About the service Rutland House Community Trust is a residential care home registered to provide personal care for up to 10 people with a physical disability, learning disability, or autistic spectrum disorder.
Not everyone who lived at Rutland House Community Trust received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were eight people living at the home at the time of the inspection, seven received personal care.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe and well-led. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support:
• Model of care and setting maximises people’s choice, control and independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
The home was in a local residential area. However, it was at the end of a side road on a separate gated area.
The home was bigger than most domestic style properties. Yet the size did not have a negative impact on people. We believe this was because the home was under occupied. An increase in the number of people living at the home may impact on the provider’s ability to provide personalised care.
The care home was spacious and had two communal areas people could use. There was an additional seating area in the foyer.
The provider had identified the need to refurbish and redecorate the home and were reviewing options available to them at the time of inspection, to ensure this met the requirements of Right support, right care and right culture.
Quality assurance systems and processes had not always been undertaken or identified concerns we found on inspection. We observed occasions where staff wore face masks below their chin in close proximity to people. Improvements were needed to systems and processes to check visitors and staff entering the building did not have symptoms of COVID-19 or had been a close contact of someone with COVID-19.
Staffing levels had not been regularly reviewed to ensure they met the needs of the service. There were not enough staff employed or deployed to meet the needs of the service. This put additional pressure on care staff and meant they did not always have time to spend with people to support them with their social and recreational needs. The provider was experiencing challenges in fulfilling staffing vacancies at the time of the inspection.
Improvements were needed to the providers medicines recording keeping systems. People received their medicines from staff that had been trained in medicines management.
People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The registered manager was passionate about providing person-centred care and knew people well as they were involved in care delivery. People received support from staff that knew them well. They had positive behaviour support plans in place, which were person-centred. Staff were discouraged from wearing anything that suggested they were care staff, other than the PPE required to keep people safe.
People were supported by staff that knew how to keep them safe from harm or abuse and had been safely recruited. Staff had a good knowledge of risks associated with providing people’s care and had received training relevant to people’s needs.
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 02 March 2019).
Why we inspected
We received concerns in relation to the management of people’s falls risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. 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 Rutland House Community Trust on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches in relation to the governance of the service and staffing.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.