About the service: Rawlings House is a care home which provides accommodation and personal care for up to seven people who have a learning disability and/or autistic spectrum disorder. At the time of our inspection there were three people using the service. One of whom was in hospital.

People’s experience of using this service:

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming and staff were warm and considerate towards the people they cared for. People and their relatives felt involved and supported in decision making. People's privacy was respected and their dignity maintained.

There was a stable staff team which provided consistency of care for people, with enough staff to support people, meet their needs and keep them safe. People were supported by staff who had received training, relevant to their roles and responsibilities.

People received their medicines as prescribed. Systems were in place for the safe management and supply of medicines. Incidents and accidents were investigated, and actions were taken to prevent recurrence.

People's needs were assessed and care was planned and delivered to meet legislation and best practice guidance. 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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

Care plans were detailed with clear explanations of control measures for staff to follow to keep people safe. Support was planned and delivered in a structured way to ensure people's safety and wellbeing. We recommended that further work be carried out to provide information as to people’s end of life wishes.

The premises were clean and staff followed infection control and prevention procedures.

Staff roles and responsibilities were clear. Staff worked in partnership with professionals to deliver care and support and maintained links with the local community. Access to health care was supported by staff including annual health checks.

There was a varied range of social activities on offer according to individual needs and choice. People were provided with a varied diet and they were complimentary about the choice of food offered.

The service continued to be well led. The registered manager worked well to lead the staff team in their roles and ensure people continued to receive a good service.

Rating at last inspection: Good (report published on 24 November 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 28 September 2016 and was unannounced.

Rawlings House provides accommodation and personal care for up to seven people. On the day of our inspection there were six people living in the service. Some people because of their complex needs were not able or did not want to communicate with us; we therefore used observations and also gathered feedback from people’s relatives.

The service had 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.

When we had visited in 2015, we had concerns in that medicines were not managed safely, appropriate consent was not obtained, care and treatment did not always meet people’s assessed needs and expressed preferences and the quality and safety of the service was not regularly monitored. We had therefore asked the provider to send us an action plan detailing how they were going to ensure they were meeting the outlined regulations.

The provider had sent us a detailed action plan. Therefore part of this inspection was to ensure that they had carried out the necessary actions detailed in the plan. We were happy that they had made improvements and were now meeting these regulations.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medicines to be stored and administered safely. There were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision had been taken in accordance with the Mental Capacity Act.

People’s care plans were individual and contained information about people’s needs, likes and dislikes and their ability to make decisions.

People had access to healthcare professionals. A choice of food and drink was available that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People were encouraged to follow their interests and hobbies and supported to keep in contact with their family and friends.

There was a strong management team who encouraged an open culture and who led by example. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements when this was needed.

This inspection was carried out on 2 November 2015 and was unannounced.

The service provides care and support for up to seven people. On the day of our inspection there were six people living in the service. One person was able to communicate their views to us. Therefore we gathered feedback from people’s relatives

The service has 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.

Risks to people had been assessed and action to mitigate the risk recorded. However, risk assessments were not always up to date and did not reflect the risks on the day of our inspection.

The administration of medicines were not recorded accurately and medicines were not stored in an environment which ensured they remained in good condition.

Staff were trained in all essential areas and undertook an induction process when they began working in the service. Staff had also received training to meet the specific needs of individuals using the service. They received regular supervision from the manager. There were sufficient staff to meet people’s needs.

Staff demonstrated knowledge of the Mental Capacity Act 2005 when providing care, giving people choices and time to come to a decision. However, this was not supported by the service documentation with mental capacity assessments not being recorded appropriately or regularly. Applications had been made to the relevant authority under the Deprivation of Liberty Safeguards.

People were not actively involved in decisions relating to their care and treatment. They were not involved in developing their care plans and care plans did not always accurately record the needs of the individual.

Staff cared for people in a respectful and caring manner.

Quality assurance audits were not carried out across the service and were not available to drive improvement.

You can see the action we told the provider to take at the back of the full version of the report.

We talked with three people who used the service to gain their views and experiences about the service they were provided with. They told us their needs were met and staff treated them well. One person told us, “I like it here. I am happy here.”

People we spoke with confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, “They (staff) are good. They take me out and about when I want. We go to the pub, MacDonald’s, go bowling and when it’s nice we have a picnic. I like that. Where I lived before I didn’t get to go out. Here we go out all the time if we want and they take me to the doctors if I am unwell.”

We looked at three people’s care records which provided information for staff on how to meet people’s individual health and care needs. We saw that people’s choices and preferences were reflected in their care records and written in a way that promoted their independence.

The care records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan. We saw evidence in the care records that people received safe and coordinated care, treatment and support where more than one provider was involved.

We saw that people were given their medication at the required time and records were completed appropriately.

We saw that the service provided enough qualified, skilled and experienced staff to meet people’s needs. We looked at staff records and spoke with two members of staff who told us they were being appropriately supervised and supported. Staff were knowledgeable about the people they supported and how to meet their needs.

During our inspection we observed that the interaction between staff and people using the service was friendly, respectful and professional. We saw that staff sought people’s agreement before providing support or assistance.

People using the service had complex needs which meant some of them were not able to tell us about their experiences. Many people shared their views through gestures, facial expressions and body language. We spoke generally with some people and we observed how people interacted with one another and with members of staff. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. One person spoke with us generally and said they liked the home and felt safe living there. We could see that people were confident and happy.

Relatives that we spoke with during our inspection told us that they were very happy with the service provided and were confident that staff understood their relatives care needs well. they also told us that they were always kept informed of any changes in their relatives health or care needs.

During our inspection we saw that people received good care and that staff treated them with respect. Staff showed a good understanding of people's needs and their individual ways of communicating.