Redclyffe House

Redclyffe House is a residential home providing accommodation for people who require nursing or personal care. Redclyffe House does not provide nursing care. The service is provided over two floors with people having their own rooms with en-suites. The service provides support to people living with dementia, people with learning disabilities or autistic spectrum disorder, older people and younger adults. The service can support up to 12 and was fully occupied on the day of our inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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 provider needed to ensure safe recruitment procedures and better records for checks, so people were supported by safely recruited staff.

Staff supported people with their medicines in a way that promoted their independence. However, medicine management records needed improvement.

People’s care and support was provided in a safe, well-furnished environment that met their sensory and physical needs.

Staff supported people to take part in some activities. However, further improvements were needed to ensure people could pursue their interests and achieve their aspirations and goals.

People had a choice about their living environment and were able to personalise their rooms. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful life.

Staff enabled people to access specialist health and social care support. Staff supported people to play an active role in maintaining their own health and well-being.

Staff supported people to make their own decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care:

Staff had the right knowledge to encourage and enable people to take positive risks. People received kind and compassionate care. Staff understood and responded to people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Staff supported people consistently and understood their individual communication needs. Staff spoke to people patiently, giving them time to respond and express their wishes.

People received care and treatment that reflected their assessed needs, and this promoted their well-being and enjoyment of life.

Right Culture:

The provider did not always follow their quality assurance policy effectively to assess, monitor and mitigate any risks relating to the health, safety and welfare of people using services, the service and others.

The provider did not always maintain accurate and complete records relating to people’s care and service management.

The provider did not always ensure records demonstrated they fulfilled the requirements of duty of candour.

We found the provider notified CQC of reportable events as required. The service work together with people and those important to them to help improve the service.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. People and those important to them were involved in planning their care. Staff valued and acted upon people’s views.

Staff turnover was low, which meant people received consistent care from staff who knew them well.

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 good (published 5 April 2019).

Why we inspected

We looked at infection prevention and control measures 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.

We received concerns in relation to the management of medicines, people’s care and support needs, premises, activities, management of the service and staff. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified a breach in relation to good governance and keeping accurate and complete records for medicine, staff recruitment and service management. We have made recommendation about keeping accurate records for duty of candour requirements at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager had followed current guidance in relation to infection prevention and control. The home has been temporarily closed to non-essential visitors due to a recent positive Covid 19 result from a member of staff, the registered manager carried out a risk assessment and consulted with people and families and due to the increased risk to service users and other people, a decision was made to keep the home closed to non-essential visitors. The registered manager advised they would be reviewing visiting restriction in 10 days following inspection. Measures had been implemented to ensure when people did visit the home, current guidance regarding visiting, personal protective equipment (PPE) and social distancing was followed.

The registered manager and staff communicated regularly with family of people living in the home. They also had effective relationships with other professionals such as GP surgeries for the benefit of people living in the home.

The home was clean and tidy and had designated cleaning staff. Housekeeping and care staff were documenting cleaning being carried out within the home. All staff ensured regular disinfection of frequently touched surfaces of the home for example handrails and door handles.

There were adequate PPE supplies in the service. This was always located at designated points throughout the home to ensure staff had access to required PPE. We observed staff donning, doffing and wearing PPE appropriately.

Staff had worked hard to support people's wellbeing during the pandemic by providing in-house activities and also spent time with people to help ensure they did not feel isolated.

The provider and registered manager supported staff with their well-being during the pandemic with supervision, informal chats and with information packs to support staff wellbeing.

There was an infection control policy and contingency plan in place that had been up dated as guidance had changed.

Redclyffe House is a residential home situated close to the centre of Gosport. The home provides support for up to 12 people with learning disabilities.

People's experience of using this service: People expressed they were very happy living at Redclyffe House. People told us they were encouraged to be independent and involved in developing their care and support plans. Staff understood people’s individual communication needs and worked in proactive ways to provide person-centred support.

Staff demonstrated knowledge of how to safeguard adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe. People were supported with their health needs, this included being supported for learning disability annual health check. People were referred to other health and social care professionals when required and were supported with their emotional well-being. Staff we spoke with told us they felt supported by the provider.

People and relatives told us staff were caring, supportive and kind. We observed staff to treat people in a dignified manner and people told us they were given privacy within the home. Activities were arranged for people that suited their individual interests. Staff actively explored what other activities or community groups were available locally to ensure that people had opportunities to engage in their community.

Support plans were detailed and recorded what was important to the individual. People were involved in planning their own lives and agreeing future goals. Support plans were person-centred, meaning people were at the heart of how they wanted their care and support to be provided.

Staff told us they felt well trained and supported. The home had a consistent staff team who understood the needs of people well. We saw staff upheld and promoted people's rights relating to equality and diversity.

People, staff and professionals told us they thought the home was well led and spoke positively about the registered manager. The provider and registered manager carried out numerous audits to ensure the service was effective. Staff supported people to integrate into the local community and the culture of the service promoted the values of supporting people to be as independent as possible.

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

Rating at the last inspection: The service was rated as Good and the report was published on 2 December 2016.

Follow up: We will continue to 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.

There was not 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 person currently managing the home had not yet registered with the Care Quality Commission (CQC). They have submitted an application applying for registration and this is currently being processed. We have referred to this person as ‘The manager’ throughout the report.

People told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received training to enable them to carry out their duties and there were opportunities for them to study for additional qualifications. All staff training was up-to-date. Team meetings were held and staff had regular communication with each other at handover meetings which took place each day.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA).

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals. Staff supported people to ensure their healthcare needs were met. People were registered with a GP of their choice and the manager and staff arranged regular health checks with GPs, specialist healthcare professionals, dentists and opticians. Appropriate records were kept of any appointments with health care professionals.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways – verbally, through physical gestures or body language. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Each person had a plan of care which provided the information staff needed to provide effective support to people. The manager and staff were in the process of updating all of the care plans at the home.

The manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable and staff understood their role and responsibilities. The registered manager demonstrated a ‘hands-on’ approach, knew people well and was committed to providing a high standard of care to people. They had implemented a range of audit processes to measure the overall quality of the service provided to people.

Is the service safe?

People were cared for in an environment that was safe and provided care which they had agreed to. There were sufficient staff to support the needs of people and the manager told us new staff who had been recruited to the home would be able to work as soon as the appropriate checks had been completed. People were cared for by people who had the appropriate skills and experience to ensure their care and welfare.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. The manager had a good understanding of DOLS, when an application should be made, and how to submit one.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People who lived at this home often had difficulties in communicating with others. We saw that staff knew people well and were responsive and patient with people when they were communicating. This meant that people were able to express themselves and were supported by people who understood their needs. From our observations and from speaking with staff we saw that they had a good understanding of the care needs of people.

Staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff ensured people were given time and the means to communicate their needs. Staff treated people as individuals and provided support which was in line with their agreed plan of care. People's needs were supported in a calm, dignified and respectful way.

Is the service responsive?

People's needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the care needs of people who lived at the home and quality assurance processes were in place. Staff were clear about their roles and responsibilities and told us that management were supportive of their roles.