Rainscombe House is a residential home which provides care and accommodation for up to three adults with learning disabilities, autistic spectrum disorders and behaviours that may challenge others. People had varied communication needs and abilities. Some people were able to express themselves verbally using one or two words; others used body language to communicate their needs. On the day of our inspection three people were receiving care and support.

This inspection took place on 9 September 2016 and was unannounced.

We carried out an unannounced inspection of this service on 24 November 2015. During this visit we identified areas of concerns where the provider was failing to comply with the relevant requirements of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014).

We asked the provider to take action to make improvements. The registered manager sent us an action plan that stated these actions have been completed. We undertook this comprehensive inspection on 9 September 2016 to review the improvements made and to see if they met the legal requirements. We identified no serious concerns during our inspection.

The home was run by a registered manager. However they were on leave on the day of 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 and associated Regulations about how the service is run. We were supported throughout the inspection by the deputy manager and a senior care worker.

The provider did not have a robust process that had ensured people’s finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received.

People appeared happy and at ease in the presence of staff. Staff had written information about risks to people and how staff managed these in order to keep people safe. There had been a reduction of incidents of people’s behaviour that may challenge since our last inspection.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises was safe and well maintained.

People and their families had been included in planning and agreeing to the care provided. People had an individual plan, detailing the care they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were not always involved in making decisions about their and choices offered to people were not always recorded. We have made a recommendation about this.

Staff had the specialist training they needed in order to keep up to date with

Rainscombe House is a residential home which provides care and accommodation for up to three adults with moderate learning difficulties, autism and display behaviours that may challenge others. The home, which is set over two floors, is located in extensive farm grounds. There is a dining and lounge area on the ground floor, kitchen and a level garden to the rear of the building. On the day of our inspection three people were living in the home.

This inspection took place on 24 November 2014 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. 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. Staff had written information about risks to people and how to manage these. We found the registered manager needed to consider additional risks to people in relation to bathing as changes had not always been reflected in peoples care plans.

The provider did not have the processes in place to safeguard people’s finances.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff said they would report any concerns to the registered manager. They knew most types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns however they were unclear what to do where financial abuse was suspected

Care was provided to people by a sufficient number of staff who were appropriately trained. Staff were seen to support people to keep them safe. People did not have to wait to be assisted.

People who may harm themselves or other’s behaviour that challenged had improved since being at the home and the number of staff on duty were adequate for their individual needs.

Processes were in place in relation to the correct storage and audit of people’s medicines. All of the medicines were administered and disposed of in a safe way.

The Care Quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be restricted.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were told by the registered manager that people could go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People took part in community activity on a daily basis; for example trips to the shops. The choice of activities was specific to each person and had been identified through the assessment process and the regular house meetings held.

People had an individual care plans, detailing the support they needed and how they wanted this to be provided. We read staff ensured people had access to healthcare professionals when needed. For example, the doctor or optician.

The registered manager told us how they were involved in the day to day running of the home People felt the management of the home was approachable.

Complaint procedures were up to date and people and relatives told us they would know how to make a complaint. Confidential and procedural documents were stored safely and updated in a timely manner.

The home had a satisfactory system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. We found that the registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, and decided if any actions were required to make sure improvements to practice were being made.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction surveys.

The provider has produced a statement of purpose and service user guide which contains information about the service and the support that would be provided regarding the care and treatment of the people who used the service.

People who used the service had limited capacity and no verbal communication so were not directly involved in this inspection visit.

We saw that everyone receiving a care package from the service had an assessment of their needs undertaken before a care agreement was offered. This was to ensure that people's assessed needs could be met and that the service had the staff with the relevant skills and qualifications to meet these needs.

We looked at three care plans for people who used the service. Care plans were based on the needs assessment that had been undertaken prior to admission.

We saw the service had adult protection policies and procedures in place known as safeguarding. These demonstrated how the provider identified potential abuse and prevented abuse from happening for the people who used the service.

There were sufficient numbers of bathrooms and toilets for the people to use. We found that some of these had been adapted to provide assistance for people that had been assessed with mobility needs.

The provider had an established quality assurance (QA) program in place. We looked at the provider’s QA system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk.

The people who used this service had little or no verbal communication skills, we were therefore unable to talk to all individuals who lived at the service during our visit.

We observed people were able to exercise choice with regard to what they wanted to do or go within the service.

People were observed to be offered appropriate assistance from the member of staff on duty to enable them to access their chosen activities.

During our observations the people who used the service were happy to interact with member of staff and the manager.

The staff demonstrated a good knowledge and understanding of the people they were supporting.

There was clear records that indicated that each person or their relative/representative had been involved in the admissions assessment process.

People's values and human rights have been respected. The manner in which the member of staff spoke to people was respectful, but also warm and friendly.

People where seen to be supported effectively and respectfully by staff who were trained and supported by the provider.

People who live at Rainscombe House have multiple complex needs.

We were not fully able to ask them about their levels of satisfaction with the outcome areas reviewed.

We were able to observe that people using services, appeared relaxed and at ease in their surroundings.

We saw good interactions between staff and people who use the service.

We observed that the staff member on duty was attentive to those at home and they demonstrated a good understanding of their communication styles or body language.