Raby Hall

People’s experience of using this service: At our previous inspection in July 2016 the service was rated as good. At this inspection we saw that the service needed to make improvements and has been rated Requires Improvement. This is because, the systems in place to address and reduce risks to people were not always working effectively; exposing people to risk of harm. Processes were not always followed to ensure that decisions made on a person’s behalf were appropriate and in their best interests. Some people’s support plans and other reports were not consistently written in an everyday and respectful manner; at times they did not demonstrate treating the person concerned with dignity and respect. Leadership of the service had been inconsistent in ensuring all aspects of the service provided for people was appropriate and of high quality.

We found the registered managers of the service to be candid and responsive during our inspection; with some of the areas requiring improvement being addressed within the inspection timeframe.

In June 2017, CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism. The service has not been developed and designed in line with this best practice guidance. Raby Hall was at the centre of a large campus of five registered services for up to 59 people with autism along with day services for more people. Current best practise guidance promotes housing models that increase opportunities for people’s independence, choice and control so they are able to achieve the best possible outcomes.

Some of this was mitigated by the renovation of the accommodation within Raby Hall, 10 people stayed in the main building in self-contained ‘flats’ for between one to three people; with another seven people living in the courtyard area of the building with a separate entrance. This helped create a less institutional feel within people’s home.

People told us that they were happy with the support they received. There was a friendly atmosphere at the home and people looked relaxed and comfortable. Staff were thoughtful and spoke with people in a kind and dignified manner.

People and their relatives told us they felt safe living at Raby Hall. Staff received training on and were knowledgeable in how to safeguard people from the risk of harm and abuse. New staff were safely recruited in line with best practise. People received their medication safely, the home was clean and the main building was safe.

We saw that people’s needs and wishes were assessed and recorded as part of an initial assessment. Staff at the service had tailored how people were introduced to the home in ways that met their needs and preferences as much as possible.

Each person had an individualised care plan that asked people the question, “What’s important to me.” These plans outlined people’s preferences, likes and dislikes. From observing people’s support, it was clear that staff knew people and their support needs and preferences well. People’s relatives told us that they were consulted on people’s care plans.

Each person had a health care plan called, “All about my health” which detailed people’s healthcare needs. We also saw that staff kept good records of people’s daily health, with any concerns they had receiving prompt attention. We saw examples of when staff being observant and vigilant to people’s health needs had led to people receiving healthcare in a timely way.

Rating at last inspection: At our previous inspection published in October 2016 we rated the service as Good. During this inspection the rating was changed to Requires Improvement.

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: Ongoing monitoring; we have asked the provider to tell us what they will do to make improvements to the areas of the service identified during this inspection.

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

Raby Hall is registered to provide accommodation for persons who require nursing or personal care and also provides end of life care. The home is registered to provide accommodation and care for up to 25 people. The people who lived in Raby Hall had conditions on the autism spectrum and other conditions related to this.

Raby Hall comprises a large older building with a more modern annexe named ‘The Courtyard’. There were five people living in the older building and eight in The Courtyard at the time of this inspection. The older building is over three floors and The Courtyard is over two floors and is operated as a separate unit to the older building. We were told the provider was considering applying to CQC for separate registration for each part. The Courtyard accommodated people who were less dependent that those in the older building. Most of the people living at the service were away for the day when we inspected; those which remained were unable to communicate verbally.

The older building is about to undergo a major refurbishment and due to the provider acquiring other services, many of the people who lived at the home have now moved to other accommodation or another provider.

Raby Hall is situated in the large semi-rural site owned by the provider, where there are other services available for people living in the home.

The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

Before our inspection, we looked at the information contained on the Healthwatch Wirral website. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the registered manager. We checked that we had received these in a timely manner. We also looked at safeguarding referrals, complaints and any other information from members of the public. We had received some concerns about the home which related mainly to the mix and suitability of some of the people living in the old building, but this had been addressed by the provider and the current and proposed improvements have resolved these concerns.

People received sufficient quantities of food and drink and had a choice in the meals that they received.

Medication procedures were followed and the medication stored tallied with the records.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the six files looked at there was updated information that reflected the changes of people’s health.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place that included training them to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

We saw that people appeared to feel safe and confident in the staff. The staffing levels were seen to be appropriate to support people and meet their needs and the staff we spoke with considered there were adequate staff on duty.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded.

The Wirral Autistic Society (WAS) locations and premises contained limited, records, apart from the care files for the people living at any particular location. The bulk of the files relating to such things were kept in the headquarters of WAS at Oak House. In light of this, we visited the headquarters of WAS at Oak House on 16 June 2014. We sampled records and files for each of the locations in order to fairly appraise them. We looked at 17 staff files and various other audits and records. Some of the records were kept as paper records, others were computerised.

