Archived: Radnor House

Radnor House is a residential care home providing personal care for four people with learning disabilities or autism. The service can support up to six people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear a uniform or anything that suggested they were care staff when coming and going with people. The service was provided in a large building near to the centre of the village in a house that was similar to other properties in the area.

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

People were happy living at the service and relatives told us that they wanted their loved ones to remain living there.

However, there continued to be areas where the service needed to make improvements. Checks on the quality of the service had not identified some of the issues we found at inspection, other issues had not been addressed in a timely manner. However, we did not find any impact on people’s safety or wellbeing.

People were invited to feedback on their care and their views were listened to. However, the registered manager needed to improve how they gathered feedback from relatives. Relatives views on the management of the service was mixed.

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. However, best interest decisions were not always recorded when they needed to be.

People had positive behaviour support plans in place and we observed that staff followed these. However, staff had not yet completed training in positive behaviour support. This was an area for improvement.

People had been involved in choosing the decorations for the service and their rooms and flats were personalised. However, repairs needed to one person’s kitchen had not been completed in a timely manner.

Relatives told us that people had good support to access healthcare services and were supported to maintain their health. However, one relative said that dental hygiene support could be improved.

When people moved in to the service their needs were assessed. Support plans were updated when people’s needs had changed. The service had identified where people needed more or less support and supported people to move on from the service appropriately.

People continued to be provided with appropriate support to eat and drink well. People were supported to go shopping for themselves and cook where this was appropriate. Support to people was individualised and staff knew people well. People were supported to achieve goals, increase their independence and participate in a range of activities of their choice.

Risks to people from health conditions and the environment were managed appropriately. Staff understood how to protect people from abuse and knew how to report concerns. Medicines were administered safely, and people received their medicines on time and as prescribed.

There was enough staff to support people and staff were recruited safely. Staff were appropriately managed and had the support they needed.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 27 July 2018). At the last inspection there were no breaches of the regulations. The service remains rated requires improvement with one new breach of regulation. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance of the service. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Radnor 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. Radnor House accommodates up to 6 people with a learning disability.

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.

Accommodation is over two floors and consists of four bedrooms and two semi-independent flats. There is a kitchen, lounge/dining room and a quiet room that all had access to, along with an enclosed garden.

The home had a registered manager in post who was present on the day of our visit. 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.

Radnor House was last inspected in August 2017. At that inspection six breaches of Regulation were found and it was rated as 'Requires Improvement' overall and inadequate in Safe. We issued requirement notices relating to person centred care, consent, safe care and treatment, staffing, fit and proper person employed and good governance.

We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Many improvements had been made, and the previous breaches found at our last inspection had been met. However, some areas required ongoing improvements. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our last inspection staffing levels were not sufficient, medicines were not well managed, the service was not kept clean, risk assessments were not reviewed, staff had not completed fire drills and recruitment checks were not adequate. At this inspection we found that staff were now recruited safely, they had completed fire drills and the service was clean.

Risks to people were assessed and managed to ensure their health and safety, although some risk assessments continued to need greater detail. There were enough staff to keep people safe, although staffing levels required review to ensure there was always enough staff for all people to take part in appropriate activities.

At this inspection medicines were safely managed and people were supported to lead healthy lives and see health care professionals when necessary. Staff received the necessary training and met regularly to reflect on their practice.

Our last inspection found that systems were not consistently robust to monitor and improve the quality of services and mitigate risks relating to the health, safety and welfare of people. At this inspection we found that this had improved.

Staff and people told us that the registered manager was approachable and they felt the service was well-led. The registered manager and the locality manager told us their vision for the service was to increase people's opportunities to do more for themselves. This would ensure the service was working 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. Staff were kind and caring and treated people with respect and dignity.

At our last inspection people were not appropriately supported in line with Deprivation of Liberty Safeguards (DoLS). At this inspection people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had an understanding of The Mental Capacity Act (2005) and when necessary the registered manager had applied for Deprivation of Liberty Safeguards (DoLS.) People were involved in making decisions about their care and staff knew how to communicate with them.

The registered manager was aware of their regulatory responsibilities and had notified us of any important events that had happened in the service. The rating was displayed clearly and legibly in the hallway.

Health and social care professionals fed back that they had good working relationships with the registered manager and staff, and they had worked well together to support people with complex needs.

The registered manager had reported any potential safeguarding concerns to the local authority safeguarding team and staff told us they knew how to recognise and respond to abuse. People were protected from the risk of discrimination. Any incidents that occurred were documented and the registered manager looked for ways to prevent them from happening again.

People were supported to eat and drink safely. When people had specific dietary needs, such as for cultural reasons these were catered for.

The service was not currently supporting anyone at the end of their life.

The registered manager and senior staff completed a range of checks and audits on the service. The locality manager also completed checks on the service. These were used to produce a development plan for the service.

