We conducted an unannounced inspection at Ruddington View on 15 November 2018. Ruddington View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ruddington View accommodates up to eight people in one building. On the day of our inspection, five people were using the service, all were people living with a learning disability. This was the first time we had inspected the service since they registered with us.Ruddington View is a new model of care that aims to enable people with learning disabilities to live and remain in their local community. Although the size of the service exceeds the maximum of six people as specified in the CQC policy, Registering the Right Support. It had been developed in line with the Registering the Right Support values of choice, independence and inclusion. Ruddington View was developed in response to the national ‘Transforming Care’ agenda, which aims to improve health and social care services so that more people with a learning disability can live in the community.
Within Ruddington View there are two short term ‘unplanned care’ apartments, offering support to people who may be in a period of crisis and require additional support to remain in the community. The remaining six places are ‘step down’, these are for people who have been in long term hospital placements who require support to enable them to move into the community. Ruddington View is staffed by support workers with specialist input from a behaviour therapist.
There was a registered manager in post at the time of our inspection visit; however, they left their post during the course of our inspection. 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.
During this inspection, we found the service was not safe. Risks associated with people’s behaviours were not managed safely. Risks had not always been assessed and there was a lack of guidance about how to manage some people’s behaviours. Staff did not always have the skill or guidance to respond appropriately in risky situations. This placed people who used the service and staff at risk of harm. Opportunities to learn from incidents had been missed. When incidents had been investigated the actions taken were not timely and did not reduce the immediate risks to people. People were subject to restrictive interventions that did not respect their rights. The use of medicines to manage people’s behaviours was inconsistent. There were not always enough suitability qualified staff available to meet people’s need and ensure their safety. Despite this people told us they felt safe and safeguarding referrals had been made. Overall, the home was clean and hygienic.
People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Although we found most permanent staff had training in key areas, further work was needed to embed learning into practice. Staff did not always receive supervision and felt unsupported following potentially distressing incidents. Further work was needed to ensure the environment met people’s needs. People had enough to eat and drink and their physical health needs were met. The ‘unplanned care’ part of the service had been effective in preventing hospital admissions.
Peoples choices were not always respected. There was a lack of consistency in the staff team and this had a negative impact upon the development of trusting relationships with people who used the service. People’s right to privacy was not always respected. The approach to building people’s independence was inconsistent and not always well planned. Overall, people told us they were supported by staff who were kind and caring.
People did not always receive consistent support. Support plans were not always up to date and did not reflect people’s needs. The risk of inconsistent support was exacerbated by the use of temporary agency staff. There was a risk people’s diverse needs may not be met. The approach to social and recreational activity was not well planned. There were systems and processes in place for people to provide feedback and to deal with, and address complaints.
There had been a failure to identify and address some serious issues. Where issues had been identified timely action was not taken to make improvements. Systems to analyse, investigate and learn from incidents were not effective. Staff gave mixed feedback about the support they received from the management team, they told us it was not always well organised and they were not given opportunities to influence the running of the home. Records of care and support were not accurate or up to date. Following our inspection, the provider developed a comprehensive and robust action plan detailing actions taken and planned to make improvements and reduce risk.
This was the first time the service had been rated as Inadequate. During this inspection, we found five breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.