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Inspection carried out on 26 September 2017

During a routine inspection

Rhyme House is a detached house in Sittingbourne. It provides support for up to ten young people with a learning disability, some of whom are also living with autism. There were ten people living at the service at the time of inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by staff who knew them well and were focussed on promoting their independence and happiness. People were involved in managing their own risks. Staff gave them the support and information they needed to choose how risks were managed and how much involvement staff should have. People were supported to make their own decisions and remain as independent as possible. Staff supported people in the least restrictive way possible.

People were supported by staff who had been recruited safely, there were enough staff and staffing levels were planned around people’s activities. Staff received the training and support they needed to meet people’s needs. Staff told us they felt they were listened to and valued by the registered manager and provider.

People were involved in planning their own support and which activities they wanted to take part in. Staff worked with people to develop their communication skills and introduced communications tools to support people’s involvement in care planning. People had regular house meetings and monthly key worker meetings where they could express any concerns and make plans for the future.

People were supported to have a balanced diet that met their cultural and health needs. They were involved in planning menus, shopping and food preparation. Staff worked closely with other professionals involved in people’s support. People were supported to attend health appointments when required. Advice received from healthcare professionals was followed and added to people’s care plans.

Staff knew how to recognise abuse and told us they would report any concerns. The manager was aware of their responsibilities in relation to safeguarding people and staff told us they were confident the manager would take appropriate action. Risks to the environment were assessed and plans are in place to mitigate risks. People's medicines were managed safely and in the way they preferred.

Regular audits had been carried out to monitor the quality of the service and improvements had been made because of actions taken. The service had received an award from the provider for continuous improvement. People, staff and relatives were asked for their feedback. Accidents and incidents were analysed. Changes were made to the layout of the service because of feedback and learning from incidents which have made a positive impact. There was a complaints policy which was available in an easy read format and complaints had been responded to and resolved appropriately.

Further information is in the detailed findings below.

Inspection carried out on 30 July and 3 August 2015

During a routine inspection

We carried out this inspection on the 30 July and 3 August 2015, and it was unannounced. We inspected this service due to concerns we had received. It was alleged that medicine procedures were not being followed and record keeping was not robust.

Rhyme House is a transitional service providing care and accommodation for up to ten people with learning disabilities. A transitional service provides support to people to improve their independence, with the objective to enable people to move on and live independently in the community whenever possible. There were seven people at the service at the time of the inspection. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. It is one of a group of services owned by The Regard Partnership Ltd. The service is situated near the amenities of Sittingbourne.

We last inspected the service Rhyme House on 30 September and 1 October 2014. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. The service was found to be in breach of the regulations. These breaches were in relation to, staff not being up to date with training and specialised training; there was no evidence of regular formal and recorded two way supervision; audits and on going monitoring needed to ensure people who lived in the home received a safe and good quality service were not robust; the complaints procedure was not being followed and was not effective in protecting people and improving the service offered to people who lived in the home; records were not comprehensive, had not been kept up to date and signed appropriately and people’s personal information had not been kept confidential by staff. Following the inspection the provider sent us an action plan to show how they intended to improve the service and meet the requirements of the regulations.

At this inspection we found that improvements had been made and the provider was meeting the regulations.

Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the manager and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

The service had a new manager, who had been at the service for two months. They had sent in an application to the Commission to be 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Where people lacked the capacity to make decisions the home was guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in the person’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.

Staff had been trained in how to protect people from abuse, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the manager, the locality manager or outside agencies if this was needed.

Staff were knowledgeable about people’s needs and requirements. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs.

Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal to carry out their roles.

Medicines were managed, stored, disposed off and administered safely. People received their medicines when they needed them and as prescribed.

People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.

There were risk assessments in place for the environment, and for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

The manager investigated and responded to people’s complaints and people said they felt able to raise any concerns with staff.

Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

Inspection carried out on 30 September and 1 October 2014

During an inspection in response to concerns

One inspector visited the home for 11 hours over two days, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service; one parent; the staff and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People who lived in the home were offered choices and independence was promoted. Policies and procedures were in place and training was in provided to make sure that the manager and staff team understood what abuse was and their responsibility to report any suspicions.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications had been submitted to the local authority and best interest decisions had been made.

