This inspection took place on 20 September and 4 October 2017. The first day of the inspection was unannounced.

Rodney House 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. The building is a large Georgian style building with a more recent extension over five floors in a city centre location. The home had 57 rooms all for single occupancy; nine of the rooms were en-suite. For people living at the home there were three lounge areas and smaller sitting areas on different floors. There were also two dining areas, two smoking rooms, bathrooms and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 57 people. At the time of our visit 55 people were living at the home. Rodney House supports people who may have a physical disability or require support with their mental health.

The home required and had a registered manager. 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 our previous inspection in December 2016 we had found breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service was ‘requires improvement’ and the key question ‘Is the service safe?’ was rated inadequate. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; ‘Is the service safe?’ ‘Is the service responsive?’ and ‘Is the service well-led?’ To at least a rating of good. After our previous inspection the owner and registered manager quickly took steps to make improvements. These improvements meant that all of the breaches we identified in December 2016 had been addressed. At this inspection, the service was compliant with all of the health and social care regulations.

As the domain of safe was rated inadequate at our last inspection, we were unable to rate it any higher than requires improvement at this inspection. This was because the provider needs to show that they can sustain these improvements over time. We will therefore check this at our next inspection. The domains of ‘responsive’ and ‘well-led’ were rated 'requires improvement' at the last inspection and were found to be good at this inspection. The overall rating is now ‘good’.

During our previous inspection we saw that a number of people living at the home were smoking in their bedrooms, this was unsafe and against the home’s smoking policy. There was a designated smoking room within the building that the home’s policy highlighted was the only safe place to smoke within the building. The registered manager and owner had taken some steps to keep people safe. However these had not been adequate as the home did not have the systems, staffing capacity or equipment to ensure people were kept safe.

After our previous inspection the owner and registered manager quickly took steps to ensure people were safe. The registered manager and the owner set up an additional smoking room on the ground floor and installed a system which was sensitive to cigarette smoke in people’s rooms that alerted staff at reception rather than setting off an alarm. Staff went to people’s rooms to remind them to use the smoking areas provided and asked them to extinguish the cigarette. This encouraged an increase in people using the designated smoking areas. During our inspection we saw that this system was operational and we observed staff using it to keep people saf

This inspection took place on 8, 12, 16 and 20 December 2016. The first two days of the inspection were unannounced.

Rodney House is a large Georgian style building with a more recent extension over five floors in a city centre location. The home had 57 rooms all for single occupancy; nine of the rooms were en suite. For people living at the home there were three lounge areas and smaller sitting areas on different floors. There were also two dining areas, a smoking room and toilets, bathrooms and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 57 people. At the time of our visit 57 people were living at the home. Rodney House supports people who may have a physical disability or require support with their mental health.

The home required and had a registered manager. 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 our inspection we found breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

It became clear during our inspection that at least 14 people living at the home were smoking in their bedrooms, this was against the home’s smoking policy. There was a designated smoking room within the building that the home’s policy highlighted was the only safe place to smoke within the building.

There was another specific fire risk that had not been adequately risk assessed and the risk had not been sufficiently reduced. Also we found that people’s personal emergency evacuation plans (PEEP) did not contain sufficient detail.

There were aspects of the home’s environment that were unsafe. A number of doors with signs on them saying ‘keep locked’ were open. These provided access to bulk storage of cleaning chemicals, personal documents and the home’s loft space. These are areas that contained risks for people living at the home. French doors opening onto a balcony between the first and second floors were not secured and were accessible to people at the home. In the kitchen, food was not being stored safely. During our visit the registered manager addressed these concerns with regard to the environment. They had also started to address the issue of people not keeping to the smoking policy.

Some of the checks and audits of the home and its environment and reviews of people’s care plans had not been effective. They had not addressed the concerns highlighted during our inspection.

We found the home to have a pleasant and relaxed atmosphere. We saw people being supported with kindness and respect during difficult times. The registered manager told us that “People who come here may have had very chaotic lives. We offer support that is non-judgemental in a family atmosphere”. Many people we spoke with who lived at the home told us they were happy living there. One person said, “It’s beautiful. It’s the only place where I’ve settled”. People told us that they were happy with the care staff. Visitors to the home told us they had seen good care. One visitor said, “The staff are always patient with people, never seen anyone be short”.

We found that the service operated within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguard (DoLS) applications had been made for some people who would benefit from them. We saw that this had been done thoughtfully for specific reasons after the person’s capacity to contribute to the decisions had been assessed. People’s consent to care and treatment at the home was sought and if they wished people were involved in planning their care.

Feedback from people who lived at the home, staff and visitors about staf

This inspection was carried out by two inspectors in response to concerns raised regarding the service.

