About the service:

We conducted an unannounced inspection at Ruddington View on 8 April 2019. Ruddington View accommodates up to eight people in one building. On the day of our inspection, three people were using the service, all were people living with a learning disability.

People’s experience of using this service:

People received safe care and support. Improvements had been made to how incidents were managed. This included more robust ways of involving people and staff, with an emphasis on how lessons could be learnt. Staff had received additional training in positive behavioural support and improved support and communication had impacted on people experiencing positive outcomes. Least restrictive practice in the care and support people received had greatly improved. Staff were very positive about the support and leadership of the service. This had resulted in them gaining a greater awareness, understanding and confidence in meeting people’s complex needs.

The use of agency staff had reduced and was only used to cover short notice absenteeism. This meant people were supported by a consistent staff team whom they could develop positive relationships with. Safe staff recruitment procedures were used to appoint new staff. Staff received a structured and supportive induction, ongoing training and regular opportunities to discuss their work, training and development needs.

People received their prescribed medicines safely and when they needed. Improvements had been made to guidance on medicines used ‘as required’ and national best practice guidance was followed.

The environment met people’s needs and safety. Improvements had been made to safety and access to outdoor space. The service was clean and infection control practice was understood and followed.

People received sufficient to eat and drink. People were involved in menu planning and independence was promoted. People are 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 were supported with any health conditions and accessed health services to maintain their health needs.

People were positive about the staff who supported them, who showed great care, understanding and compassion. Positive engagement was seen between staff and people who used the service, where independence and choice were promoted, encouraged and respected.

Support plans that provided staff with guidance of how to meet people’s needs had improved. However, further time was required to ensure information was sufficiently detailed to enable staff to be responsive to people’s needs. People received opportunities to pursue interests and hobbies and social activities an inclusion was being further developed. People were involved in discussions and decisions about their care as fully as possible.

Staff were clear about their roles and responsibilities and improvements had been made to the systems and processes that monitored safety and quality. The provider had an ongoing action plan that confirmed what action had been completed to make improvements with targets for future work.

The service met the characteristics of Good. The inspection found significant improvements and the breaches in legal requirements had been met. Further time was required for improved systems and procceses to be fully embedded and sustained.

Rating at last inspection:

At the last inspection the service was rated Inadequate. (The report was published 17 January 2019). For more details, please see the full report which is on the CQC website at ww.cqc.org.uk

Why we inspected:

This was a planned inspection based on the rating of the last inspection. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. Following this inspection, the service will no longer be in Special Measures.

Follow u

We conducted an unannounced inspection at Ruddington View on 15 November 2018. Ruddington View 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. Ruddington View accommodates up to eight people in one building. On the day of our inspection, five people were using the service, all were people living with a learning disability. This was the first time we had inspected the service since they registered with us.

Ruddington View is a new model of care that aims to enable people with learning disabilities to live and remain in their local community. Although the size of the service exceeds the maximum of six people as specified in the CQC policy, Registering the Right Support. It had been developed in line with the Registering the Right Support values of choice, independence and inclusion. Ruddington View was developed in response to the national ‘Transforming Care’ agenda, which aims to improve health and social care services so that more people with a learning disability can live in the community.

Within Ruddington View there are two short term ‘unplanned care’ apartments, offering support to people who may be in a period of crisis and require additional support to remain in the community. The remaining six places are ‘step down’, these are for people who have been in long term hospital placements who require support to enable them to move into the community. Ruddington View is staffed by support workers with specialist input from a behaviour therapist.

There was a registered manager in post at the time of our inspection visit; however, they left their post during the course of our 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.

During this inspection, we found the service was not safe. Risks associated with people’s behaviours were not managed safely. Risks had not always been assessed and there was a lack of guidance about how to manage some people’s behaviours. Staff did not always have the skill or guidance to respond appropriately in risky situations. This placed people who used the service and staff at risk of harm. Opportunities to learn from incidents had been missed. When incidents had been investigated the actions taken were not timely and did not reduce the immediate risks to people. People were subject to restrictive interventions that did not respect their rights. The use of medicines to manage people’s behaviours was inconsistent. There were not always enough suitability qualified staff available to meet people’s need and ensure their safety. Despite this people told us they felt safe and safeguarding referrals had been made. Overall, the home was clean and hygienic.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Although we found most permanent staff had training in key areas, further work was needed to embed learning into practice. Staff did not always receive supervision and felt unsupported following potentially distressing incidents. Further work was needed to ensure the environment met people’s needs. People had enough to eat and drink and their physical health needs were met. The ‘unplanned care’ part of the service had been effective in preventing hospital admissions.

Peoples choices were not always respected. There was a lack of consistency in the staff team and this had a negative impact upon the development of trusting relationships w