Rockmount Northwest

service provides recovery and rehabilitation support for up to 20 adults with complex mental health needs, who may also have a learning disability.

We identified prior to the inspection that no people living in the service had tested positive for COVID-19 in the last 5 days.

People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this is communicated and updated as needed.

The provider follows relevant COVID-19 testing guidance. This includes staff testing requirements as well guidance on testing for people using the service and visitors.

The service was mindful of people’s rights under the Mental Capacity Act (MCA) 2005 to make unwise or risky decisions. This included managing the risks for unvaccinated people living in the service and encouraging all people to meet social distancing and wearing masks.

Maintaining the mental health of people and staff was a priority with proactive support from the service to encourage peoples well being.

Where the provider is responsible for cleaning, there are clear schedules in place, which include the frequency of cleaning of high touch areas. Records show compliance with the cleaning schedule.

Staff are trained and know how to immediately instigate full infection control measures to care for a person who develops symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

Staff wear PPE in line with guidance where appropriate social distancing cannot be maintained or achieved.

Routine testing for all staff and people who receive support has been implemented.

The provider wrote to us to say what they would do to meet legal requirements in relation to the breach. During this inspection we found that significant work had been carried out to improve the governance and quality assurance systems in the home.

The service had a registered manager in place. 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.

Rockmount Northwest is a residential care home for people with a mental health diagnosis. The service provides recovery and rehabilitation support for up to 20 adults with complex mental health needs, who may also have a learning disability. At the time of this inspection, there were 19 people living in the home.

Rockmount Northwest is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is situated in Rishton, near the towns of Blackburn and Accrington and is in close proximity to public transport links which gives easy access to either town by bus or train.

During this inspection, we found improvements had been made to quality assurance and auditing processes to help the provider and the registered manager to effectively identify and respond to matters needing attention. The systems to obtain the views of staff had been improved. People felt their views and choices were listened to and they were kept up to date with any changes. However, we noted that further improvements were required to ensure the systems were formalised to enable accountability and to ensure audits included records of care.

We found improvements were required to the knowledge and understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People's consent to various aspects of their care was considered and where required DoLS authorisations had been sought from the local authority. The registered manager had made appropriate referral to seek authorisations to restrict some people for their safety. However, the systems for assessing and recording mental capacity assessments were not in place.

We have made a recommendation about the assessing and recording of mental capacity assessments.

People were happy with the care and support they received and made positive comments about the staff. They told us they felt safe and happy in the home and staff were caring. People were comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. Staff understood how to protect people from abuse.

The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care. People's care and support was kept under review. Risks to people's health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

The home was a clean, safe and comfortable for people to live in.

A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough suitably skilled staff to support them when they needed any help. Staffing levels were monitored to ensure sufficient staff were available.

People's medicines were managed in a safe manner. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely. We noted that some improvements were required to ensure the medicines administration practices were person centred to promote privacy and dignity.

People were supported to have 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 respected people's diversity and promoted people's right to be free from discrimination.

There was a strong drive to facilitate community and social inclusion. People had access to a range of appropriate activities both inside the house and in the local community.

People's nutritional needs were monitored and reviewed. People were given a choice of meals and staff knew their likes and dislikes. People were promoted to maintain and develop their independence. Staff supported them to undertake some of their daily living activities and to share responsibility for cleaning their own personal bedrooms and communal areas.

People who used the service knew how to raise a concern or to make a complaint. The complaint’s procedure was available and people said they were encouraged to raise concerns and were confident they would be listened to.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. After that inspection, we received notification of a serious incident which raised concerns regarding the assessment and management of risk in relation to people’s mental health needs. As a result, we undertook a focused inspection to look into those concerns and to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in October 2017 had been made. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rockmount Northwest on our website at www.cqc.org.uk.

Rockmount Northwest is a residential care home for people with a mental health diagnosis. The service provides recovery and rehabilitation support for up to 20 adults with complex mental health needs, who may also have a learning disability. At the time of this inspection, there were 17 people living in the home.

The home is situated in Rishton, near the towns of Blackburn and Accrington. The home is located in close proximity to public transport links which gives easy access to either town by bus or train.

The service had a registered manager in place. 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.

During this inspection we identified a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the systems in place to monitor the quality and safety of the service were not sufficiently robust. You can see what action we told the provider to take at the back of the full version of the report.

There were systems in place to record significant events and incidents which occurred within the home. We were told these were reviewed at each handover to ensure appropriate action had been taken. However, our review of records showed two recent incidents had occurred following which a person had been given an ‘as required medicine’ to help them sleep. The registered manager told us there had not been any review of the actions taken by staff leading up to the incident or the decision to allow staff to administer the ‘as required’ medicine in order to determine if any lessons could be learned.

