The inspection took place on 21 November 2017. The inspection was unannounced.

We last inspected the service on 08 March 2017; we only inspected the safe domain as this was a focused inspection. The service had a continued breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Recruitment practices were not always safe. The provider and registered manager were served a warning notice and were asked to meet Regulation 19 by 15 May 2017. The registered manager submitted an action plan to state that Regulation 19 had been met by this date.

Rock 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. Rock house was not registered to provide nursing care. People who required nursing received this from visiting healthcare professionals.

Rock House accommodates up to 15 people who are experiencing mental health difficulties. There were 14 people living at the service when we inspected. One person visited the service during the inspection for a trial stay to identify if they were suitable for release from hospital.

There was 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.

People gave us good feedback about the care and support they received whilst living at Rock House. They told us staff were responsive to their needs.

The service had been well maintained. However windows around the service were in a state of disrepair. Some frames were rotten all the way through. The provider had not taken timely action to address this. We made a recommendation about this.

Effective recruitment procedures were in place to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

The service design and layout met people’s needs. The service was clean and tidy and effective systems were in place to minimise and control the spread of infection.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were accurate, complete and securely stored.

People's care plans clearly detailed their care and support needs. People were fully involved with the care planning process including identifying triggers, signs and actions to address their mental health needs.

Appropriate numbers of staff had been deployed to meet people's needs. Staff had attended training relevant to people's needs and they had received effective supervision from the management team.

Risk assessments were in place to mitigate the risk of harm to people and staff. Medicines had been well-managed.

People were encouraged and supported to engage with activities that met their needs. People accessed their local community independently and with the staff.

People had choices of food at each meal time. People purchased their own food and were given a weekly allowance for this. Some people prepared and cooked their meals independently and some people had support to keep them safe. People were supported and encouraged to have a varied and healthy diet.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had systems in place to track and monitor applications and authorisations.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

Maintenance of t

This inspection took place on 08 March 2017 and was unannounced.

Rock House is a care home which provides accommodation, care and support for up to 15 people who are experiencing mental health difficulties. At the time of the inspection there were 13 people living at the home. The service is also registered for personal care. They provide outreach domiciliary care to people living in the community.

There was a registered manager 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.

At the last comprehensive inspection, the service was rated Good overall and Requires Improvement in the 'Safe' domain.

We carried out an unannounced comprehensive inspection of this service on 17 September 2015. A breach of legal requirements 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 breaches of Regulation 19 of the Health and Social Care Act Regulated Activities Regulations 2014, Fit and proper persons employed. The provider told us they would meet the regulation by January 2016. 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 Rock House on our website at www.cqc.org.uk

Why the service is still rated as Requires Improvement in the safe domain.

People told us they felt safe living in the home and staff helped them when they need supported.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

People benefited from living in an environment that was homely and had equipment to meet their needs, which was regularly serviced. Adequate checks had been made to ensure the home was safe including, gas, electricity and water checks. Personal emergency evacuation plans (PEEPs) were not in place to detail how to evacuate each person safely from the home in an emergency.

People received their medicines safely and when they should. There were systems in place to ensure medicines were managed safely.

Risks associated with people’s care and support were assessed and staff took steps to keep people safe and healthy whilst enabling their independence as much as possible.

Staff knew how to recognise and respond to abuse. They had received training on how to keep people safe.

Accidents and incidents were recorded and appropriate action taken to reduce the risk of further occurrences.

People had their needs met by sufficient numbers of staff and staff rotas were based on people’s needs and health appointments.

We found a breach 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 this report.

This inspection took place on the 02 March 2016 and was unannounced.

Rock House provides care and accommodation to up to fifteen adults with enduring mental illness. The premises looks and feels like a normal home, is well decorated and tastefully furnished. People were enabled to manage their mental health and recovery if they became unwell by the support provided by staff in the service. There were thirteen people using the service at the time of our inspection.

At our previous inspection on 17 September 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to regulation 19 and what checks were made of new staff employment histories.

At this inspection, we found that the recruitment policy and practises at the service had been improved. Safe recruitment practices had been followed before staff started working at the service, this included full employment history checks.The manager ensured that they employed enough staff to meet people’s assessed needs. Staffing levels were kept under constant review as people’s needs changed. There were enough staff with the skills required to meet people’s needs.

