Rowsley House

This inspection took place on 13 and 14 November 2018 and the first day was unannounced. At our last inspection in January 2016, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There were adequate systems in place to help ensure people were safeguarded. For example, recruitment processes were robust, enough staff were deployed to support people’s needs, medications were stored and administered appropriately, and regular environmental and equipment checks were carried out. People and relatives told us Rowsley House was a safe environment in which to live.

The service worked within the principles of the Mental Capacity Act and made appropriate applications for the Deprivation of Liberty Safeguards. People were supported to have 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.

Staff had the relevant skills and experience to carry out their role effectively and received support from their line manager in the form of regular supervisions and annual appraisals.

People told us they were well cared for by the staff team who knew them well and understood their support needs. People told us they liked the staff and we saw they had good relationships with them. Staff’s approach was very caring and empathetic, and we saw that they carried out their duties in a friendly yet professional way.

The service responded to people’s needs by ensuring support plans were person-centred and contained relevant and up-to-date information. Information was communicated to people in a format that they could understand. Within the home and in the community, people engaged in activities that were meaningful and enjoyable to them. People’s end of life wishes were discussed; some information around these discussions was recorded within their support plans.

The service had a policy and procedures in place to manage complaints or concerns raised. People and their relatives said they could approach any staff member or the registered manager if they needed to raise a concern or complaint. Since our last inspection, no complaints had been received.

There were adequate processes in place to help ensure the quality of the service was monitored. The staff team worked well together. The registered manager felt supported by staff. Staff told us the registered manager trusted their knowledge and expertise and this empowered them to carry out their roles effectively.

Regular engagement with people and their relatives helped to ensure their opinions and suggestions were heard and acted on. There were policies and procedures in place and regular staff meetings were held to help ensure staff were supported to undertake their role effectively.

The provider complied with the legal obligation to display its most recent rating within the home and on their website.

Further information is in the detailed findings below.

Rowsley House is a residential care home providing accommodation and personal care for up to seven people from 16 years of age, living with a learning disability and associated health needs. The accommodation is based over three floors. There are no mixed gender floors.

At the time of the inspection, seven people were living in the home. 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 living in the service told us they were happy living there and that the “Staff are always there to help me”. Family members told us that their relative was better since they had moved to Rowsley House, and “It was the best thing that had ever happened to them.” Staff told us it was “A special house” and it was “Run amazingly.”

Support staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.

A system was in place to identify and assess the risks associated with providing safe care and support. We saw risks had been discussed with the people who used the service and action agreed to keep people safe from accidental harm.

People were well cared for by staff who were knowledgeable about their complex needs and there was sufficient staff on duty at all times to provide the required support. A number of people living at the service had behaviours which could put them and others at risk. We saw that their needs were met and at times exceeded their own personal expectations. This was shown in the reduction of instances were these behaviours were displayed. This was possible because staff knew people so well, the very early signs of changes of mood and demeanour were picked up and distraction techniques were used to manage potential situations and avoid the need for further and more serious interventions.

We found that the care that people received was very person centred and met their individual needs. There was evidence of creativity throughout the service, and that staff and the senior managers cared about the well-being of the people who lived at the service. Staff understood people’s communication needs and supported people to make choices about the food they wanted to eat and activities they wanted to participate in. We observed that people were supported to carry out household tasks and two people using the services were supported to access the local community during our inspection.

People were referred to healthcare professionals as required. We saw people had been supported to access such as general practitioners (GPs), dentists, opticians, psychologists and psychiatrists when necessary.

We found the service to be welcoming and homely. People had activities which had been planned for them as individuals, rather than as a group. This meant the service had recognised the specific needs and interests of each person and had taken action to make sure they were met.

People said they knew how to make a complaint if they were unhappy about the support they received and that they would let the registered manager or a member of staff know.

The registered manager had developed an effective system of quality assurance, which measured the outcomes of service provision. Staff and relatives had been included in this process and their feedback had been used to make improvements to the way the service was provided.

We found that the service was well led at all levels of management. The registered provider had regular oversight of the quality of the care being delivered, as they had robust policies and procedures in place and comprehensive auditing was carried out to measure quality across all aspects of the service.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During the inspection we spoke with two people who used the service, three relatives, two care staff and the registered manager. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service caring?

We spoke with two people who used the service who both told us they liked living at the home. We also spoke with three relatives who told us they were happy with the care and support the staff provided to their family. Some comments included; "You can tell the staff care by the way they are, they are so patient, I don't know how they do it"; "They understand completely (my family members) complex needs. They are on the ball with everything and champion (my family member's) rights.' and '(The manager) is so approachable.' We saw staff were patient and kind. Our observations and the comments from people we spoke with showed us people were treated with empathy and dignity by the staff.

Is the service safe?

The people we spoke with us told us they felt safe.

The home had policies and procedures to support staff in the reporting of suspicions or allegations of harm and abuse. We asked staff what they would do if they had concerns, or needed further information and advice in the absence of the registered manager. From our discussions with staff it was clear they had a good understanding of the steps to take if they were concerned that someone was at risk from harm or abuse and we found there was an on call policy in place to enable staff to access further guidance if this was required. This meant there were systems in place to enable staff to respond to any concerns and ensure people's safety and wellbeing was maintained.

On the day of our inspection we saw there were sufficient staff on duty to support people safely. The two people we spoke with told us if they asked for help, this was provided to them quickly. We saw staffing was planned in advance and the staff we spoke with told us they felt the numbers of staff on duty were sufficient to support people in a calm and unhurried way. This showed us adequate numbers of staff were provided to meet people's needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. At the time of our inspection we saw there was an application in place and the correct procedures had been followed.

Is the service effective?

We saw people who lived at the home had received support from health care professionals as required and this was recorded within the care records. The people we spoke with were positive about their experiences at Rowsley House. Comments we received included; 'I like it here.' and 'The staff are really good. There's not one that doesn't know me and know how to look after me.' We spoke with two staff members who were knowledgeable of the care and support people needed and could also describe people's individual likes and dislikes. Our observations and the comments from people we spoke with showed us the service was effective when meeting people's needs.

Is the service responsive?

The service had systems in place to ensure people were regularly consulted about their views and ideas on how the service should be run. This was done by means of regular discussions with people and meetings. The people we spoke with told us they were consulted and the management of the home listened to their views.

Is the service well led?

We saw records which showed us regular environmental audits were carried out and we saw the home was clean and well maintained.

We discussed other audits with the manager. The manager told us audits such as records, medication and incidents and accidents and we saw documents that confirmed this was the case. The manager explained the actions they had taken when they had identified improvements could be made and the staff we spoke with confirmed the manager discussed the results of audits with them in supervisions and meetings. We considered there were systems in place to identify, assess and manage risks to people who lived at the home.

Relatives told us they were happy with the service their relative received. One person said: 'We're quite happy; they're doing their best for [my relative]. They're bending over backwards.' The advocate told us: 'As a provider, I've no problems with them. They've worked their socks off to settle [person who used the service].'

Assessments were completed when people did not have the capacity to provide informed consent. We also saw that the correct process had been followed where people had been subject to Deprivation of Liberty Safeguards. Care plans and risk assessments were in place for each person to ensure people experienced care, treatment and support that met their needs.

People were able to choose their meals and were given a range of different, nutritious options. Food and drink was available in sufficient quantities to meet people's needs.

Medicines were stored, handled and administered appropriately.

We found the provider carried out the relevant employment checks before new staff started to work at the service.