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Inspection carried out on 26 June 2019

During a routine inspection

About the service

Rhodsac is a residential care home that can provide long and short-term residential care for up to four people with learning disabilities, autism and mental health conditions; at the time of us

inspection four people lived at the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People told us that staff were kind, caring and respectful and they had good relationships with staff.

People were supported to stay fit and healthy. Staff encouraged people to live healthier lives, encouraged healthy eating and supported people to attend all medical appointments. Staff were committed to enabling people to socialise and develop and maintain relationships

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s care plans included assessments of risks associated with their care. Staff followed the risk assessments to ensure that people received safe care. Staff knew how to respond to and report any concerns about people’s safety and well-being.

People were supported by sufficient number of staff who were safely recruited to meet their needs. Staff supported people to take their prescribed medicines safely. Staff followed good practice infection control guidelines to help prevent the spread of infection.

People were supported by staff who had the right skills and knowledge to provide care that met people’s assessed needs. Staff were alert and responsive to changes in people's needs. They liaised with relatives and health professionals in a timely manner which helped to support people's health and well-being.

The provider monitored the quality of care and support people experienced and acted on their feedback to drive improvements in the service.

Policies, procedures and other relevant information was made available to people in the format that met their needs, such as easy read styles and pictures.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 July 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 15.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 8 May 2018

During a routine inspection

This inspection took place on 8 May 2018 and was un-announced.

Rhodsac Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rhodsac Care Home is registered to accommodate five people with learning disabilities, autism and mental health conditions; at the time of our inspection four people lived at the home.

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.

At the last inspection in April 2016 this service was rated good. At this inspection we found the service to require improvement.

Risks to people had not always been recognised and assessed. Window restrictors were not in place on the first floor of the building.

There was not a registered manager in post, but a manager who was going through the registration process. 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 felt safe. We saw that staff had been appropriately recruited in to the service and security checks had taken place. There were enough staff to provide care and support to people to meet their needs. People received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and ongoing professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People told us their relationships with staff were positive and caring. We saw that staff treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

People knew how to raise a concern or make a complaint and were confident that if they did, the management would respond to them appropriately. The provider had implemented effective systems to manage any complaints that they may receive.

The service had a positive ethos and an open and honest culture. The manager was present and visible within the home.

Inspection carried out on 26 April 2016

During an inspection looking at part of the service

During our previous inspection on 03 March 2016, we found that, although the provider had made improvements to the safe handling and management of medicines, people had been given over the counter homely remedies without the advice from a doctor, pharmacist or nurse. In addition, the necessary written protocols were not in place for staff to refer to ensure that the medication was administered safely.

This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we checked to see if improvements had been made to the systems and processes in place for the safe administration of homely remedies.

At this visit people using the service were out at their chosen activities so they were not able to comment about the homely remedies they received.

We spoke with the registered manager who showed us a homely remedies policy that had been implemented at the service. The written procedure included a list of over the counter remedies that were available in the service with a list of indications for which they can be used. We also saw a record of the agreed dose and maximum period of use before a referral to a GP was made. The registered manager had sought advice from each person’s GP and we saw signed letters of approval from the GP in the homely remedies file.

We found there was a procedure for recording any homely remedies administered and a procedure for checking household remedies purchased by or for people who used the service.

The registered manager told us they had also sought further advice from a pharmacist to provide advice on uses, doses and possible interactions with prescribed medicines.

In addition, we found there was a separate book with a running balance and expiry dates of each homely remedy used by people living at the service. The registered manager had also signed up to receive any medical alerts in relation to homely remedies.

We found that homely remedies were stored within the medication storage area, but separated from prescribed medication. They were not be labelled for individuals and we saw that expiry dates were checked regularly.

We also found that staff had been provided with guidance and in-house learning in relation to the use of homely remedies. This meant that people using the service could be treated for minor symptoms and ailments safely and in line with best practice.

Inspection carried out on 3 March 2016

During a routine inspection

This inspection took place on 03 March 2016 and was unannounced.

At our previous inspection on 04 August 2015 we found that people were not protected against the risk of unsafe care and treatment that included the unsafe management of medicines and inadequate systems in place to protect people against risks, by timely and robust risk assessments.

We also found that there were insufficient numbers of suitably qualified, competent, skilled and experienced persons providing care or treatment to people using the service. During the previous visit we found that people were not always protected against the risks of avoidable harm or abuse because potential safeguarding concerns had not been reported by staff. We also found that we found that robust recruitment procedures had not been followed to ensure only suitable staff were employed at the service. In addition, we found that there was not an effective system in place to assess and monitor the quality of service that people received.

The service was in breach of a number of regulations and you can read the report from our last focused inspection, by selecting the 'all reports' link Rhodsac on our website at www.cqc.org.uk.

We asked the provider to provide us with an action plan to address these areas and to inform us when this would be completed. During this inspection we checked to see whether or not improvements had been made.

Rhodsac Care Home is a residential home providing personal care and support for up to four younger adults with learning disabilities. There were four people using the service at the time of our visit.

The service had a 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.

