The inspection took place on the 12 and 13 May 2016 and was unannounced. Rawlyn House provides care and accommodation for up to 16 people with learning disabilities. On the day of our inspection 15 people were living in the service. Rawlyn House is divided into two separate buildings. The main house provides accommodation for ten people. The other unit is purpose built and accommodates six people who require wheelchair access. The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service had two registered managers, both working in the service most days.
We met and introduced ourselves with 14 people during our visit. Due to their complex needs people were not able to comment on all aspects of their care and support. However we were able to meet them and observed staff as they provided support. People used other methods of communication, for example pictures. A relative said; “I’m very impressed with the care.” A survey stated; “Very impressed with the quality of care you provide.”
The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked relaxed and were observed to be happy with the interaction between them and the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and/or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered as much choice as possible and their preferences were sought and respected. Care records were focused on giving people control and encouraging people to maintain their independence. Staff responded quickly to changes in people’s needs, for example if their behaviour changed. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support.
Due to people’s learning disability we saw a range of personalised communication methods and tools being used to support people. Communication aids were specific to people’s needs and were detailed as part of their support plan. We saw that people used this information and referred to these visual prompts to assist them when performing a certain activity or planning their day. We saw many examples of how the staff had really thought about people’s communication needs and ensured they were not a barrier to them achieving their goals and aspirations. We saw people being supported to use their individual communications methods and tools to help reduce anxiety and have greater control about their care and lifestyle.
People were supported to maintain good health through regular access to health and social care professionals, such as epilepsy nurses. Staff acted on the information given to them by professionals to help ensure people received the care they needed to remain safe.
People’s medicines were managed safely. All medicines were locked away. There were medicines policies and procedures in place. However, medicines audits completed had not picked up some minor issues. Action was taken on the day to update records and prevent reoccurrence.
People’s health and well-being needs were well monitored. The registered managers and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People enjoyed the meals offered and had access to snacks and drinks at any time. People were involved in food shopping, planning and preparing meals as much as they were able. People were supported to say if meals were not to their liking.
People’s risks were documented and well managed. We saw many examples of how staff had considered ways of helping people achieve their goals and aspirations. People were encouraged to live active lives and were supported to participate in community life where possible. Activities were meaningful and reflected people’s interests and individual hobbies. People thoroughly enjoyed activities within the home such as arts and crafts, singing and dancing and excursions to places of their choice such as the theatre and those who wished to go away enjoyed holidays.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.
People’s mental capacity had been assessed which meant care provided by staff was in line with people’s best interests. Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. Staff had completed safeguarding training and understood what constituted abuse and how to report concerns. Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.
People were protected by safe recruitment procedures. Staff received a comprehensive induction programme and the care certificate (A nationally recognised set of skills training). Staff were very kind, caring and thoughtful. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff had completed training and had the right skills and knowledge to meet people’s needs.
There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered managers had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s care and support needs. Staff described the management as open, very supportive and approachable. Staff said they felt like part of a large family and talked positively about their jobs. Staff said both registered managers made themselves available and worked in the home regularly. All staff talked positively about their roles. There was an open, transparent culture and good communication within the staff team. A comment included; “I didn’t know such kindness existed until I came to work here.”
Relatives and professionals said there was an open door policy and staff always listened and were approachable. They told us they did not have any current concerns but any previous, minor feedback given to staff had been dealt with promptly and satisfactorily. Any complaints made would be thoroughly investigated and recorded in line with Cream II Limited’s own policy.
People, friends, relatives and staff were encouraged to be involved in meetings held at the home and helped drive continuous improvements. Listening to feedback helped ensure positive progress was made in the delivery of care and support provided by the home. There were effective quality assurance systems in place. However audits did not pick up errors in the people’s medicines. Any significant events were appropriately recorded and analysed.
Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback was sought from relatives, professionals and staff to assess the quality of the service provided.
People lived in a home that was hygienically clean, spacious and suitably adapted for the people who used the service. All furniture and fittings were suitable to meet people’s needs. People had easy access to very attractive landscaped gardens with walkways and seating. All bedrooms had en-suite facilities. We found the provider had considered the design of the building and put arrangements in place to ensure the premises met people’s needs. This meant the provider had put in place facilities to support and improve the quality of life for people living in the home. When we inspected the sensory room in the garden we saw that the service had created a suitable friendly environment for people.