The inspection was completed on 28 March 2018 and was announced. 48 hours’ notice of the inspection was given because the service is small and we needed to be sure the registered manager was available and that people who used the service would be in.

Rockhaven 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. Rockhaven provides 24 hour nursing care and support for up to seven people with complex learning disability needs. It is situated in a quiet residential area on the outskirts of Leeds.

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 complex learning disability and nursing needs using the service can live as ordinary a life as any citizen.

At the last inspection the service was rated good overall. However, we found improvements were required in the safe domain. There were not at all times, sufficient staff deployed to ensure people’s needs were met safely and that people were properly supervised to ensure their safety. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘Safe’ to at least good.

At this inspection we found the provider had made the required improvements by adding additional staff in the afternoons to ensure people’s needs were met safely.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Anne's Community Services – Rockhaven on our website at www.cqc.org.uk’

Our key findings across all the areas we inspected were as follows:

The service has 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 and associated Regulations about how the service is run. At this inspection the registered manager was unavailable. However, a manager from another home from the organisation was available to assist with the inspection process.

Some people we spoke with had limited verbal communication. However, they very clearly indicated they felt safe and were happy living in the service, liked the staff and did the activities they liked to do.

Medications procedures were in place including protocols for the use of ‘as and when required’ (PRN) medications. Staff had received training in medication management and policies and procedure were audited in line with the provider’s guidance. There was good guidance for staff regarding how people expressed pain or discomfort, so they could respond appropriately and seek input from health care professionals, if necessary. People had access to a good range of health care services and advocacy services actively used for people if they felt health care services were not as responsive as they should be.

Staff were aware of the Mental Capacity Act [MCA] and the Deprivation of Liberty Safeguards [DoLS]. At the time of this inspection the manager (from another service within the organisation) told us most people who used the service had an authorised DoLS in place. This legislation was used to protect people who might not be able to make informed decisions on their own.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers and the rest of their team would act appro

We looked at people’s medicine administration record (MAR) and reviewed records for the receipt, administration and disposal of medicines and conducted a sample audit of medicines to account for them. We found records were complete and people had received the medication they had been prescribed.

We observed a member of staff whilst they conducted part of a medication round. We saw that the medicines were given safely and people were sensitively helped to take their medicines.

Clear protocols existed to guide staff as to when PRN medicines should be given.

Whilst the provider had a covert medicines policy all medicines were administered with the knowledge of the people receiving care. Staff had a good understanding of the legal framework in which they needed to work in order to administer medicines covertly.

We saw the service had a medication management policy in place. All medicines were administered by registered nurses. The service was subject to regular review and actions were taken to minimise risk. Any irregularities found during audits were used to reinforce and improve good practice.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

Some care plans and risk assessments were detailed and person centred and provided staff with clear guidance on how to meet people's health and social needs. However, there were some shortfalls with the care plans and risk assessments. Some plans did not give full details of how care needs were carried out and this could lead to people’s needs being missed or overlooked. The Registered Manager had identified the need to improve the care and support planning process.

Staff were kind and supportive to people; they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect.

There were a number of discrepancies with medication management and improvements were needed. It was not possible to account for whether all medicines we checked had been given as prescribed to people who used the service.The service did not always protect people against the risks associated with the unsafe use and management of medication, as appropriate arrangements for the storage, recording, handling, administration and use of medicines were not always in place.

Is the service effective?

People were provided with a good choice of suitable and nutritious food and drink that met their individual needs. People were protected from the risks of inadequate nutrition and dehydration.

Staff described how they met and monitored people’s health needs. Care records showed that people had regular contact with health and other professionals. Some people also had a Health Action Plan with details of the actions needed to maintain health, for example, a winter health care plan, discussed with their GP to maintain optimum health during winter months.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Training records showed that most staff in the home had completed mandatory training and other appropriate training. The Registered Manager had completed an audit of this and identified which staff needed update training. Staff told us they felt well supported to do their job and maintain high standards.

Is the service caring?

We spoke with three people who used the service. One person nodded and said they enjoyed living at the home. They said they found staff helpful. Another said they liked the staff. Others were smiling when we asked if they liked the home and if they were treated well.

We saw that care practices were good. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and good eye contact. It was clear that staff were well aware of the needs and wishes of the people who used the service. Staff understood people’s individual ways of communicating their needs.

Is the service responsive?

