Archived: Priory Rookery Hove

Priory Rookery Hove is a residential care home for up to 13 younger adults with learning disabilities, autism, or mental health conditions. Six people were living at the home at the time of our inspection. Priory Rookery Hove is a transitional unit. The aim of the service is to develop people's life skills and give them opportunities to move on to more independent living.

Priory Rookery Hove was designed, developed and registered before 'Registering the Right Support' best practice guidance was published. If the provider applied to register Priory Rookery Hove today it is unlikely the application would be granted. The model and scale of care provided is not in keeping with the cultural and professional ideas of how services for people with a learning disability and/or autism should be run to meet their needs. Improvements are needed to ensure the service develops in line with the values that underpin the Registering the Right Support and other best practice guidance. The building design fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People told us they felt safe at the home and with the staff who supported them. They said staff had time to spend with them to plan and review their support.

There was evidence of learning when things went wrong. When accidents or incidents occurred, these were reviewed to identify measures that could be put in place to prevent a similar incident happening again. If risks to people were identified, a risk management plan had been put in place. These included guidance for staff about how to support people in a way which minimised risks.

The use of Positive Behaviour Support (PBS) was more effective than it had been at our last inspection. (PBS is a person-centred approach to supporting people with a learning disability or autism.) Potential triggers for behaviours were identified and recorded. Strategies to avoid escalation had been developed, which were known by staff.

People told us staff had supported them to protect themselves from the risk of COVID-19 infection. Additional infection control measures had been implemented to protect people and staff during the COVID-19 pandemic. These measures included the use of appropriate PPE, more frequent cleaning of the home and ensuring staff were up-to-date with guidance about infection control.

People’s care records had improved since our last inspection. Old material had been archived and people’s support plans reviewed with their involvement. This meant people’s support plans were more relevant to their needs. For example, some people’s support plans focused on developing the skills needed to move on to more independent living.

Staff told us they received good support from the registered manager and deputy manager. They said the registered manager had improved many aspects of the service since taking up post in March 2020. Staff described the registered manager as approachable and supportive and said he had instilled a sense of clarity about what the service aimed to achieve for people.

Opportunities for people to have their say about the home and the support they received had increased. People told us they were involved in planning their care with support from an allocated keyworker. Residents’ meetings took place regularly at which people were encouraged to give their views about the service and the support they received. People told us staff listened to and acted upon what they had to say.

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.

Although we found evidence of improvements at this inspection and improvements in the ratings for the key questions we reviewed, we were unable to change the overall rating as we did not review all of the previously ‘inadequate’ domains.

Why we inspected

Priory Rookery Hove was last inspected in November 2019 and was rated ‘Inadequate’ overall and placed in special measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Safeguarding and Good governance.

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 and Well-led which contain those requirements.

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

Follow up

We will continue to monitor the service action plan to understand what the provider will do to improve 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.

Priory Rookery Hove is a residential care home providing personal care to 11 younger adults with learning disabilities, autism, or mental health conditions at the time of the inspection. The service can support up to 13 people. Priory Rookery Hove is a transitional unit. The aim of the service is to further develop people’s life skills to give them independence and integrate them into the community.

Priory Rookery Hove was designed, developed and registered before 'Registering the Right Support' best practice guidance was published. If the provider applied to register Priory Rookery Hove today it is unlikely the application would be granted. The model and scale of care provided is not in keeping with the cultural and professional ideas of how services for people with a learning disability and/or Autism should be run to meet their needs. Improvements are needed to ensure the service develops in line with the values that underpin the Registering the Right Support and other best practice guidance. The building design fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were not safe at the service. Policies in place to reduce risk were not always being followed or were not adequate to protect people from avoidable harm. Lessons were not learned when things went wrong, resulting in repeated events at the home where people were at risk. There were enough staff at the service to look after people, but staff worked long shifts and were often tired and stressed, which impacted on their ability to deliver care safely.

