Ryde House

This inspection was unannounced and took place on 10,11 and 13 September 2018. Ryde House provides personal care and accommodation for people with a learning disability and Autism, including people who have behaviours that can place themselves and others at risk.

Ryde House is registered to accommodate up to 64 people. At the time of the inspection there were 55 people living at the service. The service is a group of individual units set within one location. There are five units which are registered as one service, Ryde House (main house), and four separate purpose-built buildings; Maple Tree, Sycamore House, Beech House and Silver Birch. Each unit had their own staff team including unit managers, deputy managers and senior staff. All five units were looked at as part of this inspection.

Since the last inspection in 2017, the provider had reviewed their registration, in line with best practice guidance 'Registering the Right Support' for people with a learning disability. Although, they do not meet the requirement of registering the right support because each unit accommodates more people than Registering the Right Support guidance advises. Nonetheless, the service had been developed and was in line with the values and other aspects that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

We last inspected the service in May 2017 when we did not identify any breaches of regulation, but rated the service as 'Requires improvement'. At this inspection, we found improvements had been made.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was supported by a manager in each of the five units.

The registered manager for Ryde House was also one of the directors of the provider’s company and the unit manager for Silver Birch unit. At the last inspection in May 2017, we found that the director held different roles at different levels within the organisation with overlapping responsibilities, which created a lack of clarity and clear accountability. At this inspection a review of the management team had taken place and there were two senior managers who were awaiting registration with Care Quality Commission to become the joint registered managers for the service. Following the inspection, their registration was completed. The two senior managers were working to ensure there was a consistent approach across the service, with a clear process for accountability and the previous registered manager was in the process of de-registering.

Accommodation in the Ryde House unit, in the main house, was arranged over two floors which could be accessed by a staircase. There was a large lounge and a dining room, with smaller quieter rooms available for people and a large garden. The other four units were purpose built and each had a lounge, dining room and quiet areas. Most bedrooms in the purpose-built units had en-suite facilities. Each unit had its own garden and people across all five units had access to large communal grounds which included a private beach.

Staff knew how to identify, prevent and report abuse. Safeguarding investigations were completed and actions were taken in a timely way when safeguarding concerns were raised with the service.

There were sufficient staff employed to meet people's needs, keep them safe and provide them with person centred support. Recruitment procedures were robust and ensured that suitable staff were employed.

Individual and environmental risks to people were managed effectively. Risk assessments were reviewed as and when needed. Individual risk assessments identified risks to people, providing clear guidance to staff on how risks should be managed and mitigated.

Medicines were managed safely in all five units. People received their medicines as prescribed and there was a consistent system in place, with all the units using the same pharmacy.

Three of the units were clean and staff followed best practice guidance to control the risk and spread of infection. Two units had areas that were not clean. However, these were immediately addressed when brought to the attention of the senior managers.

Staff knew people well and had developed positive relationships with them. People were treated with dignity and respect and staff protected people's privacy.

People were supported to participate in activities of daily living within the home. Independence was promoted, with people being supported to maintain and learn new skills that would enable them to make choices about their own lives.

People received effective care from staff who were competent, suitably trained and supported in their roles. Staff acted in the best interests of people and followed legislation designed to protect people's rights and freedom.

Care plans contained detailed information to enable staff to provide care and support in a personalised way. People were empowered to make choices about all aspects of their lives. They had access to a range of activities suited to their individual interests.

Staff understood people's health needs and people had access to health professionals and other specialists when required. Procedures were in place to help ensure that people received consistent support when they moved between services.

The management team and staff worked collaboratively with other health and social care professionals to help ensure people received additional support when needed and there was a co-ordinated approach to their care and support.

There were robust auditing and quality assurance processes in place to review systems and allow ongoing learning and development.

This inspection, which was unannounced, took place on 24 and 25 May 2017 and 1 June 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager for Ryde House was also one of the directors and the manager for the Silver Birch unit.

However, the fact that one of the directors held different roles at different levels within the organisation with overlapping responsibilities created a lack of clarity, clear accountability and a lack clarity regarding responsibilities.

