This inspection took place on the 13 July 2018 and was unannounced.

Rawleigh House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rawleigh House is registered to provide accommodation and care for up to six people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living at the home.

The service had not had a registered manager in place since 08 January 2018. However, there was a new manager in position who had applied to the Care Quality Commission to become the registered manager of 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.

At the last inspection carried out in September and October 2017 we found concerns relating to the care and support people received. We asked the provider to complete an action plan to show what they would do, and by when to improve the key questions safe, effective, caring, responsive and well led. We found during this inspection the action plan had been followed and improvements had been made.

Following the last inspection improvements had been learnt in regards the culture of the service. The manager informed us improved systems and process ensured people were protected from harm or abuse. They ensured staff received the appropriate mentoring and support to ensure safe practice was in place, which ensured there was an open culture.

Improvements had been made to people's welfare and safety. The provider had taken action to ensure quality monitoring systems were in place with greater emphasis on whistle blowing, safeguarding and training. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would feel confident to report safeguarding concerns, where previously they had not. Staff had received training in safeguarding vulnerable adults.

People, staff and relatives told us the culture of the home had improved and changed for the better. They all felt the home was now well-led. One member of staff told us, “I used to feel intimidated, and we could not express our opinions, whereas now with the new manager it is so easy to talk and share our thoughts.”

Improvement had been made to ensure systems were in place to assess, monitor, manage and mitigate risk. Risk assessments were in place which identified risks and listed measures in place to minimise risk to people. People, relatives, health professionals and staff told us that the service was safe.

Improvement had been made in regards to people’s right to be treated with dignity and respect. Staff demonstrated that they knew, understood and responded to each person’s diverse needs in a caring and compassionate way. When staff discussed people's care needs they did so in a confidential manner.

People, their relatives and professionals told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them. We asked one person if staff were kind, they said, “Yes staff are nice.”

People their relatives and friends had opportunities to feedback in regard their care by way of a complaints procedure and suggestion box. Where complaints and suggestions had been made the provider had acted upon them.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment

This inspection took place on 29 September and 4 October 2017.

The service is registered to provide care and accommodation for up to six people who have a learning disability. At the time of our inspection six people were living at the service.

Although there was a registered manager in post at the time of the inspection they were unavailable. At the time of the inspection the home was being overseen by an interim manager and interim deputy 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 carried out in November 2015 no concerns relating to the care and support people received had been identified. At this inspection we found the service required improvement.

People had not been fully protected from the risk of abuse because staff told us they were not always confident in raising concerns. Risks to people's welfare and safety had not always been assessed and managed appropriately Allegations of abuse had been raised by staff with the provider. One member of staff told us, “There has been a culture of bullying, but it feels much better now”.

Prior to our inspection we received information of concern in relation to the safeguarding of people from harm and improper treatment. These concerns included safeguarding concerns around the unsafe treatment of people living in the home. The concerns continued to be investigated whilst this inspection took place. Staff told us they had been dissatisfied and concerned in their work before changes to the management of the service had taken place.

On receiving these concerns the provider had acted to ensure people were safe and protected from immediate harm and abuse.

Systems in place to assess, monitor, manage and mitigate risk were not always effective. This meant people were at risk of receiving unsafe care and treatment. There was not a culture of openness that ensured staff had the confidence to speak out about concerns in regards protection of vulnerable adults.

People were supported by staff who knew them well, however, people’s privacy was not always respected. When staff discussed people’s care needs they did not do so in a confidential manner. People did not have access to communication aids that would promote the knowledge and independence.

Staff did not respect people’s communal areas and stored their own personal items around the home and took their breaks in communal areas.

We recommended to the provider they reviewed their methods of communication in regards decision making and choice, and to look at accessible information standards.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met Where people had restriction on their choices, best interest decision making process were not in place. People were not always consulted in decision in regards restriction on their movements.

People received help with their medicines from staff who were trained to safely support them and who made sure they had their medicine when they needed it. The provider undertook regular competency checks on staff to ensure they followed safe practice when supporting people.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people effectively. Staff were positive about their training opportunities. Staff had attended training in safeguarding people and had access to the organisation’s policies on safeguarding people and whistle blowing.

Training certificates in staff files confirmed the training staff had undertaken, which included safeguarding of vulnerable adults, manual handling, infection control and the Mental Capacity Act 2005 (MCA).

