Rockfield Residential

Rockfield Residential is a residential care home providing personal care for up to 17 younger adults with mental health conditions. At the time of this inspection, 12 people were using the service.

People’s experience of using this service and what we found

People felt safe living at Rockfield Residential and had built positive relationships with a consistent staff team.

The service had adapted to ensure government guidance in relation to COVID-19 management was implemented and followed. Where risks in relation to COVID-19 had been identified, these had been managed appropriately but records did not always reflect this. The provider took action to address this.

Staff received regular support from their line managers and spoke positively of the management team. Appropriate training had been provided and further training specific to people’s medical conditions was planned.

People were encouraged to remain as independent as possible and were supported to make day to day decisions. A healthy, balanced diet was promoted, and people were encouraged to make their own choices with regards to meals and times they ate.

The principles of the Mental Capacity Act 2005 were followed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Effective quality assurance processes were now in place. Regular audits were completed to monitor the quality and safety of the service and action had been taken when shortfalls were found.

Some areas of the service had been refurbished. A renewal program was in place to address other areas of the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 19 September 2019)

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 31 July 2019. A number of recommendations were made, and the location was rated as requires improvement.

We undertook this focused inspection to check that improvements had been made. This report only covers our findings in relation to the key questions Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures only under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rockfield Residential on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rockfield Residential is a residential care home providing personal care to younger adults with mental health needs. The service can support up to 17 people in one adapted building. At the time of this inspection 12 people lived at the service.

People’s experience of using this service and what we found

Governance systems had been developed and improved since the last inspection. However, further work was needed to ensure these were fully embedded and effective in identifying all shortfalls and areas where the service needed to improve. We have made a recommendation about governance systems.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Best interest decisions had not been made in line with the principles of the Mental Capacity Act 2005 (MCA). We have made a recommendation about MCA and best interest decision making.

People told us they liked living at the service and felt safe. Support was provided by a consistent team of staff who had a good understanding of people’s care and support needs. Staff were visible around the service and it was clear positive, caring relationships had been developed. Staff had received appropriate support and some training, although specialist training was lacking. We have made a recommendation about specialist training.

People’s needs had been assessed and improvements had been made to the information recorded in people’s care plans and risk assessments. Consideration was given to people’s specific interests and how participation within the local community could be encouraged.

Improvements had been made to ensure a safe recruitment process was operated. Medicines were managed safely; staff had been trained and their competency regularly checked to make sure people received their prescribed medicines.

People and staff spoke positively of the manager. The manager was passionate about ensuring people received the support they required, engaged with the community and helped people to work towards achieving goals. People were encouraged to provide feedback on the service provided.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 August 2019) and there were two breaches of regulation in relation to safe recruitment and governance systems. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rockfield Residential is situated in Scarborough and provides accommodation and personal care for up to 17 younger adults with a mental health condition.

Inspection site visits took place on 23 May and 5 June 2018 and were unannounced. At the time of this inspection there were 13 people living at the service.

At the last inspection in February 2016 we found the service was meeting regulations and awarded an overall rating of good. At this inspection we found that improvements were needed.

There was a manager in post who had registered with CQC in December 2013. 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.

Safe recruitment processes had not been followed. Applications did not contain full employment history, any gaps in employment had not been explored. References did not contain dates to evidence they had been received prior to employment commencing and health declarations had not been completed to ensure new staff were fit to work in the care sector.

This was a breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act (Regulated Activities) Regulation 2014).

Quality assurance processes were in place. However, they had failed to identify concerns we found during the inspection. Audits had been completed to monitor the quality of the service. However, where concerns had been found clear action plans were not in place to evidence appropriate action had been taken.

During this inspection, we found risk assessments were in place but not for all of the areas relevant to each person. Information contained in them was limited and did not provide sufficient details to enable staff to manage risks effectively.

Accidents and incidents had not always been appropriately recorded and it was not clear that appropriate action had been taken when a person suffered and increased number of falls.