Radnor House provides accommodation and personal care for up to six adults with a learning disability whose behaviour may challenge others. There were five men living at the home at the time of the inspection. The accommodation is over two floors and consists of four bedrooms and two semi-independent flats. People have access to a communal lounge/dining room and a quiet room. There is an enclosed garden to the rear of the home.

The home had a registered manager in post who was present on the day of our visit. 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.

Since the previous inspection the service had experienced a change of registered manager and a high turnover of staff. The registered manager had been in post for just over one year and was trying to build a new staff team and address identified shortfalls. Actions towards achieving these improvements had been slow. The provider had not ensured through quality monitoring checks and audits, that adequate progress was being made in a timely manner and improvements made sustained.

At inspection for the majority of the time the atmosphere in the home was calm and relaxed. People were seen to be comfortable around staff and sought them out. Staff engaged well with people but there were not enough staff to meet the demands made on staff time and to meet everyone’s needs.

Some of the people who had complex needs were not adequately engaged in meaningful activity Observations showed them to be bored and sometimes restless. Some people were not funded for staff to provide dedicated one to one hours; staff could not, therefore give them the time and attention they needed. Care plans were person centred and people and relatives were consulted about their support needs, however, care records were not always updated. Staff did not always implement the distraction techniques in place for one person to de-escalate behaviours that were upsetting them and other people were affected by this.

A programme of ongoing staff recruitment was underway; staff records however, failed to contain evidence of the checks made in keeping with legislation requirements. Medicines were not well managed and there was a risk of errors occurring.

Risks were assessed but were not always reviewed and updated to ensure any changes had been taken account of. Health and safety checks and routine tests and checks of equipment were not carried out in either sufficient depth or frequencies, to provide assurance that people were safe. People could be placed at risk from infection because cleaning and infection control practices were poor.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had received training in this and two people were subject to DoLS authorisations. Other people were subject to restrictions and staff managed aspects of their daily care and support but they had not been referred for DoLS authorisations. The registered manager did not demonstrate a clear understanding of the criteria for making an application to ensure the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff said that they felt supported by the new registered manager and that they were bonding together better as a team and thought they supported each other. Frequencies of formal supervision and appraisal to inform staff development, and performance were however infrequent. Staff meetings were held and staff said that they felt able to express their views and felt listened to.

New staff received an induction into their role and all staff were provided with a range of mandatory and specialist training; this provided them with the right knowledge and skills. Epilepsy training for a night staff member who lone worked was an area for improvement; this was to ensure the staff member knew how to recognise and respond to seizures should they occur.

People’s health and wellbeing was monitored by staff. People were supported to access health appointments and health professionals when needed. People were consulted about what they ate and drank but the siting of the pictorial menu to a more accessible location for people is an area for improvement. Staff understood how to identify abuse in all its forms and respond and report their concerns to keep people safe. Staff understood how to respond and report incidents and accidents so people were provided with the right support, these were analysed for trends or patterns so measures could be implemented to reduce recurrence where possible.

People new to the service were assessed prior to admission to ensure their needs could be met. The majority of staff support was provided in a way that upheld people’s dignity. Most people were unable to use the complaints procedure; staff understood how they expressed their sadness and unhappiness and would look for the causes of this. There was a need to ensure that all parties understood when a complaint was resolved and is an area for improvement. Staff respected people’s privacy and supported them to maintain links with the important people in their lives.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

People's needs had been assessed and care and support was planned and delivered in line with their individual plan that was flexible and tailored to their needs. The interactions we observed between staff and people using the service were positive. The staff we spoke with were aware of people's needs and preferences. Many of the records were in an 'easy read' format, and included pictures to support people using the service to understand them. They were written in a person-centred way, and included the views and perspective of the people using the service.

People's physical healthcare needs were addressed.

People using the service had open access to the kitchen. Their preferences were taken into account when menu planning in the service, and people were supported to make their own food where possible.

There were enough staff available to go out with people using the service, and to provide care and support.

The records were clear and well ordered, and whilst detailed the information was easy to find.

People we spoke with said they liked living at the home and they were able to make choices about their lives and things that were important to them. People chose when to get up and go to bed, what to do and what to eat and staff respected their choices. A person said they chose to 'eat in my room' and that staff respected this.

Pictures and photographs were available to help people make their choices if they needed them, such as to help them choose what to eat and what activities to do.

People had been asked how they liked their care and support to be provided and were supported to learn and maintain independence skills. People chose how to spend their time at home and in the community. They helped with household tasks and keeping their own rooms clean and tidy to the level of their ability.

People were provided with opportunities to experience a range of activities at home and in the community.

Staff understood people's needs and had the training they needed for their roles. People had good relationships with staff and were comfortable in their company. A person told us 'staff are nice '.