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Inspection carried out on 6 June 2018

During a routine inspection

This inspection took place on the 6th and 22nd of June 2018 and was unannounced.

Rascasse is a ‘care home’ and is located in the village of Silver End in Essex. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rascasse provides accommodation in a main house and adjoining annex. Rooms are all single use and the services registration has recently been increased to enable the service to support up to eight adults with learning disabilities. There were seven people living at the service on the day of our inspection. Individuals using this service have complex needs and require high levels of support to enable them to be safe and engage with others.

The service had an established 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.

The service had a comprehensive inspection in February 2016 and was rated good overall and requires improvement in Safe. We subsequently received concerns about how an incident was managed at the service and we undertook a focused inspection in March 2017 to look at safety at the service. We found that the service was not meeting the requirements of the legislation and required them to take steps to address the shortfalls we found. At this inspection we found that improvements had been made.

The registered manager and registered provider were clearer as to their responsibilities under the duty of candour which is a duty on providers to be open and transparent when safety incidents have occurred. There were systems in place to identify risks and mitigate the risk of harm however we have made a recommendation that the fire safety systems in the Annex are reviewed and auditing strengthened.

Medicines were safety stored and clear systems in place for the administration of people’s medicines. We have however recommended that staff recording is strengthened to enable more effective auditing.

The provider operated a safe recruitment system to ensure that staff were suitable and safe to work with people.

There were sufficient numbers of staff available to support people. New staff received induction training to prepare them for their role. Staff received ongoing training and supervision to reflect on their practice and ensure that they had the skills and knowledge to meet people’s complex needs.

People had sufficient amounts to eat and their nutritional needs were met. There were clear systems in place to support people to access health support when they needed to.

Staff had a good understanding of consent and there were best interest assessments in place in line with the legal requirements. The registered manager was aware of their responsibilities with regard to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DOLs).

People were supported by staff who knew them well and we observed that people had good relationships with staff. Staff were kind and respectful in their interactions.

Staff had access to comprehensive care plans and access to a range of professionals including a clinical psychologist to guide their practice. There were strategies in place to manage people’s anxiety and behaviours which others may find challenging.

People were supported to have as full and meaningful live as possible.

There was a complaints procedure in place to address concerns and the management of the service had a number of ways of gathering people’s views including the use of satisfaction surveys.

There was a clear management structure and relatives told us that they had good rela

Inspection carried out on 20 March 2017

During an inspection looking at part of the service

The inspection took place on 20 March 2017 and was unannounced. The service provides accommodation and care for up to seven male adults with learning disabilities. There were seven people living at the service on the day of our inspection.

The previous inspection of the service was undertaken on 8 February 2016 and the service was rated good overall with requires improvement in Safe. Since that inspection we received information about an incident which indicated potential concerns about the management of risk to people living in the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to Safe. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rascasse on our 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 who lived in the service looked at ease with staff. They were not able to talk to us about the support they received so we observed how they were supported. We also spoke with some of their relatives about the care and they were positive about the support provided and the kindness of staff.

Staff sought to understand the causes of distressed behaviours in individuals but the risk management plans were not sufficiently clear and practice was inconsistent. We were not assured that risks were anticipated and that the management of the service were taking all necessary steps to minimise risks and protect people.

Investigations into incidents were not sufficiently robust and the provider’s responsibilities to be open and objective were not fully understood.

Risks relating to the environment were identified and steps taken to reduce the likelihood of harm. However, we found that these were not always implemented consistently for example, the fire safety plans were compromised by the fact that fire doors were propped open.

Staffing levels were satisfactory and enabled people to have good access the community. Recruitment processes ensured that staff suitability to work with vulnerable people was checked however the systems in place for obtaining references should be strengthened to protect people.

The administration of people’s medicines was not consistently safe. There were arrangements in place for the use of as and when required medicines (PRN) but these needed to be strengthened as we found anomalies between what was recorded and prescribed, which meant that people were at risk of being given the incorrect amount of medicine.

Staff were clear about what was abuse and expressed confidence in the registered manager to report and seek advice appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 8 February 2016

During a routine inspection

The inspection took place on 8 February 2016 and was unannounced. The service provides accommodation and care for up to seven male adults with learning disabilities. There were seven people living at the service on the day of our inspection.

The registered manager was no longer working at the service and a new manager had recently been appointed who told us that they were in the process of applying to be registered. 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 who lived in the service appeared happy and looked at ease with staff. They were not able to talk to us about the support they received so we observed their care and support and spoke with their relatives who were positive about the service and the approach of staff.

Risks relating to the environment and to individuals were identified and management plans were in place to reduce the likelihood of harm. However, we found that the fire safety plans were compromised by the fact that doors were propped open. Incidents such as the use of restraint were reviewed however people would be provided with more protection if there was further evidence of oversight and analysis.

Staffing levels were flexible and reflected the needs of individuals. Recruitment processes ensured that staff suitability to work with vulnerable people was checked.

Medicines were safely stored and administered by staff who were trained and assessed as competent.

New staff received induction training to prepare them for their role. The service was in the process of implementing the new care certificate. This is a national initiative to develop staff and demonstrate they have key skills, knowledge and behaviours appropriate for the role they were employed to perform.

Staff had a good understanding of consent and there were best interests assessments in place in line with the legal requirements. The manager was aware of their responsibilities with regard to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards.

People received a varied choice of nutritional meals. People health was monitored and they had good access to health care support which helped them to maintain their wellbeing.

People were at ease and comfortable when staff were present and staff interacted with people in a caring way. People were supported in a way which promoted their independence. People’s needs were assessed and the information was used to develop comprehensive care plans. These were person centred and provided clear guidance to staff on how best to deliver care. People were supported to follow their interests and maintain the relationships which were important to them.

There was a complaints procedure in place and relatives told us that they were aware of the process and the service was responsive to issues of concern when expressed.

There was a clear management structure and relatives told us that they had good relationships with the service. Staff were supported and morale was good. There were systems in place to provide governance and drive improvement.

Inspection carried out on 18 July 2013

During a routine inspection

We found that the service had appropriate arrangements in place for obtaining consent to care. Where appropriate the service had mental capacity assessments in place for people in accordance with the Mental Capacity Act 2005.

We found that the provider had systems in place to maintain the safety and welfare of service users. The service provides staff with specilaised training to ensure the safety of people with specific medical needs.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager. Staff received regular supervision and an annual appraisal. Staff told us they were able to raise issues with their manager and gave examples of the incidents and concerns, such as staffing levels, that they had reported and their concerns were addressed by the manager.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people�s care was regularly reviewed and that additional provisions to support their care were provided where required.

We found that the provider had systems in place to ensure the safe management and administration of medication.

Inspection carried out on 30 October 2012

During a routine inspection

We used various methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to were not able to communicate with us verbally. We talked with a number of staff in detail about the service users and how they liaise with relatives. We found that care was provided according to very detailed care plans, behavioural action plans and risk assessments of the people living in the service

We observed people being cared for by staff during our visit. They shared their views through gestures, facial expressions and body language wherever possible. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The service was well supported by the provider through extensive training for staff, clear policies and procedures, and regular refurbishment and maintenance.

Inspection carried out on 1 December 2011

During a routine inspection

All of the people who used the service were not able to communicate with us verbally. However, they shared their views through gestures, facial expressions and body language wherever possible.

We saw that people responded well to the encouragement they were given and staff communicated with people clearly and respectfully. One person with whom we spoke was sitting in the lounge using their laptop to watch a DVD. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.