RNID Action on Hearing Loss Ransdale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides personal care to a maximum of six adults who have profound deafness or significant hearing loss and who have other disabilities or additional support needs. At the time of the inspection there were six people who used the service.

The care service has been developed and designed 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. Registering the Right Support CQC policy.

At our last inspection in October 2015 we rated the service as Good. However, we found for people who did not always have capacity, staff had not completed mental capacity or best interest assessments. The provider wrote to us telling us the action they were to take to address this. At this inspection on 19 March and 3 April 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. However, we did rate the caring domain as outstanding and this section is lengthier to reflect our findings.

The service had a registered 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 a 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 provided outstanding care to people. Staff were exceptionally caring and inspired people to do well in achieving their goals. People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life, this was reflected in the care and support that people received. We saw that staff treated people with dignity and respect.

Staff understood people's different ways of communicating and how to make people feel valued. The home had a strong, person centred culture and staff went that extra mile for the people and families they supported. We received feedback from people, a relative and professionals which was exceptionally positive about the progress and quality of life that people experienced.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place.

People and relatives told us there were sufficient numbers of staff on duty to ensure people’s needs were met. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with people.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

On the first day of our inspection we found the service needed redecoration and improvement. The provider did not own the building, they had a rental agreement with a landlord. The landlord was responsible for most of the refurbishment and redecoration. Where repairs had been ma

A British sign language interpreter accompanied us on our inspection to help us communicate with those people who used the service. During the inspection we spoke with five people who used the service. We also spoke with the manager, the deputy manager and a support worker. People told us that they were happy with the care and service received. One person said, “It’s good.” Another person said, “The staff help me with everything I need.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that there was sufficient staff with the right knowledge and experience to support people.

Regular checks were carried out to monitor the quality of the service provided

We spoke with four people who used the service. They told us, "I like it here, the staff are good. This one here helps me and I like my key worker" and "It's good. The staff are good." They all told us that they were asked what they would like to do and when. One person told us, "That's right I choose what I want to do, and the staff help me to do what I want to do. I have a review coming up soon. They send an invite to my Mum, Dad, Social Worker. I get involved in the review, they involve me." Another person told us, "I am asked what I would like to do and when. Yeah, that works well."

We found that the service had used a person centred approach to plan and deliver care. This helped ensure that the people who used the service were at the centre of everything they did. The people we spoke with did not raise any concerns with us about their safety within the service. One person said, "I feel safe and comfortable. It's a calm place. I am happy here."

We found people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

We inspected Ransdale House on 29 October 2015 and 5 November 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 5 November 2015.

Ransdale House is a large residential house situated in a residential area of Middlesbrough. The service provides care and support for six adults who have profound deafness or significant hearing loss and who have other disabilities or support needs. The service is close to all local amenities. The property had been adapted to incorporate assistive technology to enable people with hearing loss to live there safely and be as independent as possible.

The home had a registered manager 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.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working in a way that empowered people to make their own decisions and working in people’s best interests where they felt they lacked capacity. However they were not formally assessing people’s capacity or recording the decisions that had been made in people’s best interests.

We saw that staff had not received supervision on a regular basis. Staff also had not always been trained or completed refresher training; this meant staff’s ability to perform their role could be affected.

People told us that there were enough staff on duty to meet people’s needs.

We found that safe recruitment and selection procedures were in place. Records we were provided on the visit related to staff recruited in 2003 and 2007 and we therefore could not assess the current process. However the registered manager knew their responsibilities in relation to this for when they next recruit new staff. The registered manager understood they must ensure all documents relating to recruitment are kept at the service for inspection.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Only one safety check was out of date and this was rectified by the service immediately.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as ironing, cooking and behaviour that challenged. This enabled staff to have the guidance they needed to help people to remain safe.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, and patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people were involved in all aspects of their care plans.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were effective systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the registered manager and senior staff within the organisation. We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the registered provider to take at the end of this report.