Housing 21 - Rohan Gardens

Rohan Gardens is an extra care service, which provided personal care to people living in their own homes in a 42-apartment residential area of Warwick. People are supported by staff during pre-arranged care calls. At the time of our inspection there were 20 people using the service.

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

There had been improvements in the way service promoted people’s safety and was led.

People were confident staff would assist them if they required any support with their safety. Risks to people’s safety were now appropriately assessed and monitored. People’s care plans and risk assessments were regularly updated as their needs changed. Staff had completed training linked to people’s specific safety needs and promptly took action to support people when they wanted assistance. People were supported to have the medicines they needed to remain well. Staff took action to reduce the likelihood of the spread of infections.

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.

Improvements had been made to the way the service was managed and monitored. Governance systems now alerted the registered manager to any concerns or improvements required in the safety and quality of the service. There was a positive and open culture within the service. People had opportunities to share their views about the service and were complimentary about the support they received. People and staff told us the registered manager was visible and approachable. The service worked positively in partnership with health and social care colleagues to meet people’s needs.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Rating at last inspection and update.

The last rating for this service was requires improvement (published 26 February 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service, including the findings at our last inspection.

We carried out an announced focused inspection of this service on 28 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management of people’s safety and how the service is run.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Housing 21- Rohan Gardens on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rohan Gardens has 42 apartments. People living at Rohan Gardens share on-site facilities, such as lifts, lounge, restaurant, laundry and garden. People who need support with personal care are free to choose Housing and Care 21 - Rohan Gardens or any other domiciliary care service as their provider. At the time of this inspection, the service supported 17 people with personal care.

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

Risks associated with people's health and care needs were not always assessed and governance systems to monitor the quality and safety of the service required improvement.

The registered manager and provider had failed to maintain sufficient oversight of the service, to identify that risk management was not consistently effective or in place.

Some audits were in place, but they were not robust enough to ensure areas for improvement were identified and action taken in a timely way. Staff did not always have the training or information they needed to consistently reduce risks of potential harm or injury to people. Care plans were not regularly reviewed or updated to contain all the information needed by staff to support people safely.

Improvements were needed related to risks of cross infection between people. We found the provider was not always following government guidelines associated with COVID-19. Improvements had been made to infection prevention and control practices following support from the local authority (LA) and the local clinical commissioning group (CCG). However, further improvements were still required to keep people as safe as possible and minimise infection control risks associated with COVID-19.

There were enough staff on shift to meet people's agreed care calls, but staff told us there had been numerous occasions when staffing levels at night needed to be increased to allow them to support people in a safe and more dignified way.

There had been recognition that some aspects of medicines management required improvement following reported medicine administration errors. Improvements had been made. Staff received assessments on their competency and skills in supporting people with their medicines.

Overall, people spoke positively about the care staff and the care they provided. However, people felt improvements were needed in the management team. Staff did not feel consistently supported by the management team.

The registered manager was registered with us for Rohan Gardens and another Housing and Care 21 service. However, we were told the registered manager was not based at Rohan Gardens and had not visited since November 2020. The registered manager had failed to inform us of their absence as they are required to do so. We found there was a lack of support from the registered manager and provider to the Housing and Care Manager who had day to day responsibility for the management of Rohan Gardens. The Housing and Manager was open and explained this was their first managerial role and they had struggled with some aspects of their role because systems and processes were not in place at Rohan Gardens.

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. (Report published 24 October 2018).

Why we inspected

Prior to our inspection, we had received whistle-blowing concerns about infection prevention control management, the safe handling of medicines and reduced staffing levels at night. These concerns were looked at as part of our inspection. We were aware of an on-going police investigation into a safeguarding concern, however this was not a part of our inspection as this matter is being handled by the police.

We joined a multi-disciplinary meeting with the local Clinical Commissioning Group (CCG) and the local authority (LA). They gave immediate support and guidance related to infection prevention control.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Housing and Care 21 – Rohan Gardens on our website at www.cqc.org.uk.

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this inspection.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches of the regulations in relation to the safety of people's care and the management of the service. We have identified a further breach of the registration regulations in relation to the registered manager’s legal duties to notify.

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 work alongside the provider, the local CCG and the LA to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Housing and Care 21 – Rohan Gardens is registered to provide personal care to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented or purchased on a shared ownership scheme, and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection only looked at people's personal care service.

Housing and Care 21 – Rohan Gardens also provide an on-call emergency service to everyone living in the building under a separate arrangement which people pay for as part of the service charge for the shared premises.

Rohan Gardens has 42 apartments. People living at Rohan Gardens share on-site facilities such as lifts, lounge, restaurant, laundry and a garden. People who need support with personal care are free to choose Rohan Gardens or any other domiciliary care service as their provider. At the time of this inspection, Rohan Gardens supported 24 people with personal care.

There was a registered manager in post. 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.

We last conducted a comprehensive inspection of the service in August 2016, where the service was rated as ‘Good’ overall, however effective was rated as ‘Requires Improvement’, because the provider had not met the legal requirements of the Mental Capacity Act 2005. We conducted a focussed inspection in October 2017, to review improvements made by the provider in that area and we rated the service as ‘Good’ because satisfactory improvements had been made. At this inspection we found the evidence continued to support the rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from the risks of abuse because staff received training in safeguarding people and understood their responsibility to report any concerns to senior staff. Most risks to people's health and wellbeing were managed, however some risks had not been fully assessed.

The manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely and effectively. The provider checked staff were suitable for their role before they started working for the service.

Staff worked within the principles of the MCA and supported people to have maximum choice and control of their lives. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences. People were supported to maintain their health.

People felt well cared for. Staff understood people’s needs and interests and supported them to enjoy their lives according to their preferences. Staff respected people’s right to privacy and supported people to maintain their independence.

The provider and the registered manager demonstrated they valued care staff and promoted their learning and development. Staff enjoyed their work and were motivated to provide people with a good standard of care.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. People knew how to complain and had the opportunity to share their views and opinions about the service they received.

People were happy with the quality and leadership of the service. The registered manager was committed to ensuring people received good quality care and shared good practice with staff. There were processes to monitor the quality of the service, however they had not identified some risks were not fully assessed.

This inspection took place on 04 October 2017 and was unannounced.

We had previously carried out an unannounced comprehensive inspection of this service in August 2016. At that inspection we found the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We gave the provider a rating of 'requires improvement' in 'effective' as a result. This was because, where people lacked capacity to make decisions, this was not always clearly assessed or recorded. Applications to protect people who were being deprived of their liberty had not been made to the local authority as required. Following our visit, the provider sent us information telling us how they planned to ensure they met the legal requirements.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements. We found the provider had made the required improvements and was no longer in breach of the regulation. This report only covers our findings in relation to those requirements and to the key question of how effective the service was. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Housing and Care 21 - Rohan Gardens, on our website at www.cqc.org.uk.

The service is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of this inspection the service had a registered manager in post.

People were supported by staff who were well trained and knowledgeable, and knew about people's needs and how they preferred them to be met. Staff had access to essential and specialist training on an ongoing basis, and had regular opportunities to meet individually so they could develop.

The registered manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. People were asked for their consent before staff supported them.

Staff supported people to eat a healthy and regular diet so they could manage their own health conditions. Staff supported people to attend health appointments, and ensured people had access to urgent medical attention where required.

Rohan Gardens provides housing with care. People live in their own flats and received personal care and support from staff at pre-arranged times throughout the day, and in emergencies. Rohan Gardens consists of 42 flats and at the time of our visit, 24 people at Rohan Gardens received personal care.

The service had a registered manager, however they had been on extended planned leave since May 2016. The service was being managed by a deputy manager who was in the process of making an application to be registered with us. 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 felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Staff knew what actions to take to keep people safe and had a good understanding of what constituted abuse. The suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

The deputy manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided personal care and supported people to retain as much independence as possible.

There were enough staff to deliver the care and support people required. Staff received training and supervision to support them in meeting people’s needs effectively and to help develop their own learning.

People received care from a team of staff they were familiar with, who stayed long enough to complete the care calls people required. People told us staff were kind and respectful and knew how they wanted to receive their care.

Support plans and risk assessments contained relevant information to help staff provide the personalised care people required, although some required further information to ensure staff continued to provide consistent care. People knew how to complain and information about making a complaint was available for people. People told us they felt they could raise concerns or complaints if they needed to because the management and staff were always available and approachable.

Staff had opportunities to raise any concerns or issues with the managers, knowing they would be listened to and acted on.

Management provided good leadership and who care staff found approachable and responsive. There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service.

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

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found people's care records had been recently reviewed by a senior member of staff. We saw people's care records reflected most of their care needs.

We saw people had risk assessments in place that made sure most risks to their health and wellbeing were managed. However we found some people who were at risk of developing pressure areas to their skin had not been assessed. We found there was some information in people's care plans which gave instructions to staff about how to check people's skin integrity.

We found staff understood the importance of safeguarding vulnerable adults and knew how to report a concern. People we spoke with told us they felt safe using the service.

We found information relating to some incidents was not reported straight away to senior staff.

We looked at staff records and found the provider's recruitment practice was safe and thorough.

Is the service effective?

People told us the care they received met their needs. When talking about the care staff, one person told us, 'They're great.' Another person told us, 'They ask if there's anything I need.'

Staff we spoke with had a good understanding of the needs of the people they supported and what they told us was reflected in people's support plans.

Is the service caring?

We spoke with four people who used the service. They gave us mixed views about how the staff treated them. Some people were satisfied with the service and told us staff were 'very friendly and polite'. Other people told us staff had not treated them with respect. They told us they had raised these issues with the care team leader and improvements had been made to the service they received.

Is the service responsive?

We found people had been asked for their views about their care in a recent customer survey. We found some issues had been raised by people about the quality of care they received. The care team leader explained how these issues had been addressed on an individual basis with people.

We saw incidents, accidents and complaints had been logged. We found the service had taken action, but some of the actions had not been fully documented.

People told us care staff noticed when their needs changed and took action.

Is the service well led?

We found the service had an internal quality assurance system in place. The provider visited the service at intervals and checked a variety of issues. There was an action plan in place which identified improvements required to be undertaken by the manager. We saw the manager had engaged with the plan and was working towards completing it.

People who used the service told us they were able to speak with the manager and the care team leader and felt able to raise any issues or concerns they had. We found issues were responded to by senior staff in a timely way.