Raby Hall

Updated 9 July 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: This inspection was carried out by an adult social care inspector.

Service and service type: Raby Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service had two managers who were registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This inspection was unannounced.

What we did: We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

We spoke with four people who used the service and two relatives about their experience of the care provided. We spoke with seven members of staff including the registered managers, service manager and support workers.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 9 July 2019

About the service: Raby Hall is a residential care home for people who have autism. The service was split between the main building of Raby Hall and an annex called The Courtyard; there was also a part of the building that was currently not being used. These two parts of the service had a different registered manager. At the time of our inspection the service provided accommodation and support for 18 people in a variety of settings, including individual self-contained flats, three people within a flat and shared group accommodation.

People’s experience of using this service: At our previous inspection in July 2016 the service was rated as good. At this inspection we saw that the service needed to make improvements and has been rated Requires Improvement. This is because, the systems in place to address and reduce risks to people were not always working effectively; exposing people to risk of harm. Processes were not always followed to ensure that decisions made on a person’s behalf were appropriate and in their best interests. Some people’s support plans and other reports were not consistently written in an everyday and respectful manner; at times they did not demonstrate treating the person concerned with dignity and respect. Leadership of the service had been inconsistent in ensuring all aspects of the service provided for people was appropriate and of high quality.

We found the registered managers of the service to be candid and responsive during our inspection; with some of the areas requiring improvement being addressed within the inspection timeframe.

In June 2017, CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism. The service has not been developed and designed in line with this best practice guidance. Raby Hall was at the centre of a large campus of five registered services for up to 59 people with autism along with day services for more people. Current best practise guidance promotes housing models that increase opportunities for people’s independence, choice and control so they are able to achieve the best possible outcomes.

Some of this was mitigated by the renovation of the accommodation within Raby Hall, 10 people stayed in the main building in self-contained ‘flats’ for between one to three people; with another seven people living in the courtyard area of the building with a separate entrance. This helped create a less institutional feel within people’s home.

People told us that they were happy with the support they received. There was a friendly atmosphere at the home and people looked relaxed and comfortable. Staff were thoughtful and spoke with people in a kind and dignified manner.

People and their relatives told us they felt safe living at Raby Hall. Staff received training on and were knowledgeable in how to safeguard people from the risk of harm and abuse. New staff were safely recruited in line with best practise. People received their medication safely, the home was clean and the main building was safe.

We saw that people’s needs and wishes were assessed and recorded as part of an initial assessment. Staff at the service had tailored how people were introduced to the home in ways that met their needs and preferences as much as possible.

Each person had an individualised care plan that asked people the question, “What’s important to me.” These plans outlined people’s preferences, likes and dislikes. From observing people’s support, it was clear that staff knew people and their support needs and preferences well. People’s relatives told us that they were consulted on people’s care plans.

Each person had a health care plan called, “All about my health” which detailed people’s healthcare needs. We also saw that staff kept good records of people’s daily health, with any concerns they had receiving prompt attention. We saw examples of when staff being observant and vigilant to people’s health needs had led to people receiving healthcare in a timely way.

Rating at last inspection: At our previous inspection published in October 2016 we rated the service as Good. During this inspection the rating was changed to Requires Improvement.

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: Ongoing monitoring; we have asked the provider to tell us what they will do to make improvements to the areas of the service identified during this inspection.

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