We carried out our second unannounced comprehensive inspection on 3 March 2016 and found that, although the provider had made improvements to the safe handling and management of medicines, people had been given over the counter homely remedies without the advice from a doctor, pharmacist or nurse. In addition, the necessary written protocols were not in place for staff to refer to ensure that the medication was administered safely.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements had been made to the safeguarding process to make sure staff knew how to report any concerns they had to keep people safe. The procedures in place and the knowledge staff had gained from staff safeguarding training helped ensure people were kept safe from harm.

The risk assessment process had been strengthened and we found that risk assessments had been reviewed for all people who used the service. Risks to people’s safety had been assessed and provided staff with guidance to protect and promote their independence.

We found there were appropriate numbers of staff employed to meet people’s needs and this could be increased to ensure people attended their chosen activities or appointments.

Improvements had been made to the recruitment process and we found that appropriate recruitment checks now took place in order to establish that staff were safe to work with people before they commenced employment.

Quality assurance systems had been strengthened and sufficient improvements had been made to ensure the service could obtain feedback, monitor performance and manage risks.

Staff received an induction based upon the fundamental standards of care, which determined their competency in a variety of subjects. They also received on-going training and formal supervision, to help them to deliver safe and appropriate care to people.

Staff sought people’s consent before supporting them on a daily basis and ensured they were off

Inspection carried out on 04 August 2015

During an inspection looking at part of the service

This inspection took place on 04 August 2015 and was unannounced.

Prior to our visit we received information of concern about the service from two different sources. This was in relation to potential verbal abuse against people using the service, inadequate staffing levels, poor recruitment practices, medication being administered by staff that were not trained to do so and people and staff being put at risk because of a lack of support and guidance. In addition, concerns were raised about the lack of leadership and frequent changes to the manager at the service.

During this inspection, we looked at these specific areas to check if the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rhodsac Care Home is a residential home providing personal care and support for up to four younger adults with learning disabilities.

The service had a 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.

Staff had a good understanding of safeguarding and who to report their concerns to. However, we were made aware of two incidents that had not been reported to the relevant authorities, by staff, which were potential safeguarding issues.

We found the risk assessments in relation to people’s behaviours that could challenge others, were not reviewed on a regular basis and lacked clarity about what staff members needed to do to reduce risk.

There were insufficient numbers of suitably qualified, competent, skilled and experienced persons providing care or treatment to service users.

Recruitment policies and procedures were not robust and did not ensure that staff were suitable to work with people at the service.

Medicines were not managed safely. The systems and processes in place did not ensure that the administration, storage, disposal or handling of medicines were safe for people who lived at the service.

We found the culture at the service was not open and transparent and we found a lack of leadership in the day to day running of the home.

Staff did not feel able to express their views and ideas and said they would not have confidence that the provider would address any concerns they raised.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 07 October 2014

During a routine inspection

Rhodsac Care Home is a residential home providing personal care and support for up to four younger adults with learning disabilities.

The inspection took place 07 October 2014 and was unannounced.

There was a manager employed. The manager was not registered however; they were going through the process of registration with CQC.

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.

At the last inspection, 02 January 2104 we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Care and welfare of people who use services. The provider had not taken proper steps to ensure that care was planned in a way that ensured the welfare and safety of service users. Regulation 9(1) (b) (ii). A satisfactory action plan was submitted.

At this inspection we found that support plans were fully completed, regularly reviewed and up to date.

People who used the service told us they felt safe.

Staff were aware of signs and symptoms of abuse and how to report it if necessary.

Risk assessments in peoples support plans were completed and regularly reviewed to enable people to live active lives.

There were adequate numbers of appropriately skilled staff to support people with their chosen activities and to keep them safe.

Staff we spoke with told us they were not allowed to start working at the service until they had completed thorough recruitment checks and had received an induction.

Medicines were managed safely and the processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were very knowledgeable of these and correct processes were in place to protect people.

People we spoke with were very complimentary about the manager and staff. Staff we spoke with told us the manager worked alongside them and knew everyone well. It was obvious from our observations that staff, people who used the service and the manager had good relationships.

We observed people being assisted to prepare their own meals, following specialist diets where appropriate.

People had access to a variety of health care professionals to make sure they received ongoing treatment and care.

People’s care and support plans were reviewed regularly with the involvement of appropriate people.

Regular meetings were held for staff and people who used the service to enable everyone to be involved in the development of the service.

We saw that effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Inspection carried out on 2 January 2014

During a routine inspection

At the time of our inspection visit, this small care home had been operating for a few months and provided care and support for two people. We spoke with both people who used the service about their experience of living at Rhodsac. They told us they liked living there, and were happy with the care and support they received from staff. They told us their views were listened to and any concerns they had were taken seriously and acted on and they felt safe. We also spoke with two relatives who said they thought their relations were happy.

We found that people received good day to day care from staff who knew them well, however this was not supported by having individualised care plans and risk assessments in place. This meant there was a risk that people�s care may not have been effectively managed and individual risks minimised to ensure people�s safety and welfare.

Recruitment checks were sufficiently robust to guard against employing unsuitable staff. There was no registered manager in post at the time of our inspection. The service was being managed by the company director until a registered manager was recruited.