Rosswood Gardens

Rosswood Gardens is a residential care home providing personal care to up to sixteen people. The service provides support to people who have a learning disability and/or autism. At the time of our inspection there were nine people using the service. Rosswood Gardens comprises three adjoining properties.

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

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.

This was a targeted inspection that considered the safety and suitability of the environment, risk management and governance arrangements.

Right Support:

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. People had a choice about their living environment and were able to personalise their rooms. 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.

Right Care:

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks, this included in relation to environmental risks.

Right Culture:

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Where improvements were identified as being required, action was taken to address the concerns and ensure continuous improvement. A new permanent manager had been recruited to ensure stability within the management team and provide greater oversight of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 May 2022) 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

We undertook this targeted inspection to check whether the Warning Notice and requirement notice we previously served in relation to Regulation 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Rosswood Gardens is a residential care home providing personal care to 10 people. The service can support up to 16 people. People using this service have a learning disability and/or autism. Rosswood Gardens is comprised of three adjoining properties.

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

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.

Right Support

The service did not provide people with care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People did not benefit from an interactive and stimulating environment.

People were encouraged to be as independent as possible and had choice and control over how they were supported.

The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support in the community.

Staff enabled people to access specialist health and social care support in the community.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care

Staff did not appropriately assess risks people might face, including risks associated with the environment and access to items that may cause harm to people.

People’s care and support plans did not always reflect their range of needs and promote their wellbeing and enjoyment of life.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right culture

Staff did not effectively evaluate the quality of support provided to people to ensure continuous improvement. The service did not have a culture of improvement and did not make timely improvements to enhance people’s quality of life.

People and those important to them were involved in planning their care. Staff asked people, their families and other professionals for their views about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 May 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 that all of the improvements required had not been made and the provider continued to be in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to check whether they were now meeting legal requirements. We also assessed whether the service was applying the principles of Right support, right care, right culture. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination 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 remains requires improvement. This is based on the findings at this inspection.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, the premises and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosswood Gardens is a residential care home providing personal care to 11 people, two of whom were in hospital at the time of the inspection. The service can support up to 16 people. People using this service have a learning disability and/or autism. Rosswood Gardens is comprised of three adjoining properties.

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

People were not adequately protected from risk and supported to remain safe. Risks to people’s safety had not been appropriately assessed or mitigated. This included environmental risks as well as individual risks to people’s safety. People were not adequately protected against the risk of infections. Staff did not consistently adhere to the governments’ guidelines about how to minimise the risk of catching and spreading the COVID-19 virus. There were no cleaning schedules in place and there were a lack of checks and audits to ensure an enhanced level of cleaning during the COVID-19 pandemic.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The provider had failed to robustly assess the mental capacity of people and put in the appropriate level of restriction to maintain balance between independence and safety. Staff did not adhere to the Mental Capacity Act 2005 and assessments were not undertaken when staff thought a person may lack capacity to make certain decisions.

Care and support did not always reflect current guidance, standards and best practice. Care plans and risk assessments provided conflicting information and lacked vital information about people and their needs. People were not adequately supported to maintain a healthy, balanced diet and staff did not access and follow appropriate healthcare support and guidance.

The provider did not have a consistent approach to supporting staff to maintain their professional skills or knowledge of best practice. Staff training was in place however staff’s completion of mandatory modules was inconsistent.

There was a lack of oversight and management at the service. The registered manager was absent from the service due to ill-health and another senior member of staff was off shielding due to the COVID-19 virus. Whilst these key members of staff were absent from the service, there was insufficient oversight from the provider to ensure good leadership at the service, support to staff and ongoing review of the quality and safety of service delivery. The provider’s procedures for obtaining feedback from people about their care had not been implemented at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. The service was not inclusive and did not empower people to achieve good outcomes. People were not adequately involved in the design and delivery of the service. They were also not adequately involved and consulted about day to day decisions. The staff did not engage with people in line with the principles of the Mental Capacity Act 2005 and care and support was not adequately reviewed or personalised to meet people’s changing needs.