The s

We inspected Rawleigh House on 19 November 2015, the inspection was unannounced. The service was previously inspected on the 22 January 2014 when it was fully compliant with the regulations. The inspection team consisted of a single inspector.

The service is registered to provide care and accommodation for up to six people who have a learning disability. At the time of our inspection six people were living at the service. 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.

People were relaxed and comfortable in the Rawleigh House and we saw people freely approached staff for support and reassurance throughout our inspection. People told us, “They [the staff] are good, they look after me” and “I like living here.” We observed that staff and managers knew people well and were able to communicate effectively with each person they supported.

Staff spoke warmly of the people they supported and told us, “[People] are great, easy to get on with” and, “I enjoy it here. We have a good set of people, they are a nice bunch.” People’s relatives said, “[my relative] is happy there” and, “It’s a really nice house with a good atmosphere.” Staff understood local procedures for the safeguarding of vulnerable adults and their responsibilities in relation to protecting people from possible abuse.

People’s care plans were detailed, informative and up to date. Each person’s care plan provided staff with detailed guidance on how to meet their individual care needs. This including information on the level of support the person normally required with specific activities as well as guidance on the individuals specific likes and preferences. Risks had been clearly identified and people’s care plans provided staff with guidance on the actions staff must take to protect people from identified risks.

People and their staff got on well together and were able to communicate effectively. We saw that staff varied their approach in accordance with each person’s individual preferences and needs. When one person became anxious at lunch time staff appropriately supported this person to manage their anxiety using techniques described in the individuals care plan.

People were supported to lead full and varied lives and staff supported people to engage in a wide variety of activities they enjoyed. People told us they enjoyed living at Rawleigh House and one person said, “One day we went to Longleat (safari park), it was good. We also go to the Swannary, beach park, fun fair and that.” Relatives told us, “I know [my relative] has a busy schedule.” Staff said, “We try to encourage people to do lots of activities.” We saw individual activities schedules were in place for each person living at Rawleigh house and that the service employed personal assistants to support people on an individual basis with activities both within the service and in the local community.

Staff supported people to maintain relationships with people who were important to them. Wi Fi internet access was available throughout the service and staff supported one person to contact one of their relatives using video conferencing technology during our inspection. Staff regularly supported people to go on holiday and records showed one person had recently enjoyed a family cruise trips while another person had been supported on a holiday to Disney Land Paris.

There were enough well trained staff on duty on the day of our inspection to meet people’s care and support needs. The services recruitment processes were safe and robust. All new staff received appropriate induction training designed to ensure staff understood their new role and felt confident they could mee

We spoke with a person living at Rawleigh House and two relatives. The person told us that staff looked after them well. We saw this happening as we observed staff with them during the day. Relatives told us that care was planned to meet their family member’s particular needs. One said “the staff couldn’t be kinder.” Another said that they were “kept fully informed of any changes.”

We saw that staff spoke in a kindly and respectful way. People could choose what they did during the day as well as choosing menus and how their rooms were furnished.

Staff told us that they knew the people they worked with very well, through spending one-to-one time with them each week. One of them said, “Everyone has different care needs: we are here to support them." We saw that care plans were up-to-date and detailed.

We looked at how medicines were managed, and were satisfied that this was done safely and securely. Although there was a recent error, no-one was harmed and practice was changed to reduce the chance of it happening again.

We also looked at how staff were recruited, and were satisfied that this was done with all the necessary checks. Staff received mandatory training before working unsupervised, and were supported by more experienced members of staff.

Finally, we looked at how the home monitored quality. We found that the manager and staff conducted regular audits and reviews and fed this information back to the provider, Dorset Residential Homes, each month.

People who lived in this service had varying abilities in communicating.

Some of the people who lived in this service were unable to talk with us. Because of this we looked at records, talked with staff and observed the way that the care was provided.

However, some people were able to tell us that they were well looked after. They said that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect.

Many people were able to make it clear to us that they liked living at Rawleigh House. Some said such things as “I like it” and “It’s nice”.

People told us that they felt able to raise any issues with the managers or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw that staff were always available when people needed help. People told us that staff were friendly and always acted professionally.

The service’s management held regular meetings with the people who live in the home to find out what they thought about how their care was delivered.