Staff had not received training in some of the specific mental health needs of people at the home. The home was not clean and was in a state of disrepair. Doors, radiators, cupboards, windows and a stair rail were all broken at the time of the inspection. People had food cooked for them by a chef on only three days a week, on other days support staff cooked. Support staff were not trained in nutrition or cooking. The communal kitchen which people should have been able to use was damaged, this left people to eat a repetitive diet with little choice.

Due to a lack of training staff did not always understand or respect people’s equality and diversity. Staff and people told us there was not enough time to give people the support they needed. People were often bored at the home and one said there were times when they could not go out with staff as staff were supporting other people. People at the home did not always get on and the layout of the home meant people could not have the privacy they wanted unless they remained in their own rooms.

Complaints were not always responded to in a timely fashion and relatives had complained that issues raised with the service went unanswered. The service had been without a full time positive behavioural support practitioner for some time. However, this role was now filled, and the service hoped to see a change in planning people’s care.

The service was not person centred. The service was designed as a transitional unit to enable people to learn to live independently, however people were not learning new skills in preparation for leaving the home and some people had lived at Priory Rookery Hove for over five years. Staff worked well as a team together, but felt poorly informed by senior management. Senior management changes during the year and several staff vacancies had made this problem worse. New senior staff were making changes to communication with staff to rectify this issue. The provider was aware of the issues with management support and had put plans in place to improve staff support, however these had not been embedded and improvements had not yet been made.

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service did not always consistently apply 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons. People had a lack of independence and care was not always person centred. The large number of people living at the home and the complex needs of some of the people meant that staff did not always have the skills to support people who needed it.

Following the inspection, we asked the provider to act to ensure people’s safety. The provider said they would act. Despite this visiting health and social care professionals reported that incidents of self-injurious behaviour continued and people continued to be at risk of harm.

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 4 April 2019) and there was a breach of regulation 12. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulation 12 and was now also in breach of regulations 9, 13, 15,16 and 17.

Why we inspected

The inspection was prompted in part due to concerns received about safety of people at the home. 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 full report for details.

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

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

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.

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 of 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.

The provider runs and manages a wide range of services for people, including hospitals, rehabilitation services and longer stay facilities. They generally specialise in providing services to people who have mental health conditions or who are living with a learning disability.

Priory Rookery Hove 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 Priory Rookery Hove provides care and support for up to 13 younger adults living with Asperger’s Syndrome or associated conditions. Priory Rookery Hove is not a home for life, but a transitional facility. During people’s time in the service they will be supported where possible to able be to access a combination of educational, social development, life skills, work experience and therapeutic care. The aim is to further develop their life skills to gain independence and integration into their community. There were 11 people living in the service at the time of our inspection.

Priory Rookery Hove had been designed, developed and registered before ‘Registering the Right Support’ and other best practice guidance was published. Had the provider applied to register Priory Rookery Hove today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs. Improvements are needed to ensure the service develops 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.

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. There was a clear management structure with identified leadership roles. The registered manager was supported by a deputy manager, and two senior care staff. However, the registered manager was not present for the inspection, and we were told they are due to leave the service. A new manager has been recruited and had started working in the service the previous week. They were present for the inspection.

At our last inspection on 24 January 2017 we rated the service Good overall but Requires Improvement in Effective. Where new staff were completing Care Certificate modules, they did not appear to have deadlines for completing these to ensure they were completed in a timely manner. At this inspection we found this had been addressed. Not all care staff had completed training to provide specific care and support needs for people using the service in relation to managing challenging behaviours. Some staff felt they hadn’t received enough support and guidance in the management of such incidents. At this inspection we found not all these issues had been fully addressed and further areas were in need of improvement. The overall rating of Good for the service had not been maintained.

Prior to this at our inspection on 15 December 2015 the service was rated overall as Requires Improvement, and at our inspection on 16 April 2015 the service was rated overall as Inadequate. The provider had not ensured through the management of the service the maintenance of the required standards and continuous improvement to ensure the service had maintained the overall rating of Good.