This was a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

There was enough staff on duty to support people when required. Medicines had been managed, administered and stored appropriately. Staff competencies with regards to medicines had been assessed which ensured they had the relevant skills and training to administer medicines safely.

People were supported to maintain a balanced diet and there was a variety of meals on offer. Appropriate monitoring tools were completed to highlight any concerns in relation to weight loss or gain. Staff were aware of the action they would take if they had any concerns.

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 support this practice.

Staff received effective support from the management team. Regular supervisions took place as well as annual appraisals. These gave staff the opportunity to develop within their role. Regular training had been completed in areas the provider considered mandatory as well as specialist training where required.

Positive relationships had been developed between people and staff. Staff treated people with dignity and respect. They were familiar with people’s needs, likes and dislikes and how best to support them.

Care plans contained person-centred information and focused on how people wished to be supported. Life history documents needed further development. People were encourage to participate in activities and outing of their choice.

Regular staff meetings took place. Staff and people spoke positively about the management team. Feedback was sought in an informal way, through general discussion and within one to one review meetings with people.

The home is registered to provide accommodation for up to 17 people whose main need is in relation to their mental health. On the day of the inspection there were 15 people living at the home. There is a variety of accommodation at the home; some people have a small flat and some people have a bedroom. The home is situated in the seaside town of Scarborough in North Yorkshire, close to the sea front and town centre amenities.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us that they felt safe whilst they were living at Rockfield Residential. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff also told us that they would not hesitate to use the home’s whistle blowing procedure if needed.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people told us they were happy with how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff and that their care plans were reviewed and updated as needed. People’s nutritional needs had been assessed and people told us they were very happy with the food provided.

There had been no formal complaints made to the home since the previous inspection but there was a process in place to manage complaints should they be received. There were systems in place to seek feedback from people who lived at the home, relatives and staff.

Care staff, people who lived at the home and a health care professional told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote safety and optimum care to people who lived at the home. Staff told us that, on occasions, the outcome of surveys and audits were used as a learning opportunity for staff and for the organisation.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

At this visit we looked at the shortfalls that were found with cleanliness and infection control at this service. We found that improvements had been made. Infection control auditing was in place and action had been taken to address issues that were found. A cleaner had been employed and there were effective cleaning schedules in place to ensure that the manager could monitor the effectiveness of the cleaning taking place. A member of staff we spoke with said "The cleaning has improved a great deal. Cleaning audits are in place and we can see if anything needs doing on an afternoon." We saw that the home was clean and all the issues raised in the last report had been addressed to ensure it was a pleasant place for people to live in. People we spoke with said "I am happy with the cleanliness of my room." and " The home is lovely and clean. I do my own cleaning apart from vacuuming. I am happy living here."

Is the service effective?

n/a

Is the service caring?

n/a

Is the service responsive?

n/a

Is the service well led?

The manager monitored the quality of the service provided to people. The auditing systems at the home had improved since our last visit. Corrective action had been taken to ensure the fire alarm system was up to date and that people had personal emergency evacuation plans in place to help maintain their health and wellbeing. People living at the home, relatives, visitors and staff were asked for their views about the service so that any issues raised or suggestions made could be considered by the manager. This helped people to feel involved. We found that all the shortfalls found at our last inspection had been addressed.

We considered our inspection findings to answer questions we always ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We visited the service as part of a scheduled inspection.People told us that they felt safe. When we spoke with the manager and staff they understood their role in relation to safeguarding the people they supported. The registered manager had notified us about two medication errors. When we visited we saw that the medication systems had been audited by the community pharmacist and were meeting the regulations. We spoke with the pharmacist who said that they had no concerns about the administration of medication in this service. We observed one staff member administering medication in a safe and appropriate manner. This meant that people received the correct medication at the correct time.

On the day we visited we found enough staff on duty to meet the needs of the people who used the service. The registered manager arrived later in the morning. We spoke to people who lived at the service. One person told us," I like my flat here and can come and go as I want but I can get support when I need it".

