Rother Valley View

Rother Valley View is a residential care home providing the regulated activity of accommodation and personal care to up to 6 people. The service provides support to adults with a learning disability and autistic people. At the time of our inspection there were 3 people using the service. The home consisted of 6 self-contained flats in one building. People had access to a communal kitchen, dining and living room and a large enclosed garden.

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.

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

Right Support:

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 model of care and setting maximised people's choice, control and independence. Risks to people were assessed, monitored and managed safely. Systems in place to protect people had been strengthened but needed further strengthening to ensure all incidents are reported. The provider had acted to manage infection risks. There were enough staff to safely meet people's needs. Staff had the necessary skills, knowledge or experience to know how to meet people's needs. People's medicine support was managed safely.

Right Care:

Care was person-centred or delivered in a way which promoted people's dignity, privacy and human rights. Staff offered people choices and involved them when supporting them with activities and meals. Recommendations and actions identified by partnership agencies regarding people's support needs were promptly implemented to ensure people achieved good outcomes.

Right Culture:

The internal quality assurance systems and processes to audit or review service performance and the safety and quality of care had been strengthened. These systems needed to be embedded into practice to ensure improvements were sustained. The ethos, values, attitudes and behaviours of leaders and care staff had improved to ensure all people using the service could lead confident, inclusive and empowered lives. People were now being supported to regularly identify, or review, on-going individual aspirations and life goals. Internal systems for supporting staff were now robust which led to staff feeling supported and confident in their role.

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 inadequate (published 30 May 2022). 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 regulations. At our last inspection we recommended that the provider updates their monitoring and reviewing systems for Mental Capacity Act [MCA]. At this inspection we found the provider had acted on the recommendations and had made improvements.

This service has been in Special Measures since 17 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rother Valley View on our website at www.cqc.org.uk.

Follow up

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

About the service

Rother Valley View is a residential care home providing the regulated activity of accommodation and personal care to up to 6 people. The service provides support to adults with a learning disability and autistic people. At the time of our inspection there were 4 people using the service. The home consisted of 6 self-contained flats in one building. People had access to a communal kitchen, dining and living room and a large enclosed garden.

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

Based on our review of key questions safe, effective and well led. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. We made a recommendation to the provider about following best practice in line with the MCA.

The model of care and setting did not maximise people's choice, control and independence. Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. The provider had not always acted to manage infection risks. There were not always enough staff to safely meet people's needs.

People's needs were not always holistically assessed to consider what people wanted and needed.

People did not always achieve good outcomes that effectively met their health, social and emotional needs. Staff did not always have the necessary skills, knowledge or experience to know how to meet people's needs. People's medicine support was managed safely.

Right Care

Care was not always person-centred or delivered in a way which promoted people's dignity, privacy and human rights. Staff did not always communicate or support people in dignified or respectful ways. Staff did not always offer people choices or involve them when supporting them with activities and meals. Recommendations and actions identified by partnership agencies regarding people's support needs had not always been promptly implemented to ensure people achieved good outcomes.

Right culture

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure all people using the service could lead confident, inclusive and empowered lives. People were not being supported to regularly identify, or review, on-going individual aspirations and life goals.

Internal systems for supporting staff were not robust which led to staff feeling unconfident when supporting people in situations where people could become distressed. The was a lack of management support following incidents, to assist staff in building confidence and improving practice.

There were minimal internal quality assurance systems and processes to audit or review service performance and the safety and quality of care. Where checks and audits were carried out, they had not always identified or prevented issues occurring or continuing at the service. Where issues had been identified, the manager and provider had not always effectively overseen or ensured actions were taken to maintain or improve the quality and safety of the support being delivered at the service.

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 inadequate (published 11 August 2021).

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 the provider remained in breach of regulations.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safety and management and to follow up on the previous inspection. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, safeguarding, infection control, staffing, governance and person-centred care.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rother Valley View is a residential care home providing personal care to 6 people. The home consisted of 6 self-contained flats. People had access to a communal kitchen, dining and living room and large gardens.

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

Significant shortfalls were identified in the governance of the service. Some systems were in place to check the service was working to the provider's expected standards. However, where the checks had been completed, they were not effective and did not identify the concerns we had raised as part of this inspection. There was a lack of provider oversight of the standards at Rother Valley View.

People were not always kept safe. We found concerns with the safe management of risk for areas including people who were at risk of choking and ingesting hazardous substances and environmental concerns.

Staff were not always recruited to ensure people were safe.

Infection control concerns were identified in relation to staff not consistently wearing PPE.

There was a lack of analysis of accidents and incidents to ensure lessons were being learnt to drive improvement.

Staff were not suitably trained to meet people’s needs

People's health needs were not accurately recorded and updated.

Feedback had not been sought to drive service improvement and development.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• People’s choice was not maximised, and they could have been better supported to develop more control and independence.

Right care:

• Care was not always person-centred and promotes people’s dignity, privacy and human

Rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff didn’t ensure people always lead confident, inclusive and empowered lives.

The provider set out an action plan on how they intended to improve the service moving forward.

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

This service was registered with us on 19/10/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safe recruitment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, safe recruitments, safety, staff training, supervision and management of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider took immediate action looking at the risks we had highlighted during the inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.