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. An experienced senior member of staff was in day-to-day charge of the service. The provider had recruited a new manager who was applying to register with CQC.

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

All of the people we talked with were very happy with the care and support they got from staff. They liked their home, felt safe and told us the staff were kind and caring. Staff respected people in the way they addressed them and helped them to move around the service.

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 trained to meet people’s needs and were supported through regular supervision and an annual appraisal to support them to carry out their roles.

Staff were friendly and very knowledgeable about mental health matters and the needs and requirements of people using the service. Staff supported people in making arrangements to meet their health needs. People had access to health services and referrals for additional support were made when people needed it.

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 enough.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. 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 registered provider had taken action to ensure the premises were safe and met people’s needs.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

We saw that the home was clean and tidy, and there were records to show that regular cleaning was carried out.

On the day of our visit, we spoke with three people about their experience of living in the home. They told us that they liked their home. They commented “I love it here. I love the staff and other people who live here”, “They look after me” and “I am comfortable and secure here”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were not protected from the risk of infection because appropriate guidance had not been followed.

Appropriate arrangements were in place for obtaining medicine and medicines were prescribed and given to people appropriately. Medicines were administered and kept safely.

Staff received appropriate professional development.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted upon. A number of processes were in place to evaluate and monitor the quality of the service.

There were thirteen people living in the home at the time of our visit. This service provided 24 hour support and rehabilitation through teaching life skills. We saw that people were prompted, encouraged and supported with day-to-day activities such as medication, eating healthily, managing money, domestic skills and social interaction.

We found that the service made sure people were offered choices about their care and treatment within a therapeutic framework. We found that the care and support that people received was well planned and sensitively delivered. The provider worked in cooperation with other agencies to make sure people received the support they needed. The premises were suitable and safe for the people who lived there. There were enough staff to provide the support people needed.

People lived semi independent lives with staff support.. They told us they enjoyed being independent and received all the support they needed. We spoke with people who lived in the home and mental health and social care professionals about the service.

People who lived at Rock House told us that they were happy in the home. They said, “I really like it here, it’s very homely and welcoming.” “Staff are very kind and caring, they’re brilliant.” “Staff support me to make my own meals.” “I like it here because I’ve got my own independence, staff care but they don’t interfere.”

The inspection was carried out on 17 and 23 September 2015. Our inspection was unannounced.

Rock House is a care home which provides accommodation, care and support for up to 15 people who are experiencing mental health difficulties. When we inspected, there were 12 people living in the home. The service was also registered for personal care. They provided outreach domiciliary care to people living in the community. There were 11 people receiving this service. We inspected both regulated activities.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not always followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

Staff received appropriate training relevant to their job roles. Training updates and courses had been scheduled throughout the year. Staff received regular support and supervision from the management team. Staff knew and understood how to safeguard people from abuse. Some staff had attended safeguarding training, some staff had not yet completed this.

Risks to people had been identified. Systems had been put in place to enable people to carry out activities safely with support.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours.

Medicines were appropriately managed, recorded or stored. People were supported to be as independent as possible with their medicines.

There were suitable numbers of staff on shift to meet people’s needs. People receiving their support in the community confirmed that they received their support at the right time.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes.

People had access to drinks and nutritious food that met their needs and they were given choice.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

People told us staff were kind, caring and communicated well with them. Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People had been involved with planning their own care. Staff treated people with dignity and respect. People’s information was treated confidentially and personal records were stored securely. People were able to receive visitors any reasonable time.

People’s view and experiences were sought during meetings and surveys. Relatives were also encouraged to feedback about the service by completing questionnaires. There was a complaints procedure in place, complaints forms were available to people.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community. People were supported to be as independent as possible.

Healthcare professionals told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented, they were detailed and thorough.

The provider and registered manager had notified CQC about important events such as injuries, incidents and safeguarding concerns these had been submitted to CQC in a timely manner.

Audit systems were in place to ensure that care and support met people’s needs and that the home was suitable for people. Actions arising from audits had been dealt with quickly.

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