Rowan Cottage

Rowan Cottage is a residential care home without nursing situated in Burghfield, Berkshire, providing care and accommodation for up to nine people with a learning disability, autistic spectrum disorder or mental health needs. It is a bungalow with an annexe and an enclosed garden. At the time of the inspection there were nine people living at the service, eight in the main house and one in the self-contained ground floor annexe.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

Support and care provided by staff was extremely personalised. Keyworkers went the extra mile to find out about people’s life histories, to ensure they had as much information as possible to inform the care planning process. Excellent consistency and continuity of care provided by a stable staff team has had a major impact on people’s quality of life. Visiting professionals consistently told us that the service was focused on providing person-centred care and support, which achieved exceptional outcomes for people. Staff were particularly skilful in supporting people to maintain relationships which were important to them and their emotional wellbeing.

Arrangements for social activities, education and work, were innovative, varied, highly individualised and followed best practice guidance so people can live as full a life as possible. Staff were exceptional at developing bonds between people living in the home and supporting them to be mutually supportive of people in achieving their goals. Staff tenaciously supported people to achieve their ambitions and aspirations.

People and their relatives knew how to complain and were confident the registered manager and staff would listen and take appropriate action if they raised concerns. People’s mental health needs had been sensitively considered when exploring their end of life wishes.

People consistently told us they felt safe living in the home. Staff had completed required training and understood their responsibilities to safeguard people from discrimination, harm and abuse. Staff had identified risks to people and effectively implemented measures to ensure these were reduced and managed safely. People were supported by enough staff who knew them well and how to meet their changing needs. The provider completed thorough selection procedures to ensure staff were of suitable character to support people with mental health needs. People received their prescribed medicines safely, from staff who had completed the required training and had their competency to do so regularly assessed. People lived in a home which was clean, hygienic and well maintained.

People's needs were met by staff who had the necessary skills and knowledge to carry out their duties effectively. The manager operated a system of training, supervision, appraisal and competency assessments, which enabled staff to provide good quality care. Staff promoted people's health by supporting people to access health care services when required and by encouraging people to eat a healthy diet.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 consistently treated people with kindness and compassion. People were supported to express their views and wishes about their needs, which were respected by staff. People's privacy and dignity were promoted by staff during the delivery of their care.

The registered manager effectively operated quality assurance and governance systems to drive continuous improvement in the service. Staff worked well in collaboration with key organisations to ensure the safe and effective delivery of people’s care.

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 outstanding (report published 13 July 2017).

Why we inspected

This was a planned comprehensive inspection based on the previous rating.

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.

The service is required to have a registered manager. There was a registered manager in post who had been registered to manage the service since July 2016. 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.

This was an unannounced comprehensive inspection which took place on 10 May 2017. We were assisted by the registered manager during the inspection.

People were safe at Rowan Cottage. They were encouraged and supported to learn about how to keep themselves safe and raise any concerns or worries they may have. People were protected from harm and abuse by staff who had been trained and had knowledge of how to safeguard people. Staff understood their responsibilities to report and act on issues if they arose. Risks were assessed, managed and reviewed to keep people safe. There were sufficient staff who had been recruited using effective procedures to ensure their suitability. Medicines were managed and administered safely. Routine health and safety checks were completed in accordance with legislation and guidance. Infection control procedures were followed.

Staff were praised by people for providing effective support. Staff were trained in areas relevant to their job role and their skills assessed and monitored. They were supported by the management team to develop and gain appropriate qualifications. Staff felt supported and received regular supervision and appraisal of their work. The provider was meeting the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Consent to care and support was sought in line with legislation and guidance. When appropriate mental capacity assessments had been completed and where people had been assessed as not having mental capacity to make a decision, a best interests meeting had taken place. 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 knew people and their individual needs very well. Key workers spent time with people discussing their support and any changes they wished to make. People were comfortable and relaxed with staff demonstrating trusting relationships had been established. These relationships had led to exemplary work being undertaken to develop people’s independence. Other excellent work had involved proactively supporting people to overcome difficulties and challenges. People were respected and their dignity was maintained. They were supported to develop and maintain important and significant relationships.

The service was extremely responsive. People’s support plans were comprehensive and provided detailed guidance to staff on preferences and personal routines. Innovative ways had been sought to assist people in achieving their goals and aspirations as well as overcoming personal challenges. People were encouraged to recognise their own talents and self-worth and to celebrate this with others. People’s changing needs were responded to positively and they were supported to make their own decisions whenever possible. Varied activities were sought and identified for each individual to engage them in meaningful occupation alongside social enjoyment. People were consistently offered new experiences and supported when necessary to embrace change.

