This inspection took place on the 25 and 26 June 2018 and was unannounced. At the previous inspection the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities 2014). At this inspection we found there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities 2014). This was because records were not suitably maintained, accurate and up to date and the governance of the service failed to bring about the improvements required for them to become compliant with this regulation.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well –led to at least good. The provider sent us an action plan telling us what improvements they intended to make. At this inspection we found the improvements were not sustained and the service was again rated requires improvement. This is the third inspection where the service has been rated “Requires Improvement.”

Russell 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. Russell house accommodates 20 people across four separate units, each of which have their own facilities. At the time of this inspection there was nineteen people living in 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.

The service was 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. In this report the name of a registered manager appears who 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. The registered manager had recently left the organisation and the provider was actively recruiting into the position.

Relatives were complimentary of the permanent staff and felt they were skilled, kind and caring. However, the service had a high number of staff vacancies which meant a high use of bank and agency staff were used to cover shifts. Relatives felt those staff did not always have required skills and training and the use of agency staff led to inconsistent care for their family members.

Whilst the required staffing levels were maintained on each unit staff were not deployed appropriately which meant some units had a high number of agency staff on shift. This put a lot of pressure and responsibilities on the permanent staff members who felt they were working under extreme pressure. They were expected to be drivers, administer medicine, act as shift leaders as well as providing personal care and support to people. The provider confirmed after the inspection they had moved staff around to provide a better skill mix of experienced staff across all the units. They were continuing to recruit into vacancies and they were currently consulting on a pay review which they hoped would help with the retention of staff.

Staff were not suitably inducted, skilled, trained and supported in their roles. The agency staff were not appropriately trained in that they did not have training such as epilepsy awareness and learning disabilities which the provider considered was mandatory for th

The inspection took place on the 9 and 10 May 2017. It was an unannounced inspection of the service which meant the provider did not know we were coming.

We previously inspected the service on the 1 and 2 March 2016. At that inspection the provider was in breach of one regulation and received an overall requires improvement rating. This inspection was a comprehensive inspection to review the overall rating. We found the requirement made at the previous inspection had been met.

Russell house is a care home which provides accommodation and personal care for up to twenty people with epilepsy, learning and/or physical disabilities. The home had been purpose built and is made up of four units. Each unit accommodates five people. There are two units on the ground floor and two units on the first floor with lift access available to the first floor. At the time of our inspection there were eighteen people living in the home.

There was a 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.

People and relatives were happy with the care provided. They described the permanent staff as caring and supportive of their family members. They felt staff had the skills and understanding to care for people. However, relatives were concerned about the staff vacancy levels and they felt this led to inconsistent care for their family members.

We found the home provided caring and responsive care to people. Improvements were necessary to ensure the service was safe, effective and well-led.

Aspects of the service were being audited. However regular effective auditing was not taking place to enable the provider to address issues in a timely manner. Records were not suitably maintained in that some records were incomplete, not signed and dated.

People were consented with on their day to day care but the principles of the Mental Capacity Act 2005 was not understood and followed. A recommendation has been made to address this.

Systems were in place to promote communication and ensure staff were aware of people's needs. Staff did not routinely sign to indicate they had read the relevant records to promote safe care therefore it was not clear how staff ensured they were up to date on recent changes in people’s support needs. Risks to people were identified. However a staff member was not aware of the risks associated with people’s care which meant those risks were not safely managed. A recommendation has been made for the provider to have a system in place to satisfy themselves that staff are up to date on people's care needs and associated risks.

Systems were in place to promote safe medicine practices. However one person's allergies to medicines were not highlighted and known by one member of staff spoken with during the inspection. This was highlighted to the manager who immediately took action.

The home had a number of staff vacancies. Bank and agency staff were used to cover the vacancies to maintain the required staffing levels. Agency staff were in use in all units which lead to pressure on permanent staff and people being supported by staff they didn't know. The provider was trying to recruit into the vacancies and new staff had been appointed to address the inconsistency in care. A recommendation has been made for the provider to ensure rotas are managed effectively to ensure deployment of staff provides consistent care to people.

Staff were suitably recruited, inducted and trained. The frequency of the training had changed which meant updates in some training were overdue for staff across all four units and this was being addressed. Staff felt supported and the registered manager recognised formal supervision of sta

This inspection took place on 1 and 2 March 2016. It was an unannounced visit to the service.

We previously inspected the service on 24 and 25 June 2015. The service was not meeting the requirements of the regulations at that time. Warning notices were served and the service was placed in special measures. The service was inspected on the 10 September 2015 to follow up on the warning notices. The warning notices were met but the service remained in special measures.