We considered our inspection finding to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that improvements were needed to the management of infection control procedures around the building. This was because during our visit we found that appropriate actions had not taken place to help ensure that adequate standards were maintained in and around the building.

Is the service effective?

We saw that improvements were needed to ensure that people received the care and support they required. This was because people had not always received their planned care. For example, one person’s care plan stated that they required support with maintaining the cleaning of their bedroom and changing their bed linen. We saw that this support was not being delivered.

Is the service caring?

People who used the service told us that they liked the staff. We spoke with a number of staff who worked directly with people who used the service and they demonstrated an awareness of the people they supported.

Is the service responsive?

We saw that systems were in place to monitor the service delivered at the home. However, we saw that improvements were needed in relation as to how the service responded when areas of improvement had been identified. For example, we saw that an infection control audit had taken place in February 2014 which identified areas of improvements needed, however no action had been taken in response to the improvements that were needed.

Is the service well led?

We saw that improvements were needed to the management of quality assurance systems around the home. This was because the current systems in place had failed to identify the need for improvements in relation to the environment and cleanliness around the home. Once they had been made aware of the concerns identified around the service they took action immediately.

We spoke with seven people who lived at Rodney House and asked them if they were happy living there. Most people told us they were happy and that staff helped them to be independent. We saw that staff treated people with respect and asked for their permission before carrying out any personal care.

One person told us they were not happy and they wanted to leave. We spoke to the manager about this and reviewed the person's care records. We saw that a meeting had taken place and the person had agreed to remain at the home until an alternative could be found. This showed that people were listened to and the home worked with other professionals to obtain the best outcome for the person concerned.

We saw that other health and social care professionals were often consulted because of the nature of people’s support packages. People spoken with told us they were assisted to dental and GP appointments and staff said that specialists and district nurses came to the home to provide treatment to the people who lived there.

Comments from people we spoke with about the home included :

"This is a good place".

“On a good day I'm really happy".

“I’m very happy here, the staff are great” and

“I don't really like it, but they support me and look after me".

We reviewed the environment and found carpets were well fitted, radiators were covered and upstairs windows were restricted from opening too wide. Regular maintenance of equipment was carried out by the maintenance person and fire checks were undertaken weekly. This meant that people were protected from risks around the environment they lived in because measures were in place to prevent them.

We reviewed eight staff files to make sure that appropriate checks were made on staff prior to them being employed by the service. In all files reviewed we saw that necessary pre-employment checks had been carried out and appropriate training had been provided.

There was a complaints policy in place and it was evident that complaints were listened to, acted upon and learned from.

We spoke with twelve people living at Rodney House who gave positive comments about the care and treatment that they had received. People told us that they had been involved in making everyday choices and decisions, including how their care was provided. They said they had been treated with respect and their privacy and dignity had been maintained by staff at all times. Comments made by people using the service included: "All the staff are great", “They always knock on my door before coming into my bedroom and they are polite”. “The staff care very much”. “The staff have helped me get well”.

People told us that they had accessed the community and joined in activities arranged at the home. People commented that they enjoyed activities and events which had taken place at the home over the Christmas period.

People using the service told us they knew how to complain and would do if they were unhappy about any aspect of their care and support. They also told us they were confident that staff would listen to any concerns they had and that they would sort them out. People said they felt safe using the service and would tell someone if they had been mistreated or thought somebody else had. We saw that people had been given the opportunity to put forward their views about how the home is run and that they had made suggestions about change.

People who use the service told us during our visit that they enjoy living at Rodney House. People told us that the care provided is good and that the staff are polite and very caring. They told us they know all the staff as they had been there for a long time and they are very respectful and always knock on their bedroom door before entering.

People who use the service told us that they know about their care plans and have been involved in making decisions about their care and treatment.

One person who uses the service told us that they are a member of a 'residents’ involvement group which has recently been set up in the home.

People told us that they know how to complain and are confident that their complaints would be listened to and dealt with in the right way.

People who use the service told us that they have a good choice of food available at Rodney House and that they have two choices of hot meals every lunch time and a selection of cold foods in the evening. A number of people also told us about the range of activities available to them and that they enjoy playing bingo, visiting the Irish Centre and going shopping.

People told us that they feel safe and well supported at Rodney House.

People also told us that staff treat them well and if they were treated badly or if they saw some other person being treated badly they would tell the manager or a member of staff. One person told us that they would not stand by and watch anyone being mistreated and if they witnessed abuse they would either see the manager or call social services.

During our visit we also spoke to other health and social care professionals who have regularly visited Rodney House to see people who use the service. They told us that the staff have been very helpful and have a good rapport with the people who use the service. The also told us that they feel like the care has improved over the past year and concerns raised by visiting professionals have been addressed.

