This inspection took place on 21 January 2018 and was unannounced.

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 rec

This inspection took place on 6 September 2016 and was unannounced.

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

This inspection took place on 11 August 2015 and was unannounced.

The Priory Rookery Hove provides accommodation for up to 13 young adults, between the ages of 18 and 36 years old. The provider provides care and support to people living with Asperger’s Syndrome or associated difficulties. Typically people will stay in the service for a three to five year programme. During this time they will be able 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 are also supported to attend college where identified as part of their care and support needs. The support people needed varied depending on their current needs. There were 12 people living in the service at the time of our inspection.

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. However, the registered manager had been on long term leave since March 2015. There had been several interim management arrangements which people and members of staff had found had found difficult. Currently a regional manager and a registered manager from another of the provider’s services were providing day to day leadership.

The last inspection was carried out on 11 December 2014. We found a breach of Regulation 9, 11, 12,17,and 18 of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people, staff and others were not protected with effective quality assurance systems to identify, assess and manage risks relating to the health and safety of people. Staff had not received training and supervision to support them in their role. The CQC had not been notified of applications made to deprive people of their liberty. People had not been involved in the drawing up of their care plans, which lacked detail to ensure care and support was provided constantly. The provider provided the CQC with an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection and found that the breaches highlighted had been addressed. However, we found there were still areas which needed to be improved.

Since the last inspection in December 2014, staff spoke of a significant period of change that they were still working through. There had been a change in the management team and interim management arrangements were in place. There had been a high turnover of staff which had led to use of the organisations bank staff or agency staff to help cover the staff rota. Staff had attended a lot of training to help support them in their role. The building was going through a major refurbishment programme. One member of staff told us,” With the changes we are going in a good way. We are creative, flexible and supportive.” Another member of staff told us, “It’s a lot more positive in the house now the managers are around there is a more consistent approach, we are more supported and more of a team.” Feedback from people and their relatives was that due to all these changes in staff this had been a difficult and unsettling period. Most of the feedback was that the new management in place were working to address this. However, we did receive some negative comments that there had been limited changes and improvements made in the service.

The number of staff on duty had enabled people to be supported to attend educational courses, participate in voluntary work and in local social activities. Three people were being supported to move onto to other accommodation. One member of staff told us, “We help the residents with their independence and to move on.” However, there was a lack of clarity as to who had been funded to receive additional one to one support to help support them safely in their activities. Although it was evident it was being provided for some people, staff could not tell us of all the people who should be receiving this support. This was an area they were in the process of addressing.

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 and to provide safe and effective care. The premises were safe and maintained. The décor of the building and furnishings provided were variable in quality. However, the service was in the process of a major refurbishment. A new kitchen had been fitted, new bedroom furniture had been provided and new flooring in the ground floor corridor was being fitted during our inspection.

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. New care and support plans had been introduced which were detailed and informative. People had been involved and these clearly detailed the goals people were working towards. One member of staff told us, “The residents have been really involved in their care plans with their keyworker.” However, these were very new and it was not possible to fully evidence the review process and how these had been maintained.

People were being supported to review and develop the range of activities they were involved in to develop their life skills. 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 life.

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. One relative told us, “The staff have been incredibly kind and helpful.”

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 had access to health care professionals. 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 satisfaction questionnaire, and people had the opportunity to attend weekly residents meetings. We could see the actions which had been completed following the comments received. The 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.

The inspection of the Priory Rookery Hove took place on 11 December 2014. It was unannounced. The last inspection took place on 21 February 2014. No concerns were raised at that inspection.

The Priory Rookery Hove provides accommodation for up to 13 young adults, between the ages of 18 and 35, who are living with Asperger's Syndrome and associated disorders. Typically people will stay in the service for a 3 to 5 year programme. The aim is to further develop their life skills to gain independence and integration into their community. Where relevant people are supported to attend college. The support people needed varied depending on their current needs. Most people did not need support with personal care but they did need support with areas such as time-keeping, communicating with other people and understanding the effect of how they were and what they were doing on others. There were 13 people living in the service at the time of our inspection.

The Priory Rookery Hove was a large town house, situated in a residential street in Hove. Rooms were provided over three floors with communal rooms on the ground floor. There was an enclosed garden to the rear of the building. Each person had their own room, which they could personalise if they wished.

The provider runs and manages a wide range of services for people, including hospitals as well as 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.

A registered manager was 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 and associated Regulations about how the service is run.

Some people said they did not always feel safe, particularly where other people could show signs of aggression. Staff reported they did not document all such incidents. Management was not assessing the extent and type of such incidents to ensure people’s safety.

The provider’s policies on infection control had not been followed in all cases. This was particularly in relation to a recent outbreak of an infectious disease. The service was not ensuring risks relating to infections were reduced for people.

The service did not ensure all staff were able to effectively support people. Records relating to induction of new staff did not follow the provider’s policies. Some newer staff we spoke with were unclear about certain aspects of their initial training. Some staff were not up-to-date with the provider’s on-going training programme, for example in areas such as managing aggression. Some staff were not receiving regular supervision.

People were not actively involved in drawing up their own care plans. This was contrary to the provider’s policies. Some care plans did not reflect what people told us, we observed or staff reported. This meant care provided to people was not evaluated and changed to effectively support them. People were involved in plans about their day to day lives. You can see what action we told the provider to take at the back of the full version of the report.

Issues had been raised with both us and the provider about management of the home. The manager had not informed us of applications under the Deprivation of Liberty Safeguards (DoLS), as they need to do under our regulations. They had also not ensured all relevant records were made, or kept up to date. The provider was taking action to improve the situation, using a range of measures, including meetings with staff to hear their opinions.

People and staff raised issues relating to staffing levels for some shifts. On the day we inspected people said there were enough staff on duty. The provider had also taken action to ensure enough staff were recruited. New staff would be in post shortly, following completion of necessary checks. Prospective staff had full recruitment checks carried out before they came in post, to ensure they were suitable to work with the people at the service.

People were given their medicines in a safe way. Medicines were securely stored and full records were maintained of medicines received into the home, given to people and disposed of from the home.

People were provided with a wide range of choices at mealtimes, including vegetarian options. As part of their programmes, people were supported in developing cooking skills and following principals of healthy eating.

People told us where they needed support from external healthcare professionals, this was readily available. Full records were maintained of healthcare matters for people.

Staff treated people with respect. There was a relaxed atmosphere in the house. A person told us “They know how to work with people.” People said they felt the service had established a good balance between their individual needs and those of other people living there.

We found a number of breaches 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.

There were 13 people who used the service at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We observed the care provided and looked at supporting documentation. We talked to three people who used the service, three members of support staff, the deputy manager, the registered manager, the housekeeper and administrator.

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.

There were 13 people who used the service at the time of our inspection. We used a number of different methods to help us understand the views and experiences of these people, as not all of the people who used the service were able to tell of their experiences. We spoke with the registered manager who is referred to as manager in the report, the deputy manager, two care workers, and four people who used the service.

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.

We spoke to three people using the service who told us that they were very happy with the care and support provided and had been involved in the drawing up of their care plan and ongoing review.

Staff members we spoke to told us that they were happy working in the home, that the team worked well together and that they had received the training and supervision they needed to meet individual people’s care needs.