Archived: Rubicon Rise

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.

People’s experience of using this service: People looked very comfortable and at home in their surroundings. Staff were friendly and very skilled at working with people who used the service. Staff were making a difference to people’s wellbeing by working well as a team, in harmony with one another and by sharing the same values and principles.

Staff received a wide range of training around managing risk and ensuring people remained safe. Training included, safeguarding, first aid, fire safety and basic food hygiene. Checks were made on the ongoing competency of staff.

People's rights were upheld. The person was given choice and supported to make decisions. Where people did not have capacity to make decisions, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People participated in a range of activities that met their individual choices and preferences. Staff understood the importance of this for people and provided the structured support people required. This enabled people to achieve positive outcomes and promoted a good quality of life.

Staff effectively reported any safeguarding matters. The registered manager thoroughly investigated any concerns, and resolved these matters. All incidents were critically analysed, lessons were learnt and embedded into practice.

The service was well run. Staff told us the registered manager and team leader were fair, and good at listening to people and staff thoughts about how to make the service better. The registered manager carried out lots of checks to make sure that the service was delivering a good service.

Rating at last inspection: Good (Report published on 13 June 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 7 June 2016 and the service was given short notice.

Rubicon Rise provides care and support for up to six people who have a learning disability, some of whom had physical disabilities. The service is in a quiet residential area. The home does not provide nursing care.

The service had a registered manager who had been in post for some years. 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.

Most of the people who lived at the home had communication needs that meant they found it difficult to express their views verbally. Relatives told us people were “safe” and “happy” at the home. One relative told us, “It’s brilliant for my [family member]. I would recommend it to others.”

Relatives and staff felt there were enough staff on duty at all times to make sure people were safe. Staff were clear about how to recognise and report any suspicions of abuse. There were clear systems for staff to be able to raise concerns.

There had been some changes to staff recently and there were some vacant posts being covered by staff from other homes or by agency staff. Staff were vetted before they started work at the service to make sure they were suitable to work with vulnerable adults. The staff managed people’s medicines in a safe way for them.

Staff said they felt trained and supported in their roles. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and Deprivation of Liberty Safeguards to make sure they were not restricted unnecessarily. For example five people needed staff support and supervision when out in the community because they had little understanding of road safety.

People were supported with their nutritional health. At the time of this inspection the meals had become repetitive with several pasta dishes during one week which did not correspond to the four weekly menus that were in place. People were supported to access community and specialist healthcare services, such as GPs and speech and language therapists, when they needed these.

People who were able to express their views indicated that they liked the home, their bedroom and the staff. Relatives made positive comments about how people reacted to the support they received from staff. One relative commented, “My [family member] is very happy there and we’re happy for them.”

The home had a friendly, relaxed atmosphere and people seemed comfortable with staff. Staff treated people with dignity and respect. Staff told us their colleagues were “very caring”. For example a newer member of staff commented, “They are really nice staff. They’re all about the people and want them to have lovely lives.”

The records about how to support people were personalised and identified people’s abilities and needs. But they did not always refer to people’s own future wishes and goals that they had expressed, such as holidays and contact with friends.

Each person had a plan of social activities they could take part in, although relatives and staff felt these were a bit limited due to transport arrangements. People were able to show if they were unhappy about a situation. Relatives had information about how to make a complaint and said they felt able to raise any issues.

Relatives and staff felt the organisation was well run and the home was well managed. One relative commented, “They run it like it’s their own home. It’s like a family and I know my [family member] is happy there.”

Staff felt valued and informed by the provider. Their comments included, “It’s a good organisation to work for”, “they keep us informed” and “it’s well organised”. The provider had a quality assurance system to check and improve the quality and safety of the service.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service caring?

During our inspection we observed staff interacted with people in a caring and considerate way. They were polite but friendly in the way they spoke and interacted with people. . A relative told us that, 'Staff within the home always involve us when (my relative) needs to visit the doctor or dentist.' We undertook an observation of care which showed positive interactions from staff had a good effect on people.

We saw that many people had personalised their own rooms with furniture, pictures and decorated walls to their own taste.

Is the service responsive?

Records showed that care needs were assessed and reviewed regularly. One relative told us, 'We regularly get asked about the care of our relative and people in the home do what we ask.' The staff told us that the registered manager was approachable about any issue and would help where he could.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although no DoLS applications had been made we found there were copies of 'best interest' meetings, which included full mental capacity assessments and approval by the local authority. There were proper policies and procedures in place. All people who used the service had undergone a process where their needs had been assessed via court of protection applications. This meant their interests were protected by the court which had appointed key people to safeguard people's interests, such as managing their finances independently from the home. We found relevant staff had been trained to understand when an DoLS application should be made, and how to submit one.

The home had systems in place to monitor peoples weight and where needed introduced meals with supplements to help people with their nutrition.

Staff training was up to date so they could deliver the care people needed. .

Is the service effective?

The service assessed people's needs and the risks associated with their care. One significant friend told us that a relative of a person living in the home was greatly relieved that her relative had come into such a nice home. This was because they felt they would get, 'Good quality care".

There was evidence of risk assessments being implemented where required. For example, where people living in the home had swallowing difficulties, or needed support to eat and drink.

Is the service well-led

The people who used the service and their relatives said the manager was approachable and that they acted on information they received. One person told us, 'The manager is very approachable.'

The manager had systems in place to check that staff were doing what they should be doing to provide good quality care which met people's individual's needs.

However, we undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who have some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed people being offered choices; for example, people were offered a choice of drinks. Staff were seen to be attentive and gave people the information about the drink options in a way that was appropriate to their needs. One person was supported to dress appropriately before leaving their room. In addition, we observed staff trying to engage people in discussions about the activities they had been involved in that day.

During the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed.