About the service:

Rookhurst Lodge is a residential care home that was providing personal and nursing care to people living with a learning disability, autism and/or mental health needs. At the time of the inspection, six people were receiving care and support at Rookhurst Lodge.

Rookhurst Lodge was compliant with the values underpinned in Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People had access to local amenities, facilitates and services such as healthcare and were supported to access these regularly.

People’s experience of using this service:

• Staff had access to a wide range of training which in turn supported them to meet people's needs effectively. They sought advice from a wide range of healthcare professionals, and took initiative to support people according to their needs at the time. Staff knew people extremely well, and what approaches were effective with them, which added to the effectiveness of the service.

•The provider supported staff in providing effective care for people through person-centred care planning, training and supervision. This ensured the provision of best practice guidance and supported staff to meet people’s individual needs.

• There was a friendly atmosphere in the service and staff were caring and compassionate in their approach towards people. Staff knew people extremely well and supported people to access the local community and engage in activities of their choice. Staff knew people’s daily routines and what was important to them.

• There was a positive culture within the service where people, staff and relatives felt listened to. Quality assurance systems were in place which ensured high standards were maintained.

• The management of medicines was safe and the provider was following best practice guidance around stopping the over-medication of people living with a learning disability.

• People were truly placed at the centre of the service and were consulted on every level. Respect for privacy and dignity, and supporting people to feel truly, 'at home', was at the heart of the provider's culture and values.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff empowered people to make day to day decisions and people were supported by staff to prepare their evening meal.

This service met the characteristics of Good. More information is in the 'Detailed Findings' below.

Rating at last inspection: Last rated Good. Inspection report published on 25 October 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for 'Good' services

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rookhurst provides residential care for up to six people with learning disabilities. There were four people living there at the time of our inspection. The service provides care and support to people living with learning disabilities including, cerebral palsy and to people with associated mental health conditions. Some people have epilepsy and some displayed behaviours that challenged others.

People’s communication skills varied, some were able to tell about their experiences and others needed support with communication and were not able to tell us, so we observed that they were happy and relaxed with staff.

There was no registered manager in post. 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 acting manager had recently been appointed and they had submitted their application to the CQC for registration.

We last carried out an unannounced inspection on 26 May and 03 June 2015 where we rated the home as ‘Requires Improvement’ in all areas. We issued specific requirement notices in relation to person centred care, staffing and governance. We received an action plan from the provider that told us how they would make improvements. We carried out this comprehensive unannounced inspection on 10 and 11 August 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that significant improvements had been made in the running of the home.

Although care provided was centred on people’s individual interests and wishes, the record keeping to demonstrate that this was the case, was not always in place. Three new staff had recently been appointed and were reaching the end of their induction. Staff told us that once all staff were comfortable supporting people outside of the home the numbers and variety of activities provided for people would increase.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse.

The acting manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that restrictions were required to keep some people safe and where this was the case referrals had been made to the local authority for authorisations.

Staff had a good understanding of people as individuals, their needs and interests. People’s spiritual needs were met. When people’s health changed, staff made sure they had access to healthcare professionals for specific advice and support. This included GP’s, dentists and opticians.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Regular training was provided specific to meeting people’s needs and if staff identified additional training that they would like to receive, arrangements were made for this to happen. Staff received regular supervision and support from management which made them feel valued.

The acting manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. Staff and people spoke positively about the way the service was managed and the open style of management.

People were involved in the running of their home. For example, one person helped with menu planning and they encouraged others to choose what

At the time of our inspection the service provided care and support to five people. We saw and spoke with all five people living in the service. Most were not able to tell us about their experiences of living at Rookhurst because of their complex needs. However, we were provided feedback from one person and two relatives.

We spoke with all three care support workers on duty, the appointee manager and the regional manager.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

To see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was clean and well maintained. Risk assessments were in place to provide information to staff to help minimise the risk of any harm to people.

All feedback from staff and relatives indicated that staff were well trained and supervised.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had been trained to understand when an application should be made, and the regional manager knew how to submit and review one. They discussed the use of best interest meetings and how they had been used in the past.

Is the service effective?

We saw individual plans of care were in place.

People and their relatives told us that the care provided was appropriate and met people’s needs. Discussion with staff confirmed that staff knew and understood people’s individual care and social support needs.

Training records seen confirmed staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and caring staff. We saw that staff were very kind and polite and gave people time when supporting them.

Our observations confirmed that people were encouraged to be independent but were helped when they needed any support.

Is the service responsive?

Individual care plans were developed for each person following admission. People had access to activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw that a number of quality assurance processes were in place. These included feedback from people who used the service and their representatives.

People and relatives spoken with told us that if they had any concerns they knew who they would speak with to get an appropriate response.

A new manager had taken up post the week prior to the inspection visit. They were supported by the whole management team including the regional manager and the chief executive. Both had spent individual time with them and worked alongside them in the home.