Staff across all of the units knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring. However, although the managers of three of the units had assessed individual risks to people, in the units Silver Birch and Beech House we found that risks were not always identified and managed effectively.

Staff across all of the units were responsive to people’s needs. However, although care plans in most of the units were personalised and focused on individual needs and preferences, this was not always the case in Silver Birch or Sycamore House units.

There were effective systems in place in four of the units to monitor the quality and safety of the service provided. However, in the Silver Birch unit the systems we less formal and less robust.

Staff across all of the units sought consent from people before providing care and staff followed legislation designed to protect people’s rights and freedom.

People told us and indicated they felt their unit was safe. Staff and the unit managers had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

Each of the units had suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessment. Healthcare professionals, such as chiropodists, opticians and GPs were involved in people’s care when necessary.

People across all of the units were supported by staff who had received an induction into their unit and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff developed caring and positive relationships with people and were sensitive to their individual communication styles and choices; they also treated people with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

In each unit there was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided both informally and through ‘house meetings’ and an annual survey. They were also supported to raise complaints should they wish to.

People and their families told us they felt their unit was well-led and were positive about their unit manager who understood the responsibilities of their role. The provider was fully engaged in running the home and provided regular support to the unit managers. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service.

Ryde House provides accommodation and support for up to 64 people, who have a learning disability or an autistic spectrum disorder. Accommodation was provided for people in four purpose built properties and the main older building, which were all run as independent homes within the grounds of Ryde House. People were able to access large grounds and a private beach.

The home 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.

People were not always protected from the risk of infection as infection control risk assessments were not regularly carried out to mitigate all risks. Infection control practices used by staff placed people at risk of harm from infection.

Appropriate arrangements were in place to manage most medicines safely. However, temporary arrangements for the storage of medicines in one house were not appropriate and needed to be replaced to meet legal requirements. In one instance, guidelines were not clear on when an ‘as required medicine’ should be administered. as part of a strategy to support a person when in crisis.

People’s capacity to make effective decisions was not always assessed and decisions made on behalf of them may not have been in their best interests. Relevant legislation was not being used effectively to protect the rights of individuals.

Staff did not always receive essential training, which the provider had identified as being required, to be updated annually. This meant care provided may not have reflected changes in law and guidance.

The provider was unaware of their legal obligations to notify the commission of certain incidents and had failed to do this when required. The provider was not taking effective measures to monitor the quality of the service overall.

Risks associated with the delivery of care were assessed and action plans were prepared to identify how to keep people safe when receiving care and support. Environmental risk assessments identified how to keep people safe in the home and surrounding environment.

Staff had received training in safeguarding people from abuse. They knew how to report concerns and who they should report those concerns to. The provider responded to reports of abuse and ensured they were managed appropriately. People and their relatives told us there were sufficient staff on duty to meet people’s identified care needs.

People received sufficient to eat and drink. Meals and drinks were nutritious and based on people’s individual choices and known preferences. People were able to access suitable health care treatment and assessments when required.

People and their relatives told us they had positive and caring relationships with staff and managers of the service. We observed staff were friendly, approachable and attentive to the needs of people. They were aware of how to maintain people’s privacy and dignity and ensured they knocked on doors and waited for a response before entering their room.

Staff knew the people they supported well. They knew how people communicated and supported them to make choices with their care based on their knowledge of the person, their likes, dislikes and how they demonstrated positive or negative responses.

People’s needs were assessed when they moved to the service. This assessment was regularly updated to include any changes to the person’s needs. Where people’s needs had changed, plans were prepared to ensure they received any necessary extra support.

Care plans were personalised and reflected the individual’s needs, likes and preferences. These clearly identified the support the person required and what the outcome of interventions should be for the person.

People were asked for their opinion of the care and support they received and were able to make complaints if needed. Action was identified by the provider of improvements required, although in one instance staff were unsure if the action taken had been effective.

There was a positive culture within the service and staff found their managers approachable and open with them. Staff were aware of the vision of the service to support people to be as independent as they could be.

The provider had a development plan in place to improve aspects of the service and involved staff in preparing guides for practical activities of care.