Raby Hall had a total of 69 staff. There were a total of 25 people using the service. The service comprised a large older building with a more modern annexe named 'The Courtyard'.

There were a total of 25 people living in Raby Hall at the time of our visit. 17 people lived in shared flats and another person had their own self-contained accommodation, within the older building. Eight people were accommodated in their own rooms, in The Courtyard. Each building had communal space and facilities.

We talked with four people who used the service. We observed four others but we were not able to speak with these people because they had communication difficulties. We spoke with one relative who was visiting at the time of our inspection. All the people using the service appeared relaxed and content. We also talked with six members of staff. We looked at various records including eight care plans and the staff files. We had seen other records relating to Raby Hall at Oak House.

Below is a summary of what we found. The summary describes what people using the service 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.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available or on call in case of emergencies.

Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked.

Staff had been trained in safeguarding principles and procedures and the people living in the home had been given information in easy read format to help them raise a concern if they were worried about anything. The home had a safeguarding policy which was regularly monitored.

Raby Hall had a friendly and sociable feel.

Appropriate risk assessments had been carried out and action plans put into place for safe practice.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. 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.

Is the service effective?

A relative told us that they were happy with the care received by their relatives and felt their needs had been met. They said, 'It's fantastic'. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We spoke with one person using the service who told us, 'They let me do what I want and I make my own choices'.

Staff had received training to meet the needs of the people living at the home. One staff member said, 'It's amazing training'.

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Is the service caring?

People were supported by kind and attentive staff. We saw that workers 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. Our observations confirmed this. One person told us about the staff, "They treat me well'.

People had been involved in the creation of their care plans and continued to be involved throughout their stay in the home. We noted that peoples preferences about, for example, activities, room layouts or clothing choices, were respected by the staff. The people who used the service people were supported, where necessary, to make these choices and decisions.

Is the service responsive?

People's needs had been assessed before they moved into the home and frequently re-assessed whilst they lived there.

They had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other professionals, such as speech and language therapists and the organisation's own 'Autism Practice' department, were involved in peoples care when necessary.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. All of the people we saw appeared happy and content in the home and communicated well with staff.

Is the service well-led?

The home had a registered manager in post which indicated that the person had undergone the relevant checks. This meant that they were of good character, is physically and mentally fit and has the necessary qualifications, skills and experience. A relative said, 'The registered manager is brilliant, if there is any issue they phone me'.

Staff had a good understanding of the ethos of the organisation and quality assurance processes were in place. People, staff and other professionals had been asked for their feedback on the service. This also confirmed that respondents were listened to and as a result, some changes had been made. The home completed various other audits throughout the year, which contributed to an annual audit. An action plan had been produced to address any areas of concern raised through all of the audit and feedback processes.

The provider had a number of homes and they all same systems and IT package for much of its record keeping and policies. The provider had a centralised administration at the head office. The manager was able to demonstrate effective knowledge of this and show us that he had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications.

'As always I am extremely grateful to all the team for their dedication, interest and on-going care of my special son. He and my family are so lucky to have him so well looked after, safe and secure.'

One person who lived at Raby Hall had special dietary needs and we saw that provision was made for this. There were plentiful stocks of nutritious food including fresh fruit and vegetables, eggs, and milk. People had a choice of meals and of where they wished to have their meals. People were weighed monthly.

Arrangements were in place for the safe storage and administration of medicines and medication was handled only by senior staff who had received appropriate training. A safe and comfortable environment was provided with special adaptations made to meet people's individual needs.

People were given information about how to make a complaint and the manager responded appropriately to complaints and concerns and kept good records.

We talked with one person and two parents of people living at the home. They told us they were happy at the home and that the care was good. They said:

'they absolutely love it'

'never had a problem with them since they have been here'

'they are a very good service'

'its wonderful'

We observed people were well cared for and treated with dignity and respect. Peoples' needs were assessed and reviewed. We found care records contained relevant information in relation to personal details, individual needs and preferences. Parents told us they were involved in a person's care and able to inform care planning. Care plans and risk assessments were in place, individualised and up to date.

We reviewed the staff rota. We found the home employed sufficient staff to respond to peoples' needs in a timely, responsive manner. Staff were appropriately trained, supported and appraised to care for people. They demonstrated an awareness and understanding of how to protect people from abuse.

The home regularly measured the quality of care and enabled people living at the home and their parents/relatives to feedback their views on the home.