This inspection was unannounced and took place on 23 and 24 May 2017. At the last inspection in February 2016 the home was rated as requires improvement. During the inspection in February 2016, we found people and staff were not kept fully protected from risks to their safety and wellbeing. This was because the number of incidents happening to people in the service at that time was high. During this inspection, we found the required improvements had been made.

Rookery House provides accommodation for people with learning disabilities and/or mental health needs. Seven people lived in the main house, three of whom had their own flats in the main house. Alongside Rookery House there was another house where people lived independently, called The Coach House. At the time of our inspection, three people lived in The Coach House.

There is 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.

One person living there told us they did their own cooking and worked towards living independently. They showed us their room, and told us how much they liked it. People living in The Coach House were able to join in with activities in the main house if they wished.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People were supported to be as independent as possible with meals and drinks. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff knew the people they supported and provided a personalised service. Care plans were in place, detailing how people wished to be supported and families were involved in making decisions about their care.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been lawfully authorised by the local authority as being required to protect the person from harm.

Assessments were undertaken to assess any risks to the person and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems was robust.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the registered manager and provided feedback on the service.

The registered manager and provider undertook spot checks to review the quality of the service provided and made the necessary improvements to the service where the need was identified.

The inspection took place on 26 February and 29 February 2016 and was unannounced. At our last inspection in June 2015, the service was meeting the regulations inspected. This was the first inspection of the service since it was taken over by a different provider 12 months before. Priory Radstock is one of the services run by Priory Education Services Limited. It is a home for up to 18 younger adults who have Asperger’s Syndrome and or mental health needs. At the time of our visit there were 18 people living there.

There was a registered manager for the service. 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 and staff were potentially unsafe and faced risks on a regular basis. Action was not always taken where there were risks identified to the safety and wellbeing of people. Incidents included people being aggressive, people appearing to be under the influence of drugs or alcohol, people throwing furniture, self-harming and staff finding people unrousable.

A senior manager and the registered manager carried out quality checks on the overall quality of

care and service people received. However, the checks had not fully identified and put in place actions that may be needed to keep people safe. This was in relation to the high number of occurrences and incidents that we found had been happening.

People were positive in their views of the staff and the support given by staff with their particular range of needs. People were treated in a kind and caring way and staff spent plenty of time with them. We saw plenty of positive and warm interactions between them and people looked relaxed with the staff.

People had access to health professionals to support them with their physical health needs. Care plans explained what actions were required to meet people’s range of care needs. Care records included life histories about each person. This helped staff to know each person and to provide them with personalised care.

The staff team were provided with training and support to do their jobs effectively. This gave staff the knowledge and skills to meet people’s needs.

People knew how to make complaints about the service and there was a complaints procedure in place that ensured concerns and complaints were properly addressed.

People were supported by staff to make decisions in their daily lives. Staff knew about The Mental Capacity Act 2005. The service worked with people, relatives and social care professionals when needed to assess people’s capacity to make specific decisions. Staff understood the importance of seeking consent before providing people with all aspects of care.

People were supported to have enough to eat and drink at times of their choosing. People were encouraged and assisted to prepare and cook meals for themselves.

People were supported to pursue activities and interests that they enjoyed both within and outside of the home. Individual interests and preferences were encouraged and plans of support and care were specific to people’s individual needs.

The staff team were clear about the aims and values of the home and put these into practice.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us the home was a safe place for them to live. One person said “It’s safe here. Each person has a keyworker so if you had any problems you would normally go to them first.”

Care was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks.

People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

Recruitment practice was safe and thorough. People were cared for by suitable staff.

Systems were in place to make sure that staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no one was currently deprived of their liberty, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us “The staff are really helpful and understanding. They take time to explain things to me.”

People’s health and care needs were assessed with them, and they were involved in developing and reviewing their plans of care.

Staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to therapies or activities. This meant the effectiveness of people's care plans could be fully reviewed.

There was an independent advocacy service available if people needed it. This meant that when required people could access additional support.

Is the service caring?

People were supported by skilled and attentive staff. We saw that staff knew people very well, showed patience and gave encouragement. One person told us “The staff are friendly. People seem quite happy here and do quite well.”