Care records and risk assessments had not been kept up to date and staff and people who used the service had not signed some care records. Therefore the provider could not demonstrate that they had up to date information that staff had read and understand in order to meet people�s needs who lived in the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People�s health and care needs had been assessed with them, in some cases. However we saw assessments had not been undertaken in a timely way and one person did not have an assessment on file. A Compliance action has been set for this and the provider must tell us how they plan to improve.

We were told by staff that the people who lived in the home and their relatives or advocates were involved in developing their care plans. On the files seen there was no documentary evidence to show that people and their families had been involved and agreed the plans of care and support. A Compliance action has been set for this and the provider must tell us how they plan to improve.

People�s preferences, interests, aspirations and diverse needs had not always been recorded although staff spoke with had a good understanding of the care and support needed. As this was not documented in all cases we could not be sure care was in accordance with people�s wishes. A Compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People we spoke with who were able to verbalise their wishes told us that the staff helped and reminded them about things they needed to do. One person told us �I am pretty independent I can do a lot of things for myself, when I forget they tell me. They also help me try new things, I learned to cook some things, they show me, then we do it together and then when I feel ok they just watch me do it myself�.

People who used the service were not all able to complete a survey because of communication difficulties but their relatives involved with the service were asked to complete a satisfaction survey. The new manager told us a survey would be sent out soon and where shortfalls or concerns were raised these would be addressed.

People completed a range of activities in and outside of the service regularly. We observed this when we visited. Members of staff supported people individually in most cases, for example a staff member supported one person to go swimming and to the gym as was planned for that day.

Is the service responsive?

On the day of inspection one person at the home was suffering from tooth ache. Staff arranged an urgent visit to the dentist. The person received agreed pain relief and staff knew how best to distract the person's attention and keep them as calm as possible. We spoke to the person�s parent when they visited and they confirmed that they had been contacted by the staff. They told us, �They (staff) rang me as soon as they realised the problem this morning and have kept me updated. The staff at the home are very good at keeping me informed, and they are very good with X, they know when things are not ok and how to handle X so that X does not get distraught�.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has quality assurance systems, records seen by us showed that there were shortfalls in the regular monitoring of these systems with in the home. As a result the quality of the service was not being measured and shortfalls in the service could be missed. A Compliance action has been set for this and the provider must tell us how they plan to improve.

Staff spoken with had a good understanding of the ethos of the home and were clear about their roles and responsibilities. The home has had five different manager over the past ten months and the staff spoken with said that they had supported each other and had worked well as a team to make sure that people received a good quality care and support at all times.

Inspection carried out on 18 November 2013

During a routine inspection

We visited the home and spoke with three people who lived in the home, a family member and a care manager. We spoke with staff, and observed their practice when they supported people. We viewed people�s care files and looked at the home documentation.

People who lived at Rhyme House told us that they were happy there. One person said, �The staff are really nice�; another person said, �The staff are alright, they help me a lot, I am happy here�.

We asked for people�s consent before we looked at people�s personal files. Each person had a comprehensive plan of support which they had agreed with. The plans included people�s preferences, needs assessment, goals for future independence and risk assessments.

People in the home had received their medication as prescribed.

Staff had received the training that they needed to care for people and to develop within their job role.

There were systems in place to monitor the on-going quality of the care and environment in the home.

Inspection carried out on 5 February 2013

During a routine inspection

People told us that the staff were kind and helped them. They said they liked living at Rhyme House and that they had support to manage their care and domestic tasks.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service and how to focus care around their specific needs. This was confirmed by our observations and on checking the care records.

Care records showed that people had been supported and encouraged to make decisions about their life and care. We saw that people and their representatives had been involved in planning care. When people�s needs changed, we found that records had been updated to reflect this.

Staff spoken with demonstrated a good understanding of how to safeguard people from harm and were confident to take appropriate action. Training records showed that staff received regular training on protecting people from abuse and the Mental Capacity Act. Training records also showed that staff were suitably trained and supported in their role.

Records showed the provider regularly assessed and monitored the quality of the service. We saw that people, their representatives and professionals were asked their views about the home.