Rose Villa

Rose Villa is a residential care home providing personal care to up to 20 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 16 people using the service. Accommodation is a mix of single and shared rooms in a converted and extended premises.

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

We had concerns about the providers understanding of the Mental Capacity Act 2005 and records associated with this.

We were not assured that the provider had clear oversight of the service or that CQC had been notified of all significant events in the service including safeguarding concerns. Audits had not identified the shortfalls we found at inspection. Records had not always been accurately completed.

People were cared for by staff trained to identify signs and symptoms of abuse however we were not assured the provider had taken steps to alert the safeguarding authority of all concerns. Some risks to people had not been fully addressed however environmental risks and the premises had been well managed. Staff were safely recruited and there were sufficient staff deployed to meet people’s needs. Medicines were mostly safely managed; however we were concerned that tablets were being counted in a busy area of the service and spoke with the registered manager about this.

The premises were very clean and a programme of further refurbishment would improve this. The premises were being updated to enable easier cleaning of flooring and to redecorate We were assured that current guidance in infection control and visiting care homes was being followed. Some areas of the premises were dimly lit which was not ideal for people living with dementia.

Some assessments needed additional details about how to support people should they be in crisis, but most care plans were informative of people’s needs. Staff received training when they commenced at Rose Villa and updates as needed. There was a focus on supporting staff to achieve qualifications to enable their progression.

A nurse practitioner completed a weekly ward round and addressed any health concerns for people. There were some difficulties in obtaining input from some healthcare professionals.

The service was mostly well-led and the registered manager was working to achieve a more professional approach to service provision. There was a clear management structure and clarity about roles within 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

The last rating for this service was good published 27 January 2020.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staff conduct, training, awareness of heath conditions and the conduct of the nominated individual. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this 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 Rose Villa on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to notification of significant events in the service, consent, governance and safeguarding. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Rose Villa is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 20 people in one adapted building. The service mainly provides care to people living with dementia.

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

People were cared for by staff who had a good knowledge of the signs and symptoms of abuse and staff members would not hesitate to alert senior staff if they had concerns about someone.

Risk assessments of people and the environment minimised risks to people. The premises were kept safe through regular safety checks to equipment.

Recruitment was safe and there were sufficient staff deployed to meet people needs.

Medicines were safely managed and administered according to prescriptions.

The service was very clean, and records showed all areas were regularly cleaned.

A new electronic care record had enabled analysis of accidents and incidents and could identify trends which could minimise future incidents.

Assessments and care plans were holistic, and people contributed to them informing staff of how they wanted their care to be delivered.

Staff participated in regular supervision and the management team had developed a supportive environment for each other.

We received mixed feedback about training, some staff members thought more in-depth and face to face training would be of use, however the current training provided a good basic knowledge.

Meals were appetising, and staff new peoples likes and dislikes around food. Meals were a social occasion and people appeared to enjoy the interaction with peers and staff.

The premises could be adapted to become more dementia friendly. We recommended the provider research dementia friendly environments and adapt the premises accordingly.

A pre-arranged GP call happened daily to decide if a GP visit was required. There was a positive relationship with district nurses and the service could refer directly to them for support.

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.

Staff were kind and caring and supported people with respect preserving their dignity. People were supported to maintain their independence and maintain their current level of skills.

Staff supported people to participate in care planning either through a formal approach of reviews or through informal chats.

Staff ensured that care was delivered as privately as possible and used screens to provide privacy in shared rooms.

Staff took time to get to know people which helped them in providing person centred care.

Information was supplied to people in the most suitable format and there was wide use of talking books and newspapers.

An activities programme provided structured day time activities for people. An activities officer added individual enrichments, spending time with people on a one-to-one basis.

Complaints were taken seriously and dealt with according to the providers procedures.

The registered managers were proud of the standard of end of life care provided and relatives confirmed that people were cared for well and supported to have a ‘good death’.

The management team were effective and approachable. Overall staff felt supported in their role.

The registered managers understood their responsibilities under the duty of candour.

Notifications have been received from the service to inform CQC of significant incidents such as deaths or serious injuries.

Audits had been introduced, in part enabled by the new electronic care record system.

Staff meetings and meetings for people and their relatives were in place and a quality assurance questionnaire was in planning for 2020 to be sent to people, their relatives and staff.

The provider had forged links with health and social care professionals and other care providers.

For more details, please see the full report which is on the CQC website at

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 November 2018) and there were four breaches of regulations. 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

This was a planned inspection based on the previous rating.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rose Villa is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rose Villa is registered to provide accommodation and personal care for up to 20 people. The service does not provide nursing care. At the time of our inspection 15 people were living at the home. The home provides a service for older people and people living with dementia. Accommodation at the home comprises six double rooms and eight single rooms, provided over two floors, which can be accessed using stairs or passenger lifts.