The registered manager received consistent praise and positive feedback from people, relatives and professionals. They uniformly expressed the difference his leadership had made to the service. We found an open and positive culture in the service and the staff team was supported to bring forward suggestions to better the service. There was a strong emphasis on team working and staff confirmed they worked well together. Standards of care were exceptionally high as a result of the example set by the management team and their expectations. The staff worked hard to meet the standards and expectations set and took pride in achieving positive outcomes for people. There were strong and vital links built with the community which benefitted both people and the members of the public through education and sharing of experiences. The provider valued and developed staff. They involved people in contributing to all aspects of the service and sought views and feedback in order to improve and develop.

Rowan Cottage is a care home without nursing for up to nine people with a learning disability or autistic spectrum disorder. Rowan Cottage is a one storey building with a self-contained annexe in the rear garden. At the time of the inspection eight people lived in the main building at Rowan Cottage and one person lived in the annexe. The people living at the service had a range of support needs.

The service is required to have a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the manager was not registered with CQC. They had recently been appointed and were in the process of applying to become a registered manager.

Staff felt well supported by the manager and said they were listened to if they raised concerns. However, individual staff members had not had annual appraisals or regular one to one meetings with their line manager. This had been identified and addressed by the new manager but we could not be sure at the time of the inspection if the improvement would be sustained.

Some records lacked organisation, making it difficult to locate the most current information and were not always up to date or completed fully. This was being addressed by the manager at the time of the inspection.

Relatives had raised concerns with regard to the management of the service. However, they were more positive since the appointment of the new manager and felt their concerns had been listened to.

Staff received training to meet people’s needs which was refreshed periodically. New staff received an induction, training and support from experienced members of staff.

People using the service were happy living at the service and they felt safe. People were relaxed and a sense of fun and spontaneous banter was evident throughout the two days of the inspection.

Staff treated people with kindness and showed respect to each individual. Support was focussed on individuals and designed to meet the specific needs and preferences of people living at the service.

Robust risk assessments were carried out and detailed guidance provided to staff in order to keep people safe. Staff were aware of their responsibilities to safeguard people and knew how to report concerns promptly through procedures they understood well.

The provider had robust recruitment procedures in place to ensure only staff of suitable character were employed.

People’s medicines were managed safely. Staff had received appropriate training in the safety of medicines and their knowledge and skill had been assessed.

People had their rights protected. Staff understood the relevance of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care.

People and their relatives were involved in planning and reviewing the support they required. People were encouraged to be as independent as possible and they worked toward agreed goals.

Each person had a programme of activities planned and designed to meet their personal preferences and goals. Links with the community were maintained and people were encouraged to use community facilities such as public transport, leisure centres, shops and colleges.

The manager and provider assessed and monitored the quality of the service. People, relatives and stakeholders were encouraged to give feedback on the service and this was used to make improvements. Complaints were recorded, investigated and responded to in line with the provider’s policy.

We saw staff treat people in a calm and reassured manner that met their needs and ensured their safety and welfare. People we spoke with praised the staff for supporting them to be independent and achieve their goals. One person said, 'I love it here because everyone is friendly and looks after one another.' A relative we spoke with said, 'The care is excellent and you can see immediately that the staff know the people they care for by the way they communicate with them.'

The provider had an effective system to ensure that medicines were managed safely. We saw lunchtime medication being administered in a person centred way, which was accurately recorded.

People were protected from the risk of unsafe care because the service had a thorough recruitment and selection process. Staff we spoke with confirmed that references and other security checks had been completed before they had joined the home.

The manager conducted audits and surveys to monitor the quality of the service provided. We saw that complaints and incidents were reviewed and that appropriate action had been quickly taken where required.

We were told that independence and individuality were promoted within the home. People living there were supported and enabled to do things for themselves as far as they were able. They were encouraged to express their views using their preferred individual communication styles and to participate in making decisions relating to their care and treatment.

We looked at a range of records, spoke with the manager, three staff and observed a shift handover. We also spoke with a relative of a person living in the home. They told us that they were always welcomed into the home and the manager and staff were approachable. They thought the home did a reasonable job of meeting their relatives very complex needs within the constraints of the rules and regulations they had to adhere to. We saw the communal areas of the home, some people's bedrooms and spent some time observing interactions between staff and people living in the home.