At this inspection we received similar feedback. A number of staff had left the service, which had led to a high use of bank and agency staff. This had meant not all the staff had the knowledge of people’s individual care and support needs, and had received training to support them in a safe and consistent way. Staff spoke of a number of people admitted to the service who displayed challenging behaviour. They did not feel they had received enough information, training or support to manage this safely. Staff told us this had led to a drop-in staff morale. A member of staff spoke of a, “Very stressful time.” People told us these changes in staff had resulted in a difficult and unsettling period. Feedback was varied from people and their relatives when asked if people were safe in the service. Feedback from people, relatives and staff and was that of a lack of visible management and a lack of communication and support in the service. A complaints process was in place for people and their representatives to raise any concerns. However, where concerns had been raised a relative told us there had been a lack of clarity of the process to be followed, especially where there had been a lack of satisfaction with the outcome. Some recording and notifications systems had not been fully maintained. There was a maintenance programme to ensure premises were safe and maintained. However, feedback received was that repairs identified were not always addressed in a timely manner and had affected the quality of life for people in the service.

The provider had identified these concerns through their own quality assurance processes in place. The provider’s representatives had drawn up a robust action plan with identified timescales and they were working in the service with staff and people to address these. Staff and people also spoke of improved morale and positively of the new management in place and of the work already completed to drive improvement and provide more stability in the service.

Care and support provided was personalised and based on the identified needs of each individual. Staff demonstrated a good understanding of equality and diversity when providing care and support. People were being supported to develop their life skills and increase their independence. There had been the use of technology to support people. Care and support plans were detailed and informative. People had been involved and these clearly detailed the goals people were working towards. People were being supported to be involved in a range of activities. A complaints policy and procedure was in place for people and their representatives to raise any concerns.

Robust recruitment practices had been followed. People were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

Infection control procedures were in place. Medicines were managed safely.

People were supported to follow a healthy diet. People spoke well of the food provided. People had access to health care professionals when needed.

People and their representatives could give their views of the care and support provided through reviews, quality assurance questionnaire and ‘Residents’ meetings. We could see the actions which had been completed following the comments received. A range of internal audits had been completed, and records confirmed this.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The Priory Rookery Hove provides accommodation for up to 13 young adults, between the ages of 18 and 65 years old. The provider provides care and support to people living with Asperger’s Syndrome or associated difficulties. The Priory Rookery Hove is not a home for life but a transitional facility. Typically people will stay in the service for a three to five year period. During this time they will be supported where possible to able be to access a combination of educational, social development, life skills, work experience and therapeutic care. The aim is to further develop their life skills to gain independence and integration into their community. People can also be supported to attend college as part of their care and support needs. There were seven people living in the service at the time of our inspection. Two people were away on leave at home.

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.

At the last inspection in August 2015 there had been a number of changes in staff working in the service and interim management arrangements were in place. There were areas of care provided which were in need of improvement. This was because there was a lack of clarity as to who had been funded to receive additional one to one support. New care planning and quality assurance needed to be fully embedded in the service. At this inspection we found the improvements made had been fully

embedded and maintained. However, one area of practice in relation to training for care staff was in need of improvement.

There had been a number of staff changes, and staff were still accessing training to support them in their roles. Where new staff were completing Care Certificate modules, they did not appear to have deadlines for completing these to ensure this was completed to meet current guidance. Not all care staff had completed training to support the specific care and support needs for people using the service and ensure they were up-to-date with current guidance. For example, in positive behavioural support. We discussed this with the registered manager who told us further care staff were due to attend the training at the end of September 2016. None of the staff we spoke with had up-to-date training in strategies for crisis intervention and prevention (SCIP) where people were displaying challenging behaviour. Although there were no people resident at the time of the inspection displaying challenging behaviour, we received feedback of a recent incident in the service that had highlighted not all the staff felt they had had the support and guidance to support them in the managing of such incidents. Staff told us during the inspection they would like more training and support when dealing with challenging behaviour.

