner in place to ensure staff did not miss the training required.

The service provided by this home was reviewed, audits were carried out and action was taken to ensure the quality of the provision was meeting the individual needs of people living in the home.

We saw people were enjoying their lunch and some were given either a napkin or apron to protect their clothes, depending on their choice. We also saw that people were given adapted cutlery to help them remain independent with their meal.

People looked comfortable with the staff who were assisting them and the whole lunch time experience was quiet and relaxed.