Each person who used the service had their own bedroom or flat and individuals were assisted by staff to clean their rooms. The manager told us that, "People clean their own rooms with our support on a daily basis". Individuals had decided upon the levels of cleanliness in their rooms but some of the rooms were an infection control risk. This meant that the provider was not protecting people against the risk of infection because they were not effectively maintaining standards of cleanliness and hygiene at this service.

There was a fire risk assessment in place at the service but there were no individual fire risk assessments and personal emergency evacuation plans in place.A number of people at the service smoked in their rooms so we asked for advice from North Yorkshire Fire Safety Officer.They plan to carry out their own audit to make sure that people's safety was maintained.

Recruitment procedures were safe and effective. No member of staff was allowed to work until a Disclosure and Barring (DBS) check (previously criminal records check) is carried out to ensure that people are cared for by suitable people. Staff have all received training in areas relevant to the people who used the service. There was no system in place in order for the manager and staff to learn lessons and identify trends from events such as accidents and incidents, complaints and safeguarding incidents. This meant that staff were not always adapting and updating practice following learning from incidents. This may have resulted in people who used the service not having effective and relevent support. It was not possible to confirm that the service was safe and we have asked the provider to make improvements.

Is the service effective?

Care plans were written after consulting people who used the service and health and social care professionals. We observed that specialist professional staff were involved with people who used the service. For instance one person who used the service attended a community mental health service. This was in order to have their blood levels checked due to the type of medication they were taking for their mental health condition.

We spoke with a district nurse who came into the service on the day of our inspection. They said ," District nurses visit daily and I find everything to be okay. I have no problems with this service".

We spoke with people who used the service and they told us they were happy with the support they received from staff.

Is the service caring?

The staff knew people very well and gave support to people in a friendly and caring manner throughout our inspection. The manager supported the staff and people who used the service in friendly and helpful way. One staff member told us that if they needed to they could go to the manager with any concerns.

When we walked around the service we saw people greeting the manager and stopping for a chat. One person who used the service said," They look after me".Another person said," " I'm really happy here, I love living here and the foods good". The atmosphere was relaxed.

Is the service responsive?

Records confirmed that peoples history and present support needs were recorded and that appropriate support was provided in accordance with their wishes. People had been to visit or been seen by healthcare professionals in order to maintain their well being.

The manager showed us a new care file system that was being implemented. This was well laid out and organised with sections for all areas of care and support. This made the care planning system more effective for people who used the service although it was not in operation at the time of our visit.

The complaints procedure was clearly displayed in the entrances of the service in order that people could see clearly how to make a complaint if they wished. One staff member told us," I would report any incidents to the manager or the owners".

Is the service well led?

The registered manager had worked at the service for eighteen months and was beginning to make changes to the documenting systems, training of staff and the environment. It was clear on the day of the inspection that there were still improvements to be made but the manager was effective in leading the way. One member of staff said, " I have seen changes for the better recently" and another said, "It has got better here recently". This was attributed to the manager by staff.

When the manager was walking around the building with us we saw them speaking in a friendly way to people. They were interested in the people who used the service and responded appropriately when someone had a concern. People appeared to be relaxed around the manager and approached them frequently during our visit.

The service had a quality assurance system and records seen by us showed that there were some shortfalls identified that needed addressing.

When the manager had been alerted to a medication error she had followed the correct procedures and alerted the appropriate people. She had followed appropriate employment law procedures and taken advice when needed.

We found that people received the care and support they needed. Their needs were assessed and care plans were drawn up with risks addressed. Care plans were kept under review to ensure that people had appropriate care for their current needs. We saw that the service consulted with specialists and that they responded to expert advice.

People were protected because staff had been checked by the appropriate authority and had received training in safeguarding and abuse awareness. People's money was safely handled. Staff understood about the importance of supporting people to make decisions independently wherever possible. They understood how to protect people so that they were not unlawfully deprived of their liberty.

There were sufficient staff with the correct skill mix and training to offer appropriate care for people's needs.

We saw that the home had a system to monitor and improve the quality of care it offered.