Staff told us they were clear about their roles and responsibilities. Senior staff worked in the home alongside more junior staff to lead and guide. Staff said they were kept up to date with any changes as required.

In this report the name of Mrs Ann Bond appears as the registered manager. Mrs Anne Bond was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

There were five people living at Rookhurst at the time of this inspection visit. We spoke to one person who used the service, two relatives, one visiting health care professional and three staff members, including the manager. We met with a managing director who was undertaking part of the recruitment process for a new manager.

We used a number of different methods to help us understand the experiences of people using the service, as they had complex needs which meant they were not always able to tell us their experiences. We spent time with people using the service and observed the interaction between each other and with the staff. We saw that interaction between people in the home was positive.

We saw staff engaged with people before care and treatment, offering choices and gaining consent and agreement to care or treatment.

We looked at the systems and processes that the home had in place to ensure the people who used the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We saw there were enough appropriately trained staff in place to meet the basic care needs of the people currently living in the home.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints raised were resolved to people's satisfaction.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences.

Observation throughout the inspection demonstrated that staff promoted choices and encouraged independence. There were audit tools completed to assess the level of privacy and respect afforded people in the home.

We were able to speak with one person who was happy with the home and support they were provided with. We observed people choosing what they wanted to do and being supported when required.

One person spoken with told us how much they liked their own room and the garden space. Another person was seen to have enjoyed the outside terraced area that was easy to access.

We observed positive interaction between the staff and people using the service.

We were able to speak with one person who told us that staff were helpful. A relative told us that changes in staff caused instability. Suitable stable staff were important to the maintenance and progression of good care.

We observed staff listening carefully to understand what people were communicating in regard to their needs and wishes.

A relative spoken with told us that they were listened to and that their views were taken into account.

People told us that they were consulted about what they did and when. Observation confirmed that people were used to being consulted and responded confidently.

People who used the service and were able to, told us that they ‘’liked’’ the home and the staff, and when asked about the care and support, expressed a satisfaction.

One person using the service was happy to show us their room and the communal areas. They told us how happy they were with their own room.

This inspection took place on 26 May and 3 June 2015. It was unannounced.

Rookhurst provides care for up to six people who are living with a learning difficulty, this may include people with Autistic Spectrum Disorder, behaviours that challenge and people living with mental health conditions. At the time of the inspection there were five adults living at Rookhurst. The home is owned by Trust Care Management Limited who also provided supported living services.

Rookhurst was a domestic-style, two-story house, which was situated in a quiet residential road. People’s bedrooms were provided on both floors. There was a living room and a dining room on the ground floor, as well as a large garden to the rear of the building.

Rookhurst was last inspected on 27 May 2014 and no breaches of regulation were found. We performed this inspection because we had received information of concern relating to people’s care and welfare from more than one source.

The service had a registered manager who had been appointed since the last 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.

The provider had not ensured there were enough staff on duty to follow people’s agreed care plans and enable people to choose what they wanted to do.

Staff had not been trained in areas which were specified in people’s care plans. Staff had been provided with training in other relevant areas such as first aid and infection control.

People did not have some of their care needs documented in their care plans. This meant there was not a consistent approach when supporting people. Where people’s care needs were documented, care plans were not always followed by staff.

The provider’s audit had not identified where improvements needed to be made in the service, this included people’s care plans and staff deployment.

Activities were provided to people but they were not always provided using a planned approach and were subject to staff availability.

Improvements were needed in the management of medicines in relation to certain areas, such as prescribed skin creams. Other areas were safe, such as when people were given their medicines to take when they went out of the home.

There were both environmental and individual risk assessments. Issues relating to fire safety were in the process of being addressed.

The service sought feedback from people, which was mainly positive. However one person had reported on the difficulty of using a wheelchair on the drive. The drive continued to be uneven, and there was no action plan to address this.

There had been an increased turnover in staff. Although newer staff were less familiar with the service, there were also benefits, managers reported new staff had brought in different ways of working. All staff had been recruited using safe systems.

Staff were positive about the improvements made by the new registered manager, particularly in relation to the benefits for people living in the home. The new manager had also addressed a range of other areas, including making sure people had been referred to the Local Authority under Deprivation of Liberties Safeguards. All staff spoken with reported they received regular supervision and they found the manager supportive when they raised issues.

Staff had a good understanding of their responsibilities for keeping people safe and knew how to alert relevant authorities if they identified a person might be at risk of harm. The provider had ensured staff were trained in The Mental Capacity Act 2005 and understood their responsibilities under this Act.

People’s privacy was respected. Staff supported people’s diversity and individual choice. People were supported in maintaining links with their families.

Menus had been revised with both people and staff, to include principals of health eating. The mealtime had a comfortable, family atmosphere.

Staff knew how to support people’s medical needs and referred people for specialist advice when needed.

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. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.