Since the last inspection in August 2015, staff again spoke of a significant period of change that they were still working through. There had been a change in the management team and a new registered manager had been recruited. A number of people who were using the service had moved on or were due to move on to accommodation where they could be more independent. Feedback from staff was this had been a difficult time with difficulties in recruiting staff and organisational changes having led to a drop in staff morale. Feedback from people and their relatives was also that due to all these changes in staff this had been a difficult and unsettling period. However, they told us that the new management in place were working to address this and provide more stability in the service. One member of staff told us, “Residents feel a lot calmer. We have had residents with anxiety and a permanent manager makes them feel more settled and we feel better briefed on changes.” Another member of staff told us, “Things are getting better and the manager has picked up a lot of grief but he is getting it sorted.” Two members of staff told us that they had been bank staff and had liked working in the service so much that they had become permanent members of staff.

People told us they felt safe in the service. They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. There were systems in place to assess and manage risks. The premises were safe and maintained. The décor of the building and furnishings provided were variable in quality. The service had had a major refurbishment last year. A new kitchen had been fitted, new bedroom furniture had been provided and new flooring in the ground floor corridor had been fitted. However, there were several areas of the building in disrepair including, the windows, and internal damp damage from loose or missing roof tiles. The registered manager acknowledged further work was needed to improve the environment which had been identified and was due to commence in October 2016.

People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People were being supported to develop their life skills and increase their independence. Care and support plans were detailed and informative. The new care and support plan format had been further developed and embedded in the service. People had been involved and these clearly detailed the goals people were working towards. These had been reviewed to ensure they detailed people’s current care and support needs.

People were being supported to review and develop the range of activities they were involved in to develop their life skills. Staff told us opportunities to access college courses and activities locally had diminished due to changes in being able to access these. They were working with people to look at the opportunities available for them to participate in as part of their stay in the service. People where possible were being supported to move onto further accommodation at the end of their programme such as supported living. This is where people receive support to enable them to take more control of their lives.

Where people were unable to make decisions for themselves, the staff were aware of the need to consider a person’s capacity under the Mental Capacity Act 2005 (MCA), and take appropriate action to arrange meetings to make a decision within their best interests. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Staff had policies and procedures to follow and demonstrated an awareness of where to get support and guidance when making a DoLS application. People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. They were asked for their consent before any care and support was provided.

People said the food was good and plentiful. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences. People were in the process of being consulted with about proposed changes to the lunch and dinner arrangements in the service.

People had access to health care professionals when needed. They had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans. There were procedures in place to ensure the safe administration of medicines. People were supported to take their medicines and increase their independence within a risk management framework.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.

People and their representatives were asked to complete a regular satisfaction questionnaire, and people had the opportunity to attend weekly ‘Residents’ meetings, and regular ‘Resident and manager’ forums. We could see the actions which had been completed following the comments received. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this. The manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

We found that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. People were encouraged and supported to be independent and learn new skills.

People's safety and welfare had been maintained and promoted and they had access to healthcare and other services as appropriate.

We found staff had a good understanding of people's needs and that this was helped by the systems of communication, such as regular handovers and meetings. People told us that they valued the support from staff. One person said," My keyworker has a great understanding of my needs'.

We found the service was hygienic, clean and followed appropriate guidance in relation to infection control. The building was safe and maintained.

There were enough qualified, skilled and experienced staff deployed throughout each shift to meet people's needs. We saw that staffing levels had been increased to meet people's needs and keep them safe.

People knew that they had a right to complain and told us they had confidence that their complaints would be addressed.

We observed care staff supporting people and looked at care/staff documentation. This told us people had been asked for their consent for any care or treatment, and that staff had acted in accordance with their wishes. We were able to see that people or their representatives had been involved in making decisions about their care and treatment.

Records showed that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. Care workers understood their care needs and had completed appropriate training.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

Robust recruitment practices had been followed.

The records for the management of the service were accurate and complete.