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. About the service
Rose Vale is a residential care home providing personal care and support for five people at the time of the inspection. The service can support up to eight people.
People’s experience of using this service and what we found
Right Support
The provider had not ensured the staff team was appropriately trained to meet the needs of people and keep them safe. This resulted in people being put at risk of potential harm.
The provider had introduced some improvements to the environment people lived in to help ensure it was clean, well maintained and appropriate equipment was in place. People were able to personalise their rooms; however, these were due for refurbishment.
People received their medicines when they needed them, and staff were mindful when people needed medicines. However, not all staff were trained to safely administer medicines and competency assessments had not been undertaken to ensure those staff who had received training were sufficiently skilled and able.
The provider had not ensured people had care plans in place to support end of life care. We have made a recommendation for the provider to access current guidance on end of life care planning and take action to update their practice accordingly.
Right Care
The provider had systems in place to report and respond to accidents and incidents. However, not all accidents and incidents in the home had been referred to the local authority safeguarding team for further consideration.
Staff had training on how to recognise and report abuse, however staff actions did not always show they understood how to raise concerns appropriately either to the provider or to external agencies.
People said staff were kind to them and we observed staff interact with people in a caring and appropriate way.
People’s care and support plans did not always reflect their full range of support needs. Care plans were being reviewed and uploaded to the provider’s digital care planning system. Neither the staff team or the manager were fully adept with the digital system and did not always know where to find information.
Right Culture
People had assessments to identify and manage risks they faced in their daily lives and how staff should support with these. Staff were not always knowledgeable about the content of these risk assessments.
People were supported by staff who were not all appropriately trained to meet their care and support needs. People were not always supported by staff who understood best practice in relation to supporting people with a learning disability or autism.
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.
The provider’s quality assurance system did not effectively manage improvements across the service. Where improvements had been identified by external agencies including the local authority and CQC actions were not always taken in a timely manner. This had an impact on people’s care and support.
Further improvements were needed to create an open and transparent culture in the home where all staff felt valued, engaged in the running of the home and consulted.
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 the service under the previous provider was requires improvement, published on 12 February 2020 and there were breaches of regulation.
Why we inspected
We carried out an unannounced focused inspection of this service on 08 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, response to complaints, staffing, the duty of candour and good governance.
We undertook this inspection to check the provider had followed their action plan and to confirm they now met legal requirements. The overall rating for the service remains requires improvement based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rose Vale on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 people safety, staff training and quality assurance systems in place at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.