We inspected this service on 10 April 2018. The inspection was unannounced.

Rix 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. Rix House provides accommodation and personal care; it does not provide nursing care.

At our last comprehensive inspection in January 2016 Rix House was rated ‘good’ overall. However, due to concerns with the way medicines were managed the safe domain was rated ‘requires improvement’. We completed a focused inspection in June 2016 to check the issues with medicines had been addressed. We saw some improvements had been made to the medicines management system. However, we could not improve the rating for safe from ‘requires improvement’ because we did not see evidence of consistent and sustained good practice. At this comprehensive inspection we found some of the persistent issues around medicines management had still not been addressed. Therefore we have rated the service ‘requires improvement’ in the safe and well led domains. This means the service is now rated ‘requires improvement’ overall.

Rix House accommodates up to 20 people in one adapted building. The service specialises in caring for adults with learning disabilities. At the time of our inspection there were 14 people living at the home and two people who were staying for a short period of respite care.

The service was working 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.

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.

People received personalised care from staff who were kind, caring and friendly. Staff knew people well and adapted their approach to meet people’s individual needs.

Medicines were not always managed in a safe and consistent way; improvements were still needed to ensure people consistently received the right support with prescribed creams, lotions and drops. This issue has been repeatedly highlighted as requiring improvement by the Commission.

Staff knew how to recognise and report concerns about people’s safety and welfare. Systems were in place to ensure risks were appropriately managed.

Staff received appropriate training to ensure they had the skills to deliver effective care. Before staff could start work appropriate checks were made to ensure they could safely care for vulnerable people.

The home was clean and tidy and the provider ensured the environment was safe and suitable for vulnerable people to live in.

Staff supported people to engage in interests and activities both within the home and in the local community. Staff respected people’s interests and personal pursuits.

People were involved in developing menus which meant they received food and drink which they enjoyed. Nutritional risk was effectively managed.

Staff worked in partnership with other agencies and healthcare professionals to ensure people maintained good health. The registered manager sought local and national initiatives which they could participate in to help improve the quality of care people received.

Staff treated people with compassion, dignity and respect. There was a positive focus on empowering people to be as independent as possible.

There was an open and inclusive culture. People and their relatives were involved in making decisions about their care and how the se

We carried out an unannounced comprehensive inspection of this service on 15 January 2016. A breach of legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the way medicines were managed.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Rix House is located in Keighley and is registered to provide accommodation and personal care for up to 20 people who have a learning disability and complex needs. Accommodation is situated over two floors with communal dining and living areas. To the exterior of the building is a small communal garden.

At the time of the inspection there were 17 people living within the home. There were also two respite beds which eight other people used on a periodic basis.

Overall, we found improvements had been made to the safety of the service and it was no longer in breach of regulation. Medicines were managed safely and people received their medicines as prescribed. The process for managing covert (hidden) medicines had been improved. Some improvements had been made to medicines records for topical medicines such as creams, however these improvements needed to be consistently applied.

Medication audits were undertaken, however the frequency of these needed to be increased to help robustly monitor that medicines were consistently managed in a safe way.

We could not improve the rating for Safe from Requires Improvement because to do so requires consistent good practice over time and evidence that the remaining discrepancies on MAR charts for topical medicines were addressed and sustained. We will check this during our next planned comprehensive inspection.”

Rix House is located in Keighley and is registered to provide accommodation and personal care for up to 20 people who have a learning disability and complex needs. Accommodation is situated over two floors with communal dining and living areas. To the exterior of the building is a small communal garden.

At the time of the inspection there were 17 people living within the home. There were also two respite beds which eight other people used on a periodic basis.

The inspection was unannounced and took place on 15 and 18 January 2016. The last inspection took place in May 2014 and the provider was compliant with the standards we looked at.

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.

People and their relatives we spoke with told us they were highly satisfied with the service. They spoke particularly positive about how kind and caring staff were and how the service listened to people and valued them as individuals.

Some people who used the service were unable to verbally communicate with us, however we extensively observed care and support including people’s gestures and body language. We observed excellent caring interactions between staff and people who used the service. People looked comfortable and relaxed around staff. Creative methods had been used by the service to communicate effectively with people. Staff had an excellent understanding of the individual methods of communication each person used.

People and their relatives said people were safe living in the home. They did not raise any safety related concerns with us. Staff we spoke with had a good understanding of how to identify and act on allegations of abuse and we saw examples where the registered manager had followed safeguarding procedures to keep people safe.

Improvements were needed to some medicine management practices. For example covert medicines were not given in line with recognised guidance. More robust stock monitoring systems were required for boxed medicines.

There were sufficient numbers of staff deployed to ensure safe care and support. Staffing levels were such that people received a high level of interaction and social opportunities. Staff were safely recruited to help ensure they were of suitable character to work with vulnerable people.

Risks to each person were assessed by the service and an individualised plan of support put in place to help keep people safe.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People had access to a range of food within the home based on their choices. People were supported to maintain good nutrition.

Staff received a range of training which was kept up-to-date. Staff received regular supervision and appraisal.

Staff had an excellent understanding of the people they were caring for. This included a high level of understanding of people’s likes, dislikes and preferences. Staff displayed a motivation and passion for providing caring and personalised care to people.

People’s needs were fully assessed and a range of appropriate care plans put in place. Staff had an excellent understanding of people’s plans of care and how to meet their individual needs. The service had worked with people to research and put in place individual solutions to enable people to achieve positive care outcomes.

People participated in a range of activities and social opportunities which met their individual needs. The service owned a minibus which increased the range of opportunities available to people.

A range of audits and checks were undertaken by the service to a

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

We found that appropriate risk assessments were in place and the planning of care ensured that people's needs were met. We also found that people's care was person centred and people that used the service were appropriately involved, where possible, in making decisions and influencing their care. Safeguarding processes were in place and staff understood the different types of abuse and how to report any concerns. Staffing levels were sufficient to ensure people's safety and the skill mix of the staff team was appropriate for the support required for people.

We spoke with four people that used the service and one person said "they enjoyed the food" and another person said "they liked the staff." People we observed indicated that they enjoyed the surroundings of the home and the interaction with others working and living at the home.

We spoke to two people who used the service and four members of staff. We looked at the organisation’s policies and procedures. We also looked at three care plans of people who used the service. We saw evidence staff offered choice and respected peoples decisions. We observed people being treated with care and dignity in line with their care plans. One person who used the service said, "I love living at Rix House" and another person said, "The staff are really nice and friendly".

We looked at the policy for infection control and inspected all communal and some restricted areas. We found the property to be clean and tidy with cleaning schedules in place.

We looked through the Statement of Purpose (SoP) and found clear aims and objectives for the service. All records requested were brought promptly and stored in a secure and confidential way. We saw evidence that appropriate documents were destroyed when they were no longer needed as recommended by best practice guidelines.