We inspected this service on 10 April 2018. The inspection was unannounced. Rix 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. Rix House provides accommodation and personal care; it does not provide nursing care.
At our last comprehensive inspection in January 2016 Rix House was rated ‘good’ overall. However, due to concerns with the way medicines were managed the safe domain was rated ‘requires improvement’. We completed a focused inspection in June 2016 to check the issues with medicines had been addressed. We saw some improvements had been made to the medicines management system. However, we could not improve the rating for safe from ‘requires improvement’ because we did not see evidence of consistent and sustained good practice. At this comprehensive inspection we found some of the persistent issues around medicines management had still not been addressed. Therefore we have rated the service ‘requires improvement’ in the safe and well led domains. This means the service is now rated ‘requires improvement’ overall.
Rix House accommodates up to 20 people in one adapted building. The service specialises in caring for adults with learning disabilities. At the time of our inspection there were 14 people living at the home and two people who were staying for a short period of respite care.
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.
A registered manager was in place. 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 received personalised care from staff who were kind, caring and friendly. Staff knew people well and adapted their approach to meet people’s individual needs.
Medicines were not always managed in a safe and consistent way; improvements were still needed to ensure people consistently received the right support with prescribed creams, lotions and drops. This issue has been repeatedly highlighted as requiring improvement by the Commission.
Staff knew how to recognise and report concerns about people’s safety and welfare. Systems were in place to ensure risks were appropriately managed.
Staff received appropriate training to ensure they had the skills to deliver effective care. Before staff could start work appropriate checks were made to ensure they could safely care for vulnerable people.
The home was clean and tidy and the provider ensured the environment was safe and suitable for vulnerable people to live in.
Staff supported people to engage in interests and activities both within the home and in the local community. Staff respected people’s interests and personal pursuits.
People were involved in developing menus which meant they received food and drink which they enjoyed. Nutritional risk was effectively managed.
Staff worked in partnership with other agencies and healthcare professionals to ensure people maintained good health. The registered manager sought local and national initiatives which they could participate in to help improve the quality of care people received.
Staff treated people with compassion, dignity and respect. There was a positive focus on empowering people to be as independent as possible.
There was an open and inclusive culture. People and their relatives were involved in making decisions about their care and how the service operated. Staff respected people’s views and responded to their concerns.
Staff continuously sought new ways to communicate with people and ensure everyone had the opportunity to consent to the care they received and express their views. Staff worked in line with the requirements of relevant legislation such as the Deprivation of Liberty Safeguards (DoLS).
Staff told us they would recommend the service as a place to receive care and as a place to work. Feedback about the registered manager was very positive; people told us they were hands on and led by example.
Systems and checks for monitoring the quality of care were in place however they did not always identify and address areas for improvement. Shortfalls in service delivery were not always promptly addressed and sustained.
We identified one breach of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.