People who lived in the home, their relatives and staff were encouraged to share their views of the service. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We read information in people's records which indicated they had been consulted about the care they received.

People's preferences were gathered and used to plan care to meet their specific needs.

People had access to a wide range of activities and were supported to maintain relationships with people who were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The home was run by an experienced registered manager. They were supported by a deputy manager, administration staff and senior staff who were always available to support less experienced staff. The home also employed clinical staff to help plan, monitor and review people’s care.

The service had an effective quality assurance system; records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a very good understanding of the ethos of the home and quality assurance processes which were in place.

People who lived in the home, their relatives and staff members were asked for their views about the care provided and they were acted on. This helped to ensure that people received a good quality service at all times.

We found procedures were in place to minimise any risks to people who lived at the home. Regular audits had been carried out which monitored the on-going health and safety of people. Internal audits included health and safety checks (such as the cleanliness or safety of the environment and equipment) and a check on records (such as people’s care plans and risk assessments).

We visited Rookery House on 10th October 2012, most of the people who lived there were out attending activities, work experience or education services. We saw people come and go freely throughout the day either with a support worker or individually. We saw people were supported in a friendly professional way. We observed one person prepare their lunch in the communal kitchen area. They were supported by staff and discussed healthy options; one support worker discussed how to make a specific meal and agreed to share the recipe with the person. The person told us, “I am just settling in really but I do like it here. We get plenty of support and help from staff. They are fair and really care what we do.” Another person expressed an interest in the inspection and asked what it involved. They told us they were happy at The Rookery and got a lot of support from staff to achieve their goals. We saw that staff discussed people’s likes and dislikes with them. One member of staff joined in with one person when they wanted to do some art in the afternoon. Later in the day one person agreed to talk to us about their experiences in the home. They told us they were happy at The Rookery and that they felt they were making some progress with their work placement. They said they had a new room and enjoyed a soak in the bath after work in the privacy of their own bathroom. We saw they had a very easy and relaxed rapport with support workers and shared a joke about the support they needed on occasions.

We saw that people had individual keys for the door to their room. Each room also had a doorbell for support workers to use before entering. This had been requested by people who lived in the home at a house meeting.

We spoke to four support workers who worked at The Rookery; they told us that they found the organisation to be very supportive, and provided regular training and supervision meetings. One staff member told us the needs of people who were referred to The Rookery had changed and training had also been changed to reflect that.

We spoke with five people who lived at The Rookery who gave us positive

comments on their experience of living at the home. They told us about the choices that

they had and what they enjoyed doing such as "I can choose to go to go out and what I do" and "I can choose my food". Others told us "It's nice here".

We asked people who used the service if they felt safe living at The Rookery and

they told us that they did. One person told us "If I was worried I would speak to my staff".

We found that people we spoke with knew staff well and had built up a good relationship with them. Telling us "I have been out to dinner and we go shopping to buy clothes".

During our visit people were seen to be coming and going with staff. One person told us

that they had been to the shops and another had been to college.

Two people that used the service showed us their bedrooms and told us that they had

chosen the colours and bedding. The rooms were personalised and reflected their

hobbies and interests.

Care plans contained details of the needs of people living at the home. People had

access to healthcare professionals such as GP's and dentists.

The service had a quality assurance system in place which involved seeking the views of

people living at the home and their families.

People who lived in the home said they made decisions about their day to day lives. They were involved in planning and reviewing the care and support they received. One person said "The staff are good. We tell them what we want to do and they try to organise it.”

They confirmed they were well cared for. They were supported by a range of health care professionals. One person said "I like it here. There are good staff here who look after me. They have helped me a lot.” Another person told us “There are always staff around. They are really good.”

People told us they felt safe living in the home. They knew who to speak to if they were worried or upset. One person said "Yes, I feel safe living here." People were well supported if they presented difficult or aggressive behaviour.

They said that staff helped them with their medicines and that medicines were reviewed regularly or changed if people wished. Appropriate arrangements were in place in relation to obtaining, storing and giving medicines.

The provider had various systems in place designed to monitor the quality of the service provided to people and to ensure people were safe. These were used effectively.