St Anne's Community Services - Rockhaven

About the service

St Anne’s Community Services - Rockhaven is a small care home providing 24 hour nursing and personal care to up to seven people. The service provides support to people with learning disabilities or autistic people. At the time of our inspection there were seven people using the service. Care is provided on one level and the home is located in a quiet residential area.

Based on our review of key questions Safe and Well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence. People were encouraged to set future goals and achieve these. One person was supported to spot their favourite train at the local train station. People accessed community services and they were supported to maintain family relationships. Staff communicated with people in an individualised way, to support people to make choices. 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 is person-centred and promotes people’s dignity, privacy and human rights. Staff were kind and caring when interacting with people. Care plans and risk assessments were person centred. People were encouraged to be independent and people’s own rooms were individualised to them. We saw staff had good relationships with the people they supported. The manager understood their responsibilities and there was an open and transparent culture. Relatives felt people were safe and were positive about the care people received.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Systems were in place to continuously improve the service. Staff had a good understanding of how people liked to be supported. Staff felt supported by the manager and there was a homely atmosphere in the service. The provider had regular oversight of the service. A regional manager and a quality and improvement lead supported the manager. Staff were motivated and proud of the service, they told us they felt valued and were well supported. Quality assurance and auditing systems were in place. People and relatives were kept informed of any events or incidents that occurred. The service regularly sought the views and opinions of people using the service, their relatives, staff and professionals. The service worked collaboratively with healthcare professionals and commissioners to ensure people's needs were met.

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 02 May 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to assess that the service is applying the principles of Right support, right care, right culture.

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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Anne's Community Services - Rockhaven 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.

Rockhaven 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. Rockhaven provides 24 hour nursing care and support for up to seven people with complex learning disability needs. It is situated in a quiet residential area on the outskirts of Leeds.

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 complex learning disability and nursing needs using the service can live as ordinary a life as any citizen.

At the last inspection the service was rated good overall. However, we found improvements were required in the safe domain. There were not at all times, sufficient staff deployed to ensure people’s needs were met safely and that people were properly supervised to ensure their safety. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘Safe’ to at least good.

At this inspection we found the provider had made the required improvements by adding additional staff in the afternoons to ensure people’s needs were met safely.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Anne's Community Services – Rockhaven on our website at www.cqc.org.uk’

Our key findings across all the areas we inspected were as follows:

The service has 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 and associated Regulations about how the service is run. At this inspection the registered manager was unavailable. However, a manager from another home from the organisation was available to assist with the inspection process.

Some people we spoke with had limited verbal communication. However, they very clearly indicated they felt safe and were happy living in the service, liked the staff and did the activities they liked to do.

Medications procedures were in place including protocols for the use of ‘as and when required’ (PRN) medications. Staff had received training in medication management and policies and procedure were audited in line with the provider’s guidance. There was good guidance for staff regarding how people expressed pain or discomfort, so they could respond appropriately and seek input from health care professionals, if necessary. People had access to a good range of health care services and advocacy services actively used for people if they felt health care services were not as responsive as they should be.

Staff were aware of the Mental Capacity Act [MCA] and the Deprivation of Liberty Safeguards [DoLS]. At the time of this inspection the manager (from another service within the organisation) told us most people who used the service had an authorised DoLS in place. This legislation was used to protect people who might not be able to make informed decisions on their own.

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 we spoke with had a clear understanding of safeguarding people and they were confident their managers and the rest of their team would act appropriately to safeguard people from abuse.

The support plans we looked at included risk assessments, which identified any risks associated with people’s care. They had been devised to help minimise and monitor the risks without placing undue restrictions on people.

People were provided with a clean, comfortable environment to live in and could personalise their own space to their requirements. All servicing and checks including the fire alarm and emergency lighting had been updated to help make the environment safe for people.

There was a programme of training, supervision and appraisal to support staff to meet people’s needs. Procedures in relation to recruitment and retention of staff were robust and ensured only suitable people were employed in the service.

We observed good interactions between staff and people who used the service. People were encouraged to make decisions about meals and involved in menu planning.

People were involved and consulted about all aspects of their care and support, where they were able, including suggestions for activities.