At our last inspection in June 2014, breaches of legal requirements were identified. We asked the provider to take appropriate action to ensure improvements were made. We undertook this comprehensive inspection on the 30 April and 5 May 2015. During this visit we followed up the breaches identified during the July inspection and found the provider had taken appropriate action in relation to the majority of the breaches previously identified.

Sufficient improvements had been made to way in which staff ensured peoples’ dignity and respect, the safety and suitability of the premises and its cleanliness. Appropriate action still need to be taken with regards to people’s care and welfare and how the provider assessed, monitored and managed the quality of the service provision.

Rodney House Care Home offers single occupancy accommodation over five floors. The home provides support for people with their personal care needs. There are 57 beds reserved for this purpose. The home offers short stay accommodation and long term care. At the time of our visit, there were 54 people who lived at the home, one of whom was accessing short stay accommodation.

There was no registered manager at the home. 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.’ A new manager had commenced employment at the home in November 2014 and had applied to the Care Quality Commission (CQC) to become the registered manager. This application was still in progress at the time of our visit.

During this inspection, we found breaches of Regulations 9, and 11 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 this report.

People’s care plans did not cover all of people’s needs and risks. They lacked person centred information to enable staff to understand and relate to the people they were supporting and people’s emotional needs were not fully considered in the planning and delivery of care. For example where people had episodes of challenging behaviours or upset, care plans lacked information about how to communicate with people to alleviate any distress. Some of the information provided to staff on people needs and support was also conflicting and difficult to follow. This placed people at risk of receiving inappropriate or unsafe care.

Personal emergency evacuation plans contained limited information about people’s evacuation needs and there was no record kept of which people who lived at the home were in the building at any one time. This meant staff may not know who was and wasn’t in the building in an emergency situation.

Where people had mental health conditions which had or may have had an impact on their ability to consent to decisions about their care, their capacity had not been assessed in accordance with the Mental Capacity Act 2005. There was no evidence people had had support from a family member or advocate in making decisions about their care. Consent forms in people’s files had often been signed by staff or simply noted the person had refused to sign. This meant it was unclear if the person consent to the decision or not.

People had a choice at mealtimes and were given a suitable range of nutritious food and drink. The home catered for special diets such as religious or diabetic needs and alternatives to any of the mealtime options were always provided. People identified at risk of malnutrition, had their dietary intake monitored and received dietary supplements to promote their nutritional intake. Some of the nutritional guidance for staff to follow in relation to people’s care was however poor and some people’s dietary needs were not consistently monitored.

Health and social care professionals and a GP we spoke with during our visit said they thought staff at the home cared for people well. They said staff sought advice when needed and acted on it appropriately. We observed staff supporting people at the home and saw that they were warm, patient and caring in all interactions with people. Staff supported people sensitively with gentle prompting and encouragement and dealt with potentially challenging situations in a non- confrontational way. People were seen to be relaxed and comfortable in the company of staff. From our observations it was clear that staff knew people well.

The home was clean and various parts of the home had been refurbished. Refurbishment plans were still in progress at the time of our visit. The provider’s infection control standards had recently been inspected by the NHS Infection Control Team and the provider had done well, scoring 91.13%. The home also achieved a five star rating (excellent) from Environmental Health in relation to its catering facilities and standards. We observed a medication round and saw that the way in which medication was administered was safe.

Staff were recruited safely and had had their suitability to work with vulnerable people checked prior to employment. The number of staff on duty was sufficient to meet people’s needs. We observed staff to be kind and respectful and staff offered a range of activities to occupy and interest people. The home had recently advertised for an activities co-ordinator to organise future activities and events.

We looked at how staff were appraised, supervised and trained staff at the home. We saw that staff had been appropriately supported in their job role. We found some gaps in the training of some staff members but this was in the process of being addressed by the manager.

We saw that regular residents and staff meetings took place and that the manager had been open and honest with people and staff about their future plans for the home. We saw that people were able to express their views at the meeting and that a satisfaction surveys had been sent out to gain people’s feedback on the quality of the service. The surveys returned so far indicated people who lived at the home were generally satisfied with their care. We checked a selection of complaint records and saw that the manager had investigated and responded appropriately to complaints made.

There were some audits in place to check the quality of the service. There were audits in place for medication, catering, bedroom cleanliness and routine repair and maintenance issues. The systems in place required further development to ensure the risks to people’s health, welfare and safety were identified and addressed. For instance, there were no care plan or health and safety audits in place, only one accident and incident audit had been conducted and the last medication audit had been completed in July 2014. We noted that the manager had made positive progress in improving the management of the home since they commenced in employment in November 2014. We spoke to the manager about the quality of the audits. They said they were in the process of reviewing the systems in place in order to make improvements.