About the service: 235 Rugeley Road is a residential care home providing personal and nursing care to seven people with a learning disability at the time of the inspection.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was meeting the principles of this policy.

People’s experience of using this service:

People did not always have prompt referrals to other professionals to manage risk. People’s medicines were not always administered as prescribed. People were sometimes left at risk of harm as procedures to keep people safe were not always followed.

Systems to monitor the quality of care were not effective in identifying areas for improvement.

People received care from staff who were well trained and supported to meet their needs and provided safe and effective care.

People were supported by staff that were kind and compassionate and understood their preferences. People could make choices and received support with their communication needs. People were encouraged to be independent and their privacy and dignity was respected.

People were supported to do things they enjoyed. People were involved in their care and support and their preferences were understood by staff. There was a complaints policy in place.

The manager and staff created a positive culture and there were systems in place to review and learn from incidents.

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

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 5 October 2017).

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

Enforcement: Action we told provider to take can be seen at the end of the full report.

Follow up: We will carry out ongoing monitoring of the service and check the improvements have been made at our next inspection.

235 Rugeley Road provides accommodation and residential care for up to 10 people with learning disabilities. At the time of the inspection there were eight people living at the home.

The service had 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. The registered manager had given notice to end their employment with the provider and was not available on the day of the inspection.

At the last inspection on 22 October 2015, the service was rated Good. At this inspection we found that improvements were needed to ensure the staffing levels in place met the assessed needs of the people that used the service. Improvements were also needed to the quality monitoring systems in place. There had been two registered managers since the last inspection. Inconsistent management had led to low staff morale and a reduction in the staff employed.

The staffing levels in place did not always reflect the provider’s contractual obligations with people’s funding authority. Several people were funded for one to one support but sufficient numbers of staff were not always on duty to provide this. The operations manager confirmed this would be reviewed, to ensure people’s assessed needs were met. Medicines were generally managed in a safe way although a recent oversight had meant that one person had not received a prescribed medicine for three days.

People were protected from the risk of harm because identified risks were managed and staff understood what constituted abuse or poor practice. Checks were made before employment to confirm staff were of good character and suitable to work in a care environment.

Staff received training to support the people they worked with and included people and their representatives in the planning of care. Staff understood people’s preferred communication method and the support they needed to make their own decisions. When people were unable to consent to specific decisions they were supported in their best interest.

People were supported to maintain a diet that met their dietary requirements and preferences and to use healthcare services. People were treated with respect and supported to maintain their dignity. The staff knew people’s likes and dislikes and preferences. People were supported to maintain relationships that were important to them. There were processes in place for people and their representatives to raise any complaints and express their views and opinions about the service provided.

We inspected this service on 22 October 2015. The inspection was unannounced. Our last inspection took place in January 2014. This was a desk top review to follow up on concerns raised about consent we identified at our inspection on 12 November 2013. The desk top review confirmed that the provider was meeting the required standards.

235 Rugeley Road is registered to provide accommodation and nursing care for up to 10 people.

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.

There were processes in place to protect people from harm. Staff knew how to recognise abuse and understood the actions they should take to report concerns. There were risk assessments and management plans in place to support people safely. Medicines were stored, recorded and administered correctly which ensured people had the medicines which were prescribed for them. There were arrangements in place to recruit and train staff so that they were suitable to care for people living in the home.

The provider recognised the requirements of the Mental Capacity Act 2008. There were arrangements in place to gain consent from people and support them, when they needed, with decision making.

People were supported to enjoy sociable mealtimes and take part in hobbies and activities which interested them. Staff were kind, caring and showed an interest in people. Staff understood people’s right to privacy and promoted their dignity by offering support and delivering personal care in a discreet way.

The provider understood the importance of gaining information about people’s likes and dislikes so that their care could be delivered in the way they preferred. People and their relatives were involved in the review of their care to ensure it met their individual needs.

Staff felt well supported by the registered manager. There were managerial arrangements in place to monitor the quality of the service and listen to people’s views.

We inspected 235 Rugeley Road on a planned unannounced inspection, which meant the service did not know we were coming.

We spoke with a person who used the service and observed people’s care. We spoke with two relatives, staff and the nurse in charge.

We found that the service did not always follow the correct procedures when gaining consent from people with complex needs.

We saw that care plans were clear and comprehensive. Relatives of people who used the service told us they were very happy with the care being delivered. One person told us; “My relative is happier than they’ve ever been".

We looked to see if people's medication was being managed appropriately. We found the service had systems in place to ensure medication was handled safely and securely.

We found that staff that had been recruited to the service had the relevant checks completed prior to them commencing their employment.

The service had a complaints procedure which dealt effectively with comments and complaints made by people who used the service or their relatives.

We visited 235 Rugeley Road to establish that the needs of people using the service were being met. We carried out an unannounced inspection which meant that the provider did not know that we were coming.

Seven people were in residence when we visited, including one person on a respite break. We used different methods to help us understand the experiences of people who used the service. We spoke with two people who lived at the home, three relatives and five staff members. We spent time observing the care provided in the home. We spoke to the home manager on the telephone when they returned from annual leave.

Some of the people who used the service were unable to give us their views. We observed the interactions between them and staff.

We found that care plans and risk assessments were kept under review ensuring people received the care they needed.

People spoke well of the home. One relative said, “All the staff seem to be caring people. I have no criticisms of the staff or the nursing care”.

People were protected from abuse. Staff clearly understood the different signs of abuse and were able to explain how to report any suspicions or concerns.

We saw that staff training had recently been updated and staff received regular supervisions and appraisals.

We saw that the service had a quality assurance system in place ensuring that people received safe and appropriate care that met their needs.

There were eight people staying at the home when we visited. We observed staff providing support and saw that people were treated with respect. There was information about people's care needs including their preferences and how they wanted care provided. People were dressed in their own style. Staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

We talked to families of people who use the service, they told us “The care here is absolutely fantastic.”

Some people who used the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views to us we observed interaction between people and staff.

We saw staff having their lunchtime meal with people living at Rugeley Road. The atmosphere was relaxed and homely. There were pictures in the dining room showing food choice with display boards for breakfast, dinner and tea. There was a trolley with cold drinks in the living area and we saw staff assisting people to have drinks.