Complaints procedures were in place and relatives we spoke with told us that they knew who to contact if they wanted to raise any concerns.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by representatives of the organisation. The reports included any actions required and these were checked each month to determine progress. The registered manager was supported in their role by a representative or the registered provider who visited the service regularly. They oversaw the systems and processes were to the standards expected by the registered provider.

Further information is in the detailed findings below.

We observed a member of staff whilst they conducted part of a medication round. We saw that the medicines were given safely and people were sensitively helped to take their medicines.

Clear protocols existed to guide staff as to when PRN medicines should be given.

Whilst the provider had a covert medicines policy all medicines were administered with the knowledge of the people receiving care. Staff had a good understanding of the legal framework in which they needed to work in order to administer medicines covertly.

We saw the service had a medication management policy in place. All medicines were administered by registered nurses. The service was subject to regular review and actions were taken to minimise risk. Any irregularities found during audits were used to reinforce and improve good practice.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

Some care plans and risk assessments were detailed and person centred and provided staff with clear guidance on how to meet people's health and social needs. However, there were some shortfalls with the care plans and risk assessments. Some plans did not give full details of how care needs were carried out and this could lead to people’s needs being missed or overlooked. The Registered Manager had identified the need to improve the care and support planning process.

Staff were kind and supportive to people; they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect.

There were a number of discrepancies with medication management and improvements were needed. It was not possible to account for whether all medicines we checked had been given as prescribed to people who used the service.The service did not always protect people against the risks associated with the unsafe use and management of medication, as appropriate arrangements for the storage, recording, handling, administration and use of medicines were not always in place.

Is the service effective?

People were provided with a good choice of suitable and nutritious food and drink that met their individual needs. People were protected from the risks of inadequate nutrition and dehydration.

Staff described how they met and monitored people’s health needs. Care records showed that people had regular contact with health and other professionals. Some people also had a Health Action Plan with details of the actions needed to maintain health, for example, a winter health care plan, discussed with their GP to maintain optimum health during winter months.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Training records showed that most staff in the home had completed mandatory training and other appropriate training. The Registered Manager had completed an audit of this and identified which staff needed update training. Staff told us they felt well supported to do their job and maintain high standards.

Is the service caring?

We spoke with three people who used the service. One person nodded and said they enjoyed living at the home. They said they found staff helpful. Another said they liked the staff. Others were smiling when we asked if they liked the home and if they were treated well.

We saw that care practices were good. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and good eye contact. It was clear that staff were well aware of the needs and wishes of the people who used the service. Staff understood people’s individual ways of communicating their needs.

Is the service responsive?

We saw that people who used the service were responded to promptly when they asked for any support or assistance or gave any indication that they were in any discomfort. It was clear that staff knew the needs of people who used the service very well.

People were supported to be involved in activity of their choice within the home. However, when we looked at the daily records for three people who used the service, we saw the records showed that one of these people had not left the house in the last fortnight, one had been out once and one had only been out of the house twice to their regular day care placement. Staff said it was difficult to get people out when the staffing levels on an afternoon/evening shift were only two and they also had difficulties in accessing adapted transport. The Registered Manager said they were looking at introducing more structured activity with the development of the social activity care plans and introducing more flexible shifts as the home became fully staffed, to enable more community participation.

There had been no complaints made to the service for many years. However, staff were able to say what they would do to assist anyone who wished to make a complaint.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable and enthusiastic. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

There was an effective system in place to regularly assess and monitor the quality of the service that people received. We looked at reports and records which showed the provider had assessed and monitored the quality of service provision.The Registered Manager was also planning to introduce a more detailed audit of the medication management systems.

During our visit, we saw staff interacting with people in a positive, respectful and caring manner. Staff we spoke with told us they encouraged people to be as independent as possible and make their own decisions where possible. People experienced care, treatment and support that met their needs and protected their rights.

When we asked one person if they liked the home and the staff who supported them, they told us, 'It is alright here, I like it.' Another person gave us a, 'Thumbs up' sign and smiled when we asked them if they liked the home.

People appeared relaxed and comfortable in the presence of staff. We observed staff treating people kindly with regard to their dignity and privacy.

The service had effective recruitment and selection processes in place. Appropriate checks were made before people were employed by the service.