The service had two registered managers. 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.

Staff had not received appropriate supervision and support to enable them to carry out the duties they are employed to perform.

The provider did not fully understand the legal requirements of the MCA 2005 and its associated Code of Practice and how these should be used to protect and support people who do not have the ability to make decisions for themselves.

The provider did not fully understand their responsibilities in relation to their registration with the Care Quality Commission (CQC) and the reporting to the Commission of accidents and or incidents.

The provider had a robust and effective recruitment procedure that ensured people they employed were of suitable character and background.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment.

Medicines were managed in a safe way.

People, their relatives and staff told us the registered managers were supportive and approachable.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

Rose Villa is a privately owned residential care home which provides accommodation for up to 20 people who are elderly and or may be living with dementia. On the day of our inspection 16 people were living at the home.

Accommodation at the home comprises six double rooms and eight single rooms, provided over two floors, which can be accessed using stairs or passenger lifts.

The service had two registered managers. 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 told us they were safe and well cared for at the home. Staff knew how to identify abuse and protect people from it.

There were enough staff deployed to provide the support people needed.

Staff were supported by the provider through regular supervision, appraisals and on-going training.

People received care from staff that they knew and who knew how they wanted to be supported.

People were supported to maintain their independence through positive risk taking.

People were encouraged to maintain relationships that were important to them. Relatives were able to visit the home when they wanted to.

People were encouraged to take part in daily activities that ensured the risk of social isolation was reduced.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

People who required support to eat or drink received this in a patient and kind way.

The registered managers and staff were knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. Staff understood their responsibility to ensure people's rights were protected.

People, relatives, staff and health care professional told us the service was well led by the registered managers

There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted to.

Due to their physical and/or mental frailty we were unable to speak with some people who lived at the home and consequently we used other methods to help us understand their experiences such as observation of daily life in the home and looking at records and other documents.

We also spoke with four of the five care staff on duty and the home's managers.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

All the people we spoke with who lived at Rose Villa told us they received all the support and help they wanted. People also described the home's staff as 'accommodating', 'attentive', 'very good', 'top class', 'friendly', 'amazing' and 'lovely'.

Is the service responsive?

The assistance and support people needed was set out in care plans and these plans were reviewed regularly or when people's needs changed. This was to ensure the home could provide people with the help they wanted.

From observations during our inspection we saw staff did not make assumptions about what help people needed but always asked them what support they wanted. The only exceptions to this were if people were very frail mentally and not always able to ask for help they needed. Staff anticipated the needs of these individuals by interpreting their behaviour.

Is the service safe?

All the people we spoke with during our inspection told us they thought there were always enough staff on duty. They told us that when they used the home's call system the staff responded quickly.

The provider had arrangements in place that ensured equipment installed or provided to help promote people's independence and safety was regularly checked and serviced and if necessary repaired or replaced.

The home's managers had recently received information from the local authority about changes to the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. This meant they would be able to take steps to ensure people who lived at the home would be protected from unlawful discrimination and arbitrary decisions to limit their freedom. They would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

Is the service effective?

People were asked for their consent before they received help and support and staff acted in accordance with people's wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's needs were assessed and the support they needed and wanted was planned and delivered in line with their individual care plans.

Is the service well led?

The provider had systems in place to check and monitor the quality of the service people received and to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However arrangements and plans to deal with some foreseeable emergencies were not sufficiently robust. We have asked the provider to tell us what they intend to do about this.

People were protected from the risks of inadequate nutrition and dehydration. They were cared for in a clean, hygienic environment by staff who had received infection control training.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We found two staff working in the evening of our visit. Both were fully aware of how to report any concerns to their immediate line manager. They were aware of their responsibilities under the services whistle blowing policy and told us they would report any concerns to the appropriate authorities if their concerns were not acted on or resolved.

At the time of our inspection the service did not have a registered manager and had been without a manager for more than five months. The provider was taking responsibility for the role as manager at the time of our inspection. We had discussed this with the provider at our inspection in October 2012 and again in December 2012. We were told by the provider that they were in the process of applying for registered manager status. We will monitor the progress of the application.

We found that there were arrangements in place for assessing and planning peoples individual care needs which ensured people received appropriate care. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People were being treated with dignity and respect. They were cared for by staff who were well informed as to what constitutes abuse and how to report any concerns. The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. There were some quality monitoring systems in place which were being developed further that would enable the service to be assessed more effectively and identify future improvements.

The service had put systems in place that ensured staff received the necessary training to care for people. However, they were being cared for by staff that were not formally supervised or appraised.