About the service: The Priory Radstock Satellite is a residential care home that was providing personal and nursing care to five adults with a learning disability at the time of the inspection.

We undertook an unannounced focused inspection on 15 February 2019. This inspection was undertaken due to whistleblowing concerns we had received. This report only covers our findings in relation to those concerns.

People’s experience of using this service:

A culture had developed at the service where staff did not always have professional boundaries and some staff did not understand the impact their conversations could have on people. People were, however, supported to receive care and live their lives in the way they wanted.

We found shortfalls in leadership and oversight of the service. Staff could not be sure they were consistently told about events in people’s lives which were important. Information in care plans and risk assessments was not always updated; staff may not always have had accurate information.

Staff received supervision but not always with the same person which meant the culture that had developed amongst some staff had not been identified and addressed quickly.

Systems and processes to monitor the effective running of the service had not been operated consistently. Records were disorganised and some audits and information could not be found.

Rating at last inspection: Good (report published 17 October 2017).

Why we inspected: We inspected following concerns raised to us by staff who worked at the service.

Enforcement: We found one breach of The Health and Social Care Act Regulations (2014). Further information is at the end of the report.

Follow up: We will ask the provider to send us a report setting out how they will improve.

Priory Radstock Satellite is a care home registered to accommodate six people with Asperger’s Syndrome. There were five people living there at the time of our inspection. There is a main house where four people live and flats where two people can be accommodated who are moving towards independence. The home had three floors; one bedroom, a kitchen and lounge on the ground floor; three bedrooms and two bathrooms on the middle floor and the top floor was used for office space.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to cook their own meals. 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.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. People were supported to follow their own activity programmes. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home continued to be well led. People and staff spoke highly about the management. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The service met all relevant fundamental standards.

We carried out this inspection on 4 August 2015 and this was an unannounced inspection. When the Priory Radstock Satellite was last inspected in September 2013 there were no breaches of the legal requirements identified.

The Priory Radstock Satellite provides accommodation and personal care for up to six people who have learning disabilities or mental health needs. The main home has four separate bedrooms and a self-contained flat at the rear of the property has an additional two bedrooms. At the time of our inspection there were four people living at the service.

A registered manager was in post at the time of our inspection. 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 said they felt safe and there were suitable systems to ensure staff could respond to allegations of abuse. The provider had a safeguarding and whistleblowing policy for staff that gave guidance on the identification and reporting of suspected abuse.

People said they felt staffing levels were sufficient and that they received the individual allocated support time they required with staff. There was a stable staff team and safe recruitment processes were in operation. People received their medicines when they needed them and suitable systems to order, dispose and retain medicines were in place.

Staff received training and were supported through a supervision and appraisal process. An induction was completed by new staff when they commenced employment. Staff received training in the Mental Capacity Act 2005 and the registered manager was aware of their legal responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and it is in their best interests to do so. People received the support they needed with meals and drinks and people could see healthcare professionals when required.

Staff at the service were caring towards people and there was a good relationship between people and staff. People were involved in the planning of their care and support. People’s support records reflected people’s involvement and the decisions made in their care planning. Staff understood the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them if they became anxious or upset. People were involved in employment and activities of their choice and staff continually ensured the support people received was in line with their wishes. The provider had a complaints procedure and people felt confident they could speak with staff about matters of concern.

People and staff spoke positively about the registered manager and we observed a good relationship between people and the registered manager. Communication with people and staff was frequent and auditing system to monitor the service provision and safety was in operation.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke with the one service user who was using the service. He told us that “I decide what I do each day. I have a timetable which I have agreed with my keyworker and it helps me work towards independence”. He also told us “I agree to see a psychologist and a doctor when I need to do this; in fact nothing is arranged without my agreement”. We also saw that there was good documentation of the consent to care, treatment and support received by the people who used the services.

We saw that care and support was centred on people as individuals and considered all aspects of their circumstances. We observed one case file for the person using the service where we saw individual care plans for a number of aspects of their care such as personal care, self-medication, cooking, cleaning, independent travel, physical health and contact with family.

We saw that risks have been identified, managed and reviewed.

We found that the provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. We spoke to one person using the service who told us that he was very pleased with his accommodation.

We saw that the service had effective recruitment and selection procedures in place.

We saw that there was system for monitoring quality of service delivery which included surveys and audits.

We visited Rookery Radstock Satellite in Midsomer Norton, Somerset on 4 April 2012. Rookery Radstock Satellite was a small residential care home for young adults with Asperger's Syndrome. The home in Midsomer Norton was a satellite of The Rookery Radstock which was located a short drive away. Senior management directed the satellite service from the larger location in Radstock.

The service provided social skills and therapeutic programmes to enable young adults who used the service to develop skills to enable them to live independently. The service is registered to accommodate six people. Four people could live in the main house and two people in self contained flats at the rear of the property.

There were five people living at the home on the day we visited. We met and talked with two of the people. The three other people were not able to talk with us due to visiting family, feeling unwell or not willing to talk with us at the time. One person told us they "love it here, it's absolutely brilliant". Another person was concerned over certain aspects of their care but got on "well" with "most of the staff".

We looked at care records, medication records and talked with staff. We found staff to be well trained and supported in their roles. Some care records were not accurate in places and had not been updated to show current information. Other records were accurate and reflected the person concerned well.

We reported our findings to senior staff at the Priory location in Radstock.