Ruth Lodge

Ruth Lodge provides care and support for two people with learning disabilities. At the time of our inspection, two people were using the service. The service was set out over three floors. One person was able to verbally communicate with us while the other person was unable to verbally communicate with us.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

The registered manager failed to notify CQC of suspected abuse or exposure of people who lived in the service to a risk of harm.

While staff understood their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally, both staff and registered manager failed to report an incident externally as appropriate. The registered manager failed in their responsibilities in relation to reporting safeguarding concerns. This is an area for improvement.

Medicine administration continued to be managed safely by both staff and the registered manager. However, we found that staff competency checks were not regularly carried out. We have made a recommendation about this in our report.

People were not consistently safe at Ruth Lodge. However, staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.

One person said,” I am happy here.” Our observation showed that people were happy living at the service.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them. They felt a part of their local community and were supported to use local resources to their advantage.

Staff understood the importance of promoting people’s choices and provided the support people required while promoting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

People and their relatives were involved in the running of the service and were consulted on key issues that may affect them.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

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 requires improvement (Report published 14 August 2018) and there were three breaches of the 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. However, we have found evidence that the provider still needs to make further improvements in order areas. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Ruth Lodge Care Home Ltd 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.

Ruth Lodge provides support for up to two people with learning disabilities. There were two people who had one to one support living at the service at the time of inspection. The service was spread over three floors of one house in a residential area and had an enclosed garden at the rear.

There was a registered manager at the service who was also the provider. 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.

The care service has been developed and designed 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.

At the last inspection on 19 January 2016 the service was rated Good. At this inspection we found that the provider had been unable to sustain the rating of Good as we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to the failure to provide good governance, the mitigation of risks from the environment and staff recruitment processes.

Staff had not been recruited safely. The provider had failed to obtain a full employment history for existing staff. Other pre-employment checks had been carried out. There were sufficient numbers of staff to meet people’s needs and keep people safe. Staff were appropriately supervised.

Risks to people from the environment had not always been addressed in that the provider had failed to ensure that there were safe systems and procedures for evacuation in the event of an emergency such as a fire at the service. Risks to people from other incidents such as choking continued to be assessed and there was guidance in place to support staff to minimise risks.

A programme of quality audits were in place but had not been effective in highlighting the issues we found at this inspection.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Staff were confident that any reported concerns would be dealt with appropriately. Where people were at risk from bulling and harassment there was guidance in place to enable staff to protect people.

Medicines continued to be managed safely. Medicine records were accurate and up to date and people received their medicines on time and when they needed them. Medicine was stored safely and staff had the training they needed to administer medicines safely.

People’s needs were appropriately assessed and support plans were up to date and accurately reflected people’s needs. People and their relatives were involved in decisions about their support as appropriate. Where people did not have capacity to make decisions staff had followed guidance in line with the Mental Capacity Act 2005.

Some people at the service could display behaviours that affect them and other people around them. There was sufficient guidance for staff to support people to maintain behaviour and protect their dignity. The service had supported people to reduce incidents of behaviour that challenged.

Staff had the skills, training and knowledge they needed to support people safely and effectively. There were opportunities for staff to undertake training and development to enhance their skills.

People were supported to eat and drink healthily and maintain or achieve a balanced diet. People were supported to manage and monitor their health and had appropriate access to healthcare services when they needed it. When people accessed other services such as going in to hospital they were systems in place to ensure continuity of care.

People were treated with respect, kindness and compassion. People were supported by a small staff team that knew them well and understood how to meet their needs. Staff knew how to support people to communicate and express their views. People were supported to maintain relationships with those who were important to them and develop new relationships in the community. People were supported to increase their independence as appropriate and learn new skills.

There were systems in place if people or their relatives wished to complain or provide feedback on how the service could be improved. Staff were involved in developing the service and felt that their views and suggestions were listened to. Relatives told us that they found the service responsive to suggestions.

The environment was suitable to meet people’s individual needs.

Staff and the provider understood their roles and responsibilities. The provider had a clear vision and values for the service and staff understood and acted in accordance with. The provider worked in partnership with other agencies to develop and share best practice.

When things went wrong lessons were learnt and improvements were made. Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon. Lessons learnt were shared with staff.

We found three breaches 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.

Ruth Lodge is registered to provide accommodation and personal care for two people who need 24 hour care. People who use the service were non-verbal, needing support to undertake life skills and be safe in the community. At the time of our inspection, people who lived in the home were dependent on the staff to provide personal care or prompting when necessary to complete life skills.

There was a registered manager at the home who was also the provider. 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 who used this service were protected against the risk of abuse; and staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s day to day care and details of how these risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of suitable staff to meet people’s needs and promote their independence and safety. Staff had been provided with relevant training and they attended regular supervision. Staff were aware of their roles and responsibilities and the lines of accountability within the home.

The registered manager/provider promoted a safe recruitment practice, which ensured staff were suitable for their job role. Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager/provider understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

The systems for the management of medicines were followed by staff. People received their medicines safely. They also had good access to health and social care professionals when required.

People’s families had been involved in assessment and care planning processes. Support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

People were always motivated, encouraged and supported to be actively engaged in activities inside and outside of the home. For example, people went out to their local community most days of the week for activities, including visiting their local club for activities and horse riding.

A health action plan was in place and people had their physical and mental health needs regularly monitored. Regular reviews were held and people was supported to attend appointments with various health and social care professionals, to ensure they received treatment and support as required.

Feedback was sought from the family and used to improve the care. People’s families knew how to make a complaint and a copy of the ‘how to complain’ was available in the home. No complaints had been received but it was evident that there was a very inclusive relationship with people’s family.

The registered manager/provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager/provider understood the requirements of their registration with the commission.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The person who lived at Ruth Lodge was treated with respect and dignity by the staff. Although the person was not able to communicate verbally, we saw that they were comfortable and happy with the staff. Safeguarding procedures were in place and staff understood how to safeguard the person they supported. We saw the home had a safeguarding and whistleblowing policy and followed the safeguarding protocols supplied by the local authority. There were systems in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. The home worked alongside the social services care managers in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made. This meant that people were safeguarded.

The service was safe, clean and hygienic. The registered manager sets the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Is the service effective?

The person's health and care needs were assessed with them and their family. They were involved in writing their plans of care. These were reviewed regularly by staff and with the family and care manager. Goals had been agreed and monitored in order that the staff could enable the person to improve their life skills and their quality of life. The person's needs were taken into account and the layout of the home enabled the person to move around freely and safely. The premises had been sensitively furnished and decorated to meet the needs of person living there.

Is the service caring?

The person was supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting them. The person's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with the person's wishes. The person was not able to communicate verbally. The person's care plan seen, described well the meaning of the person's different behaviours, from this we were able to see that the person who lived in the home was happy around the staff. We were able to see that the person was happy with our presence and comfortable with doing what they wanted during the visit. Staff guided the person only, they promoted them, and were very patient with them.

Is the service responsive?

The person was involved a range of activities in and outside the service regularly. The staff enabled the person to be involved with their local community. We saw that although the person had not lived at the home that long staff had responded to that person's needs. They had recognised that the person had a problem eating. They realised for example this could cause a loss of dignity in the community so staff would encourage the person to eat suitable meals when out. At the same time when eating at home, support was given to gradually improve the way the person eats.

Is the service well-led?

The service worked well with other agencies and services to make sure the person received their care in a joined up way. The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff spoken with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.