Housing 21 - Rokeby Gardens

Housing 21 - Rokeby Gardens is an extra care service in the Kirk Sandall area of Doncaster that contains 52 self-contained flats. There were 56 people who lived in Rokeby Gardens. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 26 people using the service who required support with their personal care needs.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were safe from the risk abuse and were supported by staff who understood safeguarding procedures. There were sufficient and appropriately trained staff in place to support people. People received their medicines safely. People were actively involved in their care and supported to maintain their independence. 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.

Right Care

Care was person-centred and maintained people’s dignity, privacy and independence. There was support for people with additional communication needs. People were encouraged to make choices about what activities they wanted to do. There was a complaints policy and process in place. The service had focussed on conversations with people and their families about making plans to meet people’s wishes at the end of life and what to do after loved ones had passed away.

Right Culture

There was a positive culture in the service. People, relatives and staff were complimentary about the management of the service. Staff were valued by the management team and were recognised for their achievements. There was an open, transparent organisational culture that was focussed on supporting staff and continuous service improvement.

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

Rating at last inspection

The last rating for this service was good (published 8 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service, specifically, the time elapsed since the last full inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We previously inspected the service in August 2016 and found breaches of the regulations in relation to quality assurance and the lack of person-centred care planning. The overall rating for the service was, "requires improvement." We asked the provider to tell us how and when they would make the required improvements. These actions have now been completed.

There was a manager in place who was in the process of being registered with CQC. Registered managers 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 continued to provide safe care to people living in their own homes. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policies to provide people's prescribed medicines safely. There were enough suitably skilled staff to meet people's needs. Staff had been recruited using safe recruitment practices.

The manager promoted a caring culture that was reflected in the comments made by people and the attitude of staff. Staff felt valued and well supported. The manager had good oversight of the service. Staff received training to ensure they had the skills and knowledge to meet people's needs and had access to development opportunities.

Staff had regular supervision and they had been trained to meet people's individual needs. They understood their roles and responsibilities to seek people's consent prior to care and support being provided. The requirements of the Mental Capacity Act 2005 (MCA) had been met.

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access other health services. People's needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. People and their relatives had been involved in planning and reviewing people's care plans.

The provider had an effective system to handle complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff. They also acted on the comments received to continually improve the quality of the service.

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received.

Housing and Care 21 - Rokeby Gardens is a domiciliary care service providing personal care to people in their own homes.

Although under one CQC registration the service runs two services independent of each other, each with a manager, both of which are in the process of registration. One delivers personal care to people in their own homes in the Doncaster area, whilst the other delivers personal care to people resident at the 52 bed Rokeby Gardens extra care scheme. At the time of our inspection there were 112 people using the service.

There were two managers in post in the process of registration. 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.

During this inspection we found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to governance and care planning. The provider did not fulfil the statutory requirement to send the Care Quality Commission (CQC) notifications of certain incidents. Quality assurance procedures at the service were not always sufficient to help them to assess, monitor and improve the quality of care being provided.

People felt involved in their care planning. Care records reflected people's preferences and other important details relevant to their care needs. However, this needed to be more consistent across the service.

Communication between care workers and the management team were effective in ensuring risks to people were understood.

Feedback received from people was very positive. Staff respected people's privacy and dignity and interacted with people in a caring, respectful and professional manner.

Staff were trained in subjects relevant to the people they were caring for, and there was an induction plan for new staff which ensured they were confident to perform their role.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe and took action when needed.

The service was flexible in meeting people's needs. Staffing levels ensured people received their care at the times they requested.

People received their medicines in a timely manner, but documentation was not always completed correctly. This was however identified during audits.

The managers and area managers were committed to achieving a service which provided high quality care to people. They accepted our findings and the need to improve documentation.

People told us they knew how to complain, and that they communicated regularly with the management team.

Training records we looked at showed staff were up-to-date with their training programme. Staff received supervisions and appraisals as part of their on-going support. People were supported by staff to have access to food and drink of their choice.

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. People we spoke with said they felt safe with staff and were able to raise concerns with the agency if required.

There were enough qualified, skilled and experienced staff to meet people's needs. The manager told us the staffing levels were based on the needs of people who used the service. People we spoke with said on the whole staff attended on time and stayed for their allocated time. They told us, "Staff are very reliable and this helps me" and "The staff generally arrive on time but let me know if they are going to be late."

There were suitable arrangements in place to ensure staff received appropriate professional development. Staff had completed relevant training to enable them to deliver care to people safely and to an appropriate standard. People we spoke with said the staff were well trained and capable to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Before people received care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us they were involved in their care and felt that staff respected their opinions and decisions in this process.

People were provided with a choice of suitable and nutritious food and drink. The care plans we looked at reflected the choice of food and drink made by people who used the service. People we spoke with confirmed they had access to drinks and snacks between mealtimes.

There were effective systems in place to reduce the risk and spread of infection. People we spoke with confirmed staff always wore protective clothing and washed their hands.

There were enough qualified, skilled and experienced staff to meet people's needs. One person told us, "I'm happy with the service staff know what to do."

People were made aware of the complaints system. Information about how to report a complaint was included in the service user guide. People we spoke with confirmed they could raise any concerns with the office and these would be acted on.