Russell house is a care home which provides accommodation and personal care for up to twenty people with epilepsy, learning and/or physical disabilities. The home has been purpose built and is made up of four individual units. Each unit accommodates five people. There are two units on the ground floor and two units on the first floor. At the time of our inspection there were seventeen people living in the home.

In this report the name of a registered manager appears who 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. At the time of this inspection the home did not have a registered manager. However a new manager had been appointed and would complete the process to be registered with the Care Quality Commission.

People and their relatives were generally happy with the care provided. They felt people got safe care. Staffing levels had improved but there was not sufficient staff on one unit to meet people’s needs. The provider addressed this and we have made a recommendation for this to be monitored and maintained.

Staff were inducted, trained, supported and supervised. They were clear of their roles and responsibilities and felt suitably skilled to do their job. Robust recruitment processes were not followed. We have made a recommendation to address this.

Appropriate Deprivation Of Liberty Safeguards (DoLS) applications were made to the local supervisory body for people who had restrictions imposed on them. The provider failed to notify the Commission when these had been approved.

Peoples health needs were met and systems were in place to promote safe medicine administration practices. We have made a recommendation for the provider to update guidance and for medicine records to accurately reflect if people have allergies to medicines or not.

Systems were in place to keep people safe and safeguarded from potential abuse. Risks to people were addressed and managed. People’s nutritional needs were met.

The home was clean, suitably maintained and systems were in place to keep it updated and fit for purpose. Equipment was serviced and safe to use.

Staff were kind, caring and had a good understanding and knowledge of the people they supported. They promoted people’s privacy, dignity and independence and provided opportunities for people to have access to activities. They recognised that access to community based activities could be better.

People had care plans in place. They were person centred, detailed, up to date and reflective of people’s care needs. People were regularly reviewed and changes in people were acted on to promote their well-being. People’s records were up to date and suitably maintained.

The provider had increased and improved their monitoring and auditing of the service to promote safe practices. The management team had a more visible presence on the units and made themselves more accessible and available to staff. They supported staff on shifts where required. As a result staff felt better supported which enabled them to provide safer care to people.

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 the report.

The service was in special measures as a result of the comprehensive inspection in June 2015. This inspection showed improvements ha

We carried out an unannounced comprehensive inspection of this service on 24 and 25 June 2015. We found breaches of a number of regulations of the Health and Social Care Act 2008. This resulted in the Commission serving two warning notices on the provider. These warning notices were in relation to staffing and safe care and treatment. The timescale for meeting the warning notices was the 20 August 2015.

The provider sent us an action plan which indicated action had been taken to address the breaches of regulations outlined in the warning notices. We undertook a focused inspection on the 10 September 2015 to check that they were meeting the legal requirements which the warning notices related to. This report only covers our findings in relation to these breaches of regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Russell House’ on our website at www.cqc.org.uk’. We will follow up the other breaches referred to in that report at a later stage.

Russell House is a care home which provides accommodation and personal care for up to twenty people with learning disabilities/physical disabilities and epilepsy. At the time of our inspection there were seventeen people living in the home.

There was a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. At the time of this inspection the service had an interim manager in post to support them in addressing the issues from the previous inspection.

At this focused inspection on the 10 September 2015, we found the required improvements had been made. Safe care and treatment was provided. People’s care plans had been updated to provide clear details on the support people required, risks were identified and managed and fluid and food charts were maintained and well completed. Staff were clear of people’s needs, risks and their role in supporting people.

Systems were in place to ensure knives and hazardous materials were kept locked. This was consistently maintained throughout the inspection. Water temperature checks were maintained and high temperatures acted on. Hot water temperatures in the kitchens were above the safe level. A recommendation was made for the provider to consider if this posed any risks to people. The home was free from odours and staff were clear who was responsible for infection control and how infections were managed to prevent cross infection.

Safe staffing levels were maintained. Systems were in place to ensure one to one observations of people was consistently maintained. Staff were clear of their roles and responsibilities and they appeared confident, motivated and happy in their roles. They felt much more supported and were positive about the changes in the service which benefitted people.

The provider had introduced morning meetings and daily audits. This meant any issues in relation to staffing levels and changes in people’s needs were immediately picked up and addressed. We saw the interim manager and deputies had a visible presence on the units and covered shortages in the rota. This provided staff with support whilst enabling the provider to satisfy themselves that people were getting safe care.

We looked at the personal care or treatment records of people who use services, carried out on a visit on 7th January 2014, observed how people were cared for and talked to staff and relatives. It was only possible to talk with one person who use services on this occasion.

People’s needs were assessed and care plans were clear and individualised, reflecting the needs of people who use services. Staff showed kindness and respect to people and this was confirmed by a person who told us, “I like it here, the staff are very kind to me.”

