This inspection took place on 24 January 2017 and was unannounced.

There is a requirement for Rhodelands to have a registered manager and a registered manager was in place. 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.

The service is registered to provide residential care for up to seven younger adults with learning disabilities or autistic spectrum disorder. At the time of our inspection seven people used the service.

Some areas of the service could not always be effectively cleaned, and cleaning had not always been completed to the timescales set by the provider.

Not all shortfalls identified by the provider were risk assessed and managed to set timescales.

We requested one notification that had not been sent in a timely manner. Notifications are changes, events or incidents that providers must tell us about.

Other systems and processes to ensure good practice were in place, for example checks on fire safety.

Staff had been trained in and had an understanding of safeguarding and how to keep people safe from potential abuse. Staff were recruited in line with the provider’s policy and procedures, and checks were completed to ensure staff employed were suitable to work at the service.

Staffing levels were based on meeting people’s needs and enough care hours were provided to do so.

Medicines were stored securely and were managed in line with the provider’s policies and procedures. However, not all records for the management of medicines were complete.

Risks to people’s health, for example from risks from medicines or other health conditions were identified and actions taken to reduce those risks.

Staff understood how to provide care to people in line with the Mental Capacity Act 2005 (MCA). Applications for Deprivation of Liberty Safeguard (DoLS) authorisations had been made when required by the registered manager.

People were given the opportunity to express their preferences for meals and drinks. We saw people had access to food and drink throughout the day.

Other healthcare professionals were involved in supporting people’s health care needs when needed to ensure people maintained good health.

Staff were supported by the registered manager and were confident in their role and responsibilities. Staff had skills and knowledge relevant to people’s needs.

Staff provided care that respected people’s privacy and dignity. Staff had built kind relationships with people.

Care plans were developed to include people and their relatives’ views. Care plans were reviewed and people and families felt involved in the process.

Staff helped to create a calm and inclusive atmosphere in the service.

Events and activities were open to family members, and people had regular contact with their local community.

People were supported to enjoy activities that were of interest to them. People had personalised their bedrooms to reflect their hobbies and interests.

Staff listened and responded to any views, suggestions and complaints. Any complaints were recorded, investigated and resolved to people’s satisfaction.

We completed an announced inspection of Rhodelands on 27 February 2015. We gave notice the day before the inspection so the manager could inform people using the service about our inspection.

At our previous inspection in June 2014, we had identified breaches in Regulations relating to consent to care and treatment, care and welfare, cleanliness and infection control, assessing and monitoring the quality of services and record keeping. Following this the provider sent an action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met and we found that they had.

Rhodelands is a care home registered to provide care for up to seven people who have learning disabilities and autism.

There was a registered manager in place at Rhodelands 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 using the service were happy and comfortable with the staff members supporting them. Families we spoke with told us they felt their relatives were cared for safely at Rhodelands. Sufficient staff were available to safely support people with their care and interests.

Risks at the location, including those associated with medicines and healthcare acquired infections were identified and well managed. The provider had taken steps to reduce the risk of abuse to people by following robust recruitment practices and checking to make sure staff understood safeguarding practices.

Where people did not have the capacity to make certain decisions the provider had acted in accordance with the requirements of the Mental Capacity Act (MCA) 2005. The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves.

Staff were supported and developed by the management team and received training to support them with their job role. Staff demonstrated a good understanding of people’s care needs and communication methods. People’s day to day needs were well managed and people had input from other professionals to support their care planning.

Staff cared about people at the service and staff supported people with kindness and respect. People using the service were supported to be involved in planning and evaluating their care. People’s preferences were incorporated in how people wanted to decorate their own rooms and where they wanted to go on holiday. People were supported to maintain relationships that were important to them.

Action had been taken in response to previous complaints over the maintenance of the garden. People were supported to give feedback on the service and this had been included in an action plan written by the manager to develop the service further.

Quality assurance systems were in place to identify where further improvements were required. The manager had a clear aim to be open and transparent and staff had confidence in her leadership.

As part of our inspection we spoke to a family member of one person using the service and three members of staff. We spoke briefly to one person directly supported by the service, however we were unable to obtain further views of people directly supported by the service. This was because some people would find it difficult to reliably give their opinion about the service they received due to their learning disability.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people using the service were not always protected from the risks associated with healthcare associated infections. This was because systems designed to prevent and control infections had not been followed.

We found that records for people’s care and treatment and other records for the safe running of the service had not always been accurately maintained.

Emergency plans were in place to keep people safe in the event of an emergency.

Is the service effective?

We found that people using the service required advocates so their views could be independently represented. However the service had not arranged any advocates for people.

We found that people’s assessed needs were not always supported in line with their care plan.

Is the service caring?

One family member we spoke with told us, “My relative is much calmer now. Staff take my relative out. I think it is the best home they’ve been in. The staff are nice and calm and there is a good atmosphere.”

We observed staff caring for people in a friendly manner and taking them out to places of interest.

Is the service responsive?

The manager had responded to a recent judgement by the Supreme Court regarding people being deprived of their liberty. We found that the manager had completed all the necessary actions in relation to this recent judgement.

We found that the service had not always responded to requests made by other professionals to follow up and monitor people’s health conditions.

Is the service well-led?

Systems in place to audit and identify improvements had not been used appropriately.

Comments made by staff and people using the service had been used to make some improvements to the service however these improvements were not always sustained.

Plans for future improvements were being supported by the new manager. One member of staff told us, "The new manager is absolutely great."

This was a follow up inspection. Please see our previous report for full comments.

The provider had carried out safeguarding training for all staff to ensure that they were fully aware of the provider’s policy and how to report concerns.

There was evidence that regular audits were being carried out and that action had been taken as a result of these. There were clear systems for the recording of medication and for the disposal of medication. Staff who administered medication had all had their competency assessed.

As part of this inspection we spoke with four members of staff including the registered manager. The people who used the service were not able to fully communicate with us due to their complex needs; therefore we also spoke with three relatives and two social workers who had knowledge of the service.

One person stated that the home was “brilliant”, another told us that they felt the home “was one of the better places and they really do cater for their interests”.

Relatives and professionals we spoke with felt that provider was generally meeting the needs of people who used the service. Care plans were person specific and updated on a regular basis.

Staff had received relevant training and there were procedures in place to safeguard people who used the service. However, we found that not all staff understood their reponsbility in ensuring that they followed the provider’s procedures for reporting concerns.

We found that people were not always given medication in accordance with the prescribing directions. There was not always sufficient information for staff about when to give a person medication that was “as required”.

Staff received regular supervision and had annual appraisals which helped to ensure that they were supported. The majority of staff were up to date with mandatory training.

We found that the provider had an effective complaints procedure in place.

At the time of our visit there were seven people living at the home. We spoke with one person, two relatives, four staff members and two professionals who have had contact with the service.

One of the people using the service who we spoke to told us they liked living in the home. A family member stated that “it’s pretty good”.

A visiting professional stated that “they are working really well” with people and meeting their needs.

The staff we spoke to at the home all enjoyed working there and described a very positive environment for staff and people using the service. One staff member told us “it’s like one big family, staff and service users”.

People talked about the things they enjoyed doing. This included shopping, cooking, playing pitch and putt and crown green bowls in the summer and singing on the karaoke machine.

People told us they liked to go into the wooden lodge in the garden, where they could play snooker with the staff, use the exercise bike and the sensory room.

People appeared relaxed and at home and were able to move freely around the communal areas of the home. People were generally unsure what abuse was. One person told us: “I feel safe here.”