People who lived in the home and staff were provided with opportunities to comment on the service provided. The most recent satisfaction survey had been distributed by the provider in August 2016. Although comments from people who used the service were positive, some negative feedback was provided by staff. The registered manager was unable to show us evidence that these comments had been taken seriously and acted upon. In addition a more recent survey had not been carried out to check whether the views of staff had changed.

People who used the service told us they felt safe and comfortable in Rockmount Northwest. We found systems were place to assess and manage risks in relation to people’s mental health needs and any other identified needs. Each person’s care records contained an assessment of the risks relevant to them. We saw that care records had been reviewed and updated when people’s needs and risks changed to help ensure they received safe care and treatment.

Staff confirmed they were always informed by the managers if the level of risk changed for anyone who lived in the home so appropriate action could be taken. The level of observations and checks required for each individual was documented in the handover record which was completed at the start of every shift. People spoken with told us staff were always monitoring their mental and physical health and would contact other professionals if they had any concerns.

Staff told us they enjoyed working in the home and found the managers in the service to be supportive and approachable. We also received positive feedback about the way the service was led from people who lived in the home and community based health professionals who visited the service on a regular basis.

Improvements had been made to the way medicines were handled in the service since the last inspection. However some minor issues needed to be rectified; this included ensuring any allergies people experienced were recorded on the medicines administration record (MAR) charts.

People told us staff supported them to undertake activities in the community and to develop their daily living skills.

Recruitment processes were sufficiently robust to protect people from the risk of unsuitable staff. People who used the service were involved in the recruitment of new staff. This helped to ensure staff understood the needs of people living in the home as well as the values and ethos of the service.

People were cared for in a safe and clean environment. Staff helped people to develop daily living skills by encouraging them to take shared responsibility for cleaning communal areas. People were also responsible for cleaning their own bedrooms and doing their own laundry with support from staff as required. Systems were in place to deal with any emergency that could affect the provision of care.

The service was last inspected on 20 January 2014 and was meeting all the regulations assessed at that time.

Rockmount Northwest is a 24 hour support, residential care home for people with a Mental health diagnosis. The service provides recovery and rehabilitation support to adults with complex mental health needs, who may also have a learning disability. The home is situated in Rishton, near the towns of Blackburn and Accrington. The home is located in close proximity to public transport links which gives easy access to either town by bus or train. The home is registered with the Care Quality Commission to provide care for up to 20 people.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we made one recommendation in regards to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in post. 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 living at the service told us they felt safe living at Rockmount Northwest. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We found people's medication was not managed safely. Medication stocks did not tally with the Medication Administration record (MAR). We also found some medicines were not administered in line with best practice. Following the inspection, the registered manager sent us confirmation that this had been addressed and systems had been implemented to identify these issues in future.

There were sufficient numbers of staff effectively deployed. Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken prior to them commencing in employment.

Appropriate risk assessments had been completed and were reviewed regularly to meet people’s needs.

Staff induction was aligned with the care certificate and staff received appropriate training and supervision to support them in their role.

People’s mealtime experience was positive and people were autonomous in deciding the services menus. The service had recently received a five star food rating and people were complimentary about the food provided.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

People were supported by staff that were kind and caring. Staff maintained people’s privacy and dignity and promoted their independence.

Each person living at the service had their own care plan, which was person centred and detailed people’s choices and personal preferences.

People were supported to maintain fulfilled and active lives. There was a comprehensive activities programme and people were supported to pursue education, employment and community activities.

The service had recently been granted an allotment and people spoke enthusiastically regarding the plans for the land.

There was a welcoming atmosphere throughout the home and people spoke positively about the visibility of the management and the leadership of the home. People told us they would recommend living at Rockmount Northwest.

Staff spoke of a positive culture and a management that were approachable and supportive.

We found the provider didn’t conduct audits and despite the management conducting a number of audits, the internal audit processes in place at the time of the inspection had not identified the concerns we had raised in regards to the safe management of medicines. We received confirmation from the registered manager that this had been strengthened following our visit.

We spoke with three staff members who were able to demonstrate knowledge on obtaining consent from people who used the service prior to any activity. On staff member told us, 'I always knock and ask permission. If a service user (People who used the service) refuses I would ask again I wouldn't force them."

In three of the care files we looked at we saw evidence of individualised care planning with evaluation and reviews seen on pressure care, mobility, nutrition and person care for example. There were copies of risk assessments in place with evidence of reviews seen in the care files we looked at.

We looked at the safeguarding file in the home. There were details of information in place for staff to follow in the event of suspected abuse. We could not see any details of any safeguarding investigation. The manager told us there had been some previous safeguarding referrals.

We spoke with staff who told us they received supervision. The manager told us she had introduced a new supervision file. We saw evidence of detailed supervision commencing with staff members.

We spoke with two people who used the service. They were able to tell us the appropriate steps to take if they had any complaints. One person said, 'I am happy in here, any concerns would be sorted'. Another told us, 'I have no complaints if I had I would go to the manager'.