People received their medicines as prescribed and safe medicines management processes were in place. Staff were knowledgeable of safeguarding adult’s procedures and were working with the local authority to implement recommendations following a recent concern raised. There were sufficient numbers of staff on duty to provide people with support.

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 (published 9 January 2019).

Why we inspected

We received concerns in relation to the support people received, particularly in regards to their diet and nutrition and also about staff’s adherence to the Mental Capacity Act 2005. The service had also had a significant outbreak of the COVID-19 virus. As a result, we undertook a focused inspection to review the key questions of Safe, Effective 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.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective 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.

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

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 breaches in relation to person-centred care, safe care and treatment, need for consent, staffing and governance at this inspection. 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 and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 our last inspection in May 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post at the time of our inspection. 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 were protected from abuse by systems in place such as staff training. Staff understood their responsibilities to safeguard people from abuse.

The provider carried out recruitment checks on staff to check they were suitable to support people with learning disabilities. There were enough staff deployed to care for people safely and meaningfully.

People were supported to take positive risks such as using the facilities and accessing the community safely. The provider assessed and managed risks relating to people’s care well.

People’s medicines were managed safely by staff who the provider checked were competent. The provider audited medicines management to check staff followed safe processes.

People lived in premises which were clean and safe. The provider checked the service remained safe and staff followed infection control procedures.

People were supported by staff who were trained and supported in their roles.

People’s care plans were based on their needs and preferences and were reliable for staff to follow. People were involved in their care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received food of their choice. People were supported to maintain their day to day health and to access the healthcare service they needed.

People liked staff and developed good relationships with them. Staff understood people including the best ways to communicate with them. People were treated with respect and were given the privacy they needed. Staff were supportive of those who were in consenting relationships in the service. People were encouraged to develop their independent living skills. People had individual activity programmes in place and took part in day trips and holidays.

Systems were in place to gather feedback from people and staff. A suitable complaints process was in place.

The service was well-led by a registered manager covering maternity leave. Leadership was visible with a clear hierarchy. Systems were in place to assess and monitor the quality of care people received.

Rosswood Gardens is a care home and short stay respite unit that provides personal care and accommodation for up to 23 adults living with a learning disability, autistic spectrum disorder or Down syndrome. The service is divided into three self-contained units which each have their own lounge, dining area, kitchen, bathroom, toilet and laundry facilities. When we inspected the service there were 12 people living at the home and four people receiving temporary respite care. Respite care can be provided to a maximum of four people at any one time. Approximately 30 people regularly receive respite care at Rosswood Gardens.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were happy living or receiving respite care at Rosswood Gardens. We saw staff looked after people in a way which was kind and caring. Feedback we received from people using the service, their relatives and community professionals supported this. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand.

People felt safe living or receiving respite care at the service. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The service managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies.

We saw people could move freely around the home. The provider ensured regular maintenance and service checks were carried out at the home to ensure the building was safe.

Staff had built caring and friendly relationships with people. People were aware of who the staff were and we observed people and staff engaging in friendly conversations. There were sufficient staff to meet people’s needs, and staffing levels were flexible to provide people with the support they required. People told us there were always staff around and if they needed any assistance a staff member came to support them promptly. We observed staff spending time with people in communal areas.

People were encouraged to maintain relationships with people who were important to them. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome. Staff encouraged people to pursue meaningful social, leisure and educational activities that interested them. People were supported to be as independent as they wanted and could be.

Care plans had been developed for each person using the service, which reflected their specific needs and preferences for how they were cared for and supported. These plans and associated risk assessments were regularly reviewed and kept up to date. This gave staff clear guidance and instructions about how they should care and support people and ensure their needs were met.

Staff supported people to make choices about day-to-day decisions. Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided.

Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. The registered manager understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services quickly when they needed them. People received their medicines as prescribed and staff knew how to manage medicines safely.

There was a choice of meals, snacks and drinks and staff supported people to eat healthily. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

The registered manager encouraged an open and transparent culture. They proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The registered manager demonstrated good leadership. It was clear they understood their role and responsibilities, and staff told us they were supportive and fair. The provider and managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. Managers took appropriate action to make changes and improvements when this was needed. Managers used learning from incidents and inspections to identify how the service could be improved.