Staff provide a healthy balance and choice of food and use the opportunity to make meal times an occasion for people who use services. Dietary needs were met and staff were properly trained in food hygiene.

The home was clean and fresh and everyone took responsibility to maintain standards of hygiene. Staff were trained in infection control/cleaning and had access to all the necessary personal protective clothing and hand sanitation.

Staff were trained to care for people who used the service and staff demonstrated a good understanding of the needs of those people. Planning of staff rostas and strategies for coping with shortfalls in staffing were in place.

The home had assurances in place to assess and monitor the quality of services.

People, who used the service, where they were able, expressed their views and were involved in making decisions about their care. We spoke with four people who use the service. Everyone told us they were happy with the service. For example one person said "I get good care here" another person told us "I am happy here because the staff take good care of me". People told us that they were treated with respect and staff preserved their privacy. Comments included "staff always knock on my door before coming in", "Staff treat me with respect and always are polite" and "Staff are very respectful".

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us "My keyworker knows me very well and understands what I need." Another person told us "My needs are taken care of here and whenever I need something or want to do something the staff help me to that." People described the quality of the care as "Good", "Better than where I was living before" and "Very good".

Staff demonstrated the knowledge and skills needed to protect people from abuse. People who lived at the service said that they felt safe living at Russell House. Comments included “Oh yes I feel very safe”, “I feel safe with all the staff here” and “I feel much safe here than some of the other places I have lived in.” People described the staff as ''Very good'', “Very nice” and “The staff are always very polite and respectful.”

People who use the service have varying levels of verbal communication, we spoke briefly to two people and observed practices and interactions to help us to understand their experiences.

We saw staff support people who use the service to attend appointments and activities.

This was done in a reassuring and sensitive manner.

We observed staff respecting people’s wishes not to attend college.

One person told us that they enjoyed their lunch and that drinks and snacks were made available to people.

We saw that people who use the service were comfortable with staff and they told us they would tell staff if they were unhappy.

We saw that people who use the service were provided with specialist equipment to meet their needs and promote their independence.

Russell house is a care home which provides accommodation and personal care for up to twenty people with learning/physical disabilities and epilepsy. The home has been purpose built and is made up of four individual units which accommodates five people on each unit. There are two units on the ground floor and two units on the first floor.

At the time of our inspection there were 19 people living in the home. There was a 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.

The inspection took place on the 24 and 25 June 2015 and was carried out as part of our schedule of comprehensive inspections. The inspection was unannounced which meant the provider did not know we would be visiting.

Relatives were generally happy with the care provided and felt confident their relatives received safe care. However we found people’s safety and care was being compromised in a number of ways.

The home had a high number of staff vacancies and as a result there was not enough staff to support people and meet their needs. We saw staff were trying to do multiple jobs at the same time and one to one care for people who required it was not consistently maintained.

Staff were not aware of potential risks to people and these risks were not addressed or managed in a way which promoted people’s safety and well- being. Medical advice in relation to an accident was not followed which put the person at risk. Items such as knives and hazardous cleaning substances were not kept locked and secure. Some people were not assessed appropriately prior to admission. People’s nutritional needs were not met and care plans did not address people’s identified needs to ensure staff provided consistent care to people.

The environment was generally clean although the design of the kitchen/diner was not suitable to meet people’s needs. Systems were in place to ensure the premises were safe. However, the hot water temperature was not consistently maintained which put people at risk of injury. Although systems were in place to manage infection control, some staff spoken with did not know who the infection control lead was and the risks associated with cross infection were not well managed and known to staff.

Medication was generally well managed although staff did not follow the policy for administration to ensure medication was signed for when administered to people.

Team leaders were not suitably trained to fulfil their roles and supervision was not provided in line with the organisations policy. Not all staff had an appraisal and appraisals were not scheduled to take place.

Quality monitoring systems were in place. These were not effective in ensuring the service was properly monitored and managed. Staff and relatives told us the registered manager and deputy manager were accessible and approachable. However, the registered manager and deputy manager were not seen to be accessible to staff during the inspection. In view of the issues found and the number of breaches of regulations we found the service was not well led and suitably managed to promote people’s health and safety.

Staff were recruited safely and they felt the induction and training provided was suitable to their role. Staff were observed to be kind, caring and had a good understanding of people’s needs.

People had access to a range of activities and complaints were managed appropriately.

People who were able to communicate with us told us they were happy living at Russell house. We saw some people appeared happy and looked relaxed and settled. Others appeared restless, anxious and required staff intervention to keep them safe and occupied which was not always available.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to the regulations 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.