The inspection took place on 12 June 2018 and was announced at short notice.

Rochester House is care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rochester House provides accommodation and or personal care for up to ten people with a learning disability, physical and sensory needs, including autistic spectrum disorder. The accommodation is provided in a house with access to garden areas. At the time of our inspection ten people were living at 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.

At our last inspection on 05 March 2016, we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

At this inspection we found the service remained Good.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 continued to receive safe care; risks associated with people's care and support were managed safely. People’s care needs were fully assessed and people were involved in the planning of their care and making choices about their lives and routines.

The provider's policies, training and work practices of staff continued to keep people safe from abuse or harm.

People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines.

There were sufficient numbers of staff, who had been recruited safely, to support people safely. Staff continued to minimise cross infection risks by following infection control guidance.

People continued to be effectively supported by staff who were trained and supported to meet their specific needs. Staff were supported through supervision and meetings which took place on a regular basis. Staff said they felt supported by the registered manager. Staff worked to the provider's vision and values.

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.

People had sufficient amounts to eat and drink and were supported to access other health professionals to manage their day to day health needs.

The accommodation was designed, adapted and decorated to meet people's needs and expectations.

People’s needs continued to be met by staff who were kind and respectful. People's privacy and dignity were promoted at all times.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely.

The service was responsive to people’s communication needs in a person-centred way.

People's care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People's feedback was sought and used

This inspection took place on the 9 and 10 February 2016 and was unannounced. At our previous inspection on 15 April 2015, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were breaches in relation to safe care and treatment, person-centred care, need for consent and dignity and respect. Following the inspection the provider sent to us an action plan. This plan stated the action to be taken and the date by when the actions would be completed. We found that improvements had been made.

Rochester House provides care and accommodation to up to ten adults with a learning disability. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. There were ten people using the service at the time of our inspection.

A registered manager was not employed at 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. A senior member of staff was in day-to-day charge of the service whilst the provider was actively recruiting a new manager.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff.

Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles. Since the last inspection, staff had received training in relation to privacy and treating people with respect. Staff respected people in the way they addressed them and helped them to move around the service. We saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

Staff had been trained to recognise and respond to the signs of abuse. Discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs. They had access to health services and referrals for additional support were made when people needed it.

People were protected against the risks of infection in the service, as professional advice had been sought and guidelines put in place to ensure that equipment was sterilised appropriately. Staff were following safe practices to reduce the risk of infections spreading in the service.

Medicines were managed, stored, disposed of and administered safely. People received their medicines in a safe way when they needed them and as prescribed.

People received the support they needed to eat and drink. They had a choice of meals from a varied menu. Mealtimes were a relaxed and pleasant experience for people.

People’s care was planned and delivered in a personalised way. The service had been organised in a way that promoted a personalised approach to people’s activities. People were involved in making decisions about their care and treatment and had been supported to decide how they would like to be occupied, for example social act

This inspection took place on 15 April 2015 and was unannounced.

Rochester House provides care and accommodation to up to 10 adults with a learning disability. There were 10 people using the service at the time of our inspection.

The last full inspection was carried out 15 May 2013 when we found concerns about the management of medicines and a failure to notify us of significant events. During this inspection we found significant events were being notified to us and although the medicines systems had changed further improvements were needed.

Rochester house is required to have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a manager who was registered with the commission, but they were not working in the service. A new manager had been appointed and was submitting their application for registration.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were not protected against the risks of infection in the service. Systems were not in place for ensuring equipment was sterilised appropriately. Staff did not always follow safe practices to reduce the risk of infections spreading in the service.

People were supported to make day to day decisions in their lives. Where people had difficulty making a decision for themselves, the correct procedure had not always been followed to assess people’s capacity to make a decision and to ensure their rights were upheld.

Staff did not consistently treat people with respect in the way they addressed them and helped them to move around the service. People’s privacy was not consistently maintained because their personal needs were discussed in open areas of the service where others could hear. Some staff were not responsive to people’s needs when they became upset.

People’s care was not planned or delivered in a personalised way. The service was not organised in a way that promoted a personalised approach to people’s activities. People had not been supported to decide how they would like to be occupied, for example social activities, going out, education or employment.

The newly appointed manager had a clear vision and set of values, which were reflected in the action plan for the improvement of the service. However the culture of the service was task orientated and the manager acknowledged that there was further work to do to embed the principles of personalised care at the heart of the service.

The manager had systems for reviewing the quality and safety of the service, but the effectiveness of these systems had not always been checked. For example keyworker meetings identified a person needed support to book a dental appointment. This had not been actioned and the manager had not checked to see if this had been done.

Staff had been trained to recognise and respond to the signs of abuse. They knew how to report any concerns and were confident to do so. People’s personal belongings were kept safe and secure.

The risks to individuals, for example in moving safely around the service, had been assessed and action taken to reduce them. Staff understood how to keep people safe. The manager had taken action to ensure the premises were safe and met people’s needs.

There were enough staff with the skills required to meet people’s needs. When new staff were recruited the registered provider followed robust procedures to ensure they were suitable to work with people.

People received their prescribed medicines when they needed them and were supported to manage these in a safe way.

Staff had undertaken training to meet people’s specific needs and to keep people safe. They knew people well and understood what their needs were. Staff were supported in their roles and had opportunities to meet with their manager to discuss their work.

People received the support they needed to eat and drink. They had a choice of meals from a varied menu. Mealtimes were a relaxed and pleasant experience for people.

People were given the support they needed to maintain good health. They had access to health services and referrals for additional support were made when people needed it.

People knew how to make a compliant if they needed to. Complaints were responded to quickly and appropriately and people were given feedback in a way they could understand.

We used a number of different methods to help us understand the experiences of people using the service, because some people were not able to tell us their experiences. This included the use of the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand people's experiences.

We observed that staff communicated with people who lived in the home in an individual way and respected their dignity.

Care plans were written from the point of view of the person who received care and gave guidance to staff about how to support people to meet their individual needs. One person said, “The staff are OK! They help me do things, and they know what I like”.

We looked at how medication was administered and found this is something the home needs to address.

A number of areas have been refurbished that had not been adequately maintained and that did not present a dignified environment to the people who lived at the home.

Since our previous visit staff training had been prioritised to ensure staff have the skills to meet peoples needs.

People who use the service and/or their representatives had been asked for their views of the quality of the service in the past and a new survey was about to be sent out.

We saw that records kept in the home relating to the people that live there and the running of the home had been reviewed and updated.

Most people were unable to directly discuss the care provided at the service due to their communication difficulties.

One person did say "The staff are very good; they make sure I have been able to do more for my self so I can move out and live on my own with support". He said he enjoyed the various activities he participated in and like to do cooking.

We saw that people were treated with dignity and their privacy was respected. Staff were seen during the day offering people choices and being given time to make decisions. People who use services had the opportunity to be asked about and take part in all aspects of life within the service as they wished or their capacity allowed.

Over the past few weeks outings in to the community had decreased as there had been a shortage of staff. Staff mandatory training was not all up to date, with some staff not completing their moving and handling which could have had an impacted on them and the people living in the service.

We also found that unresolved maintenance issues had also impacted on the people living in the home for example with just one shower being operational people had to take it in turns to have a shower.

A formal complaint made by a person living at the home with the help of there key worker had not been dealt with as per the homes’ complaints procedure.