We saw that people who used the service were responded to promptly when they asked for any support or assistance or gave any indication that they were in any discomfort. It was clear that staff knew the needs of people who used the service very well.

People were supported to be involved in activity of their choice within the home. However, when we looked at the daily records for three people who used the service, we saw the records showed that one of these people had not left the house in the last fortnight, one had been out once and one had only been out of the house twice to their regular day care placement. Staff said it was difficult to get people out when the staffing levels on an afternoon/evening shift were only two and they also had difficulties in accessing adapted transport. The Registered Manager said they were looking at introducing more structured activity with the development of the social activity care plans and introducing more flexible shifts as the home became fully staffed, to enable more community participation.

There had been no complaints made to the service for many years. However, staff were able to say what they would do to assist anyone who wished to make a complaint.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable and enthusiastic. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

There was an effective system in place to regularly assess and monitor the quality of the service that people received. We looked at reports and records which showed the provider had assessed and monitored the quality of service provision.The Registered Manager was also planning to introduce a more detailed audit of the medication management systems.

The service supported people with a wide range of complex needs. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

During our visit, we saw staff interacting with people in a positive, respectful and caring manner. Staff we spoke with told us they encouraged people to be as independent as possible and make their own decisions where possible. People experienced care, treatment and support that met their needs and protected their rights.

When we asked one person if they liked the home and the staff who supported them, they told us, “It is alright here, I like it.” Another person gave us a, ‘Thumbs up’ sign and smiled when we asked them if they liked the home.

People appeared relaxed and comfortable in the presence of staff. We observed staff treating people kindly with regard to their dignity and privacy.

The service had effective recruitment and selection processes in place. Appropriate checks were made before people were employed by the service.

The service cares for and supports people with a wide range of complex needs. They were not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

We saw that care practices were good and people looked well cared for. Staff were kind and supportive to people. They treated people as individuals overall. Staff gave good examples of how people were treated with dignity and respect. They said it was important to give people as much choice in their life as possible, to be discreet when giving support and to be mindful of privacy for people.

However, we did note that on one occasion a staff member spoke without regard for a person’s dignity. There were also occasions when a ‘pet’ name was used for people who used the service. Other staff confirmed that this ‘pet’ name was not an agreed or preferred name for people who used the service. We discussed this with the manager and senior staff member at the time of our visit and were assured that this would be addressed.

We saw that people were happy and comfortable with staff in their interaction with them. There was positive interaction and good eye contact.

We looked at surveys that relatives of people who used the service had completed in November 2010. Comments on these included:

“I would like to thank every member of staff for looking after (name of person).”

“We are very satisfied with the services that have been provided for (name of person).”

Staff said that on the whole they had enough staff to meet people’s needs properly. They said they did not feel rushed and had enough time to make sure people got what they needed. However, all staff we spoke with said they did not have enough staff to make sure people got out of the home enough and enjoyed community based activities.

This was an unannounced inspection carried out on the 15 and 16 December 2015. At the last inspection in December 2014 we found the provider met the regulations we looked at.

Rockhaven provides 24 hour nursing care and support for up to seven people with complex learning disability needs. It is situated in a quiet residential area on the outskirts of Leeds.

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 and associated Regulations about how the service is run.

Our observations showed people who used the service were comfortable with staff and had confidence in them. Relatives of people who used the service told us their family members were safe and well looked after. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe.

However, we found staffing levels were not sufficient at all times and there was a risk that people’s needs would not be met and their safety compromised. You can see what action we told the provider to take at the back of the full version of this report.

There were systems in place to ensure accidents and incidents were reported in a timely manner and investigations took place to minimise the risk of re-occurrence. However, there was no system in place to monitor accidents for any patterns or trends.

Overall, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely and address any irregularities found through audits. People got the support they needed with meals and healthcare.

Staff training and support provided staff with the knowledge and skills to support people well. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

We saw people who used the service had good relationships with staff; staff knew people and their individual needs very well. People’s support plans contained sufficient and relevant information to provide consistent, care and support. People were supported by staff who treated them with sensitivity, kindness and were respectful of their privacy and dignity.

People participated in a range of activities both in the home and community. However, opportunities to participate in activity outside of the home were at times limited due to the availability of staff.

Staff were aware of how to support people to raise concerns and complaints and there were effective systems in place to assess and monitor the quality of the service.