This inspection took place on 03 March 2016 and was unannounced.At our previous inspection on 04 August 2015 we found that people were not protected against the risk of unsafe care and treatment that included the unsafe management of medicines and inadequate systems in place to protect people against risks, by timely and robust risk assessments.
We also found that there were insufficient numbers of suitably qualified, competent, skilled and experienced persons providing care or treatment to people using the service. During the previous visit we found that people were not always protected against the risks of avoidable harm or abuse because potential safeguarding concerns had not been reported by staff. We also found that we found that robust recruitment procedures had not been followed to ensure only suitable staff were employed at the service. In addition, we found that there was not an effective system in place to assess and monitor the quality of service that people received.
The service was in breach of a number of regulations and you can read the report from our last focused inspection, by selecting the 'all reports' link Rhodsac on our website at www.cqc.org.uk.
We asked the provider to provide us with an action plan to address these areas and to inform us when this would be completed. During this inspection we checked to see whether or not improvements had been made.
Rhodsac Care Home is a residential home providing personal care and support for up to four younger adults with learning disabilities. There were four people using the service at the time of our visit.
The service had 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.
We carried out our second unannounced comprehensive inspection on 3 March 2016 and found that, although the provider had made improvements to the safe handling and management of medicines, people had been given over the counter homely remedies without the advice from a doctor, pharmacist or nurse. In addition, the necessary written protocols were not in place for staff to refer to ensure that the medication was administered safely.
This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Improvements had been made to the safeguarding process to make sure staff knew how to report any concerns they had to keep people safe. The procedures in place and the knowledge staff had gained from staff safeguarding training helped ensure people were kept safe from harm.
The risk assessment process had been strengthened and we found that risk assessments had been reviewed for all people who used the service. Risks to people’s safety had been assessed and provided staff with guidance to protect and promote their independence.
We found there were appropriate numbers of staff employed to meet people’s needs and this could be increased to ensure people attended their chosen activities or appointments.
Improvements had been made to the recruitment process and we found that appropriate recruitment checks now took place in order to establish that staff were safe to work with people before they commenced employment.
Quality assurance systems had been strengthened and sufficient improvements had been made to ensure the service could obtain feedback, monitor performance and manage risks.
Staff received an induction based upon the fundamental standards of care, which determined their competency in a variety of subjects. They also received on-going training and formal supervision, to help them to deliver safe and appropriate care to people.
Staff sought people’s consent before supporting them on a daily basis and ensured they were offered choices. We found people’s rights to make decisions about their care were respected. Where people were unable to give consent or make their own decisions, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed.
People told us that with support from staff, they received a wholesome and balanced diet. As part of their independent living skills and development, they were supported to prepare and cook meals for each other on a daily rota basis. There were regular reviews of people’s health and the service responded to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support to meet their healthcare needs.
Positive and caring relationships had developed between people and staff, who treated them with kindness. Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported on a daily basis. Staff understood how to promote and protect people’s rights and maintain their privacy and dignity.
The service had systems in place to ensure that people’s views were listened to and acted on to drive future improvement to the service. People received care that was based on their likes, dislikes and individual preferences. Care plans were detailed; person centred and clearly described people’s care, treatment and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people were involved in all aspects of their care plans and service delivery. Staff supported and encouraged people to access the community and participate in activities that were important to them.
The service had a complaints procedure available for people and their relatives to use and all staff were aware of the procedure. People were supported to raise concerns or complaints. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.
Leadership at the service had been stable since our previous inspection and as a result staff felt more supported in their role and able to contribute to the development of the service. We saw that people were encouraged to have their say about how their care and support was delivered and about the quality of service.
We identified that the provider was not meeting regulatory requirements and was in breach of one 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.