Archived: Rosetta

About the service: Rosetta is a care home providing care for up to 12 adults with learning disabilities. The accommodation is provided over two floors with some bedrooms on the ground floor. At the time of our inspection, there were nine people living at Rosetta.

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. 'Registering the Right Support' Care Quality Commission (CQC) policy. Although the service is registered for up to 12 people the provider informed us they do not intend to take any further admissions to the home in line with the principles of Registering the Right Support.

People’s experience of using this service: Whilst many positive interactions were seen we also observed occasions where staff did not always demonstrate caring values when supporting people. Quality assurance systems had failed to identify the concerns raised during our inspection.

Recruitment files showed that gaps in staff employment histories had not always been fully explored to ensure that people were supported by suitable staff. Following the inspection, we were informed that this concern had been addressed. We have made a recommendation regarding this. Staff received induction, training and supervision to support them in their roles. However, the registered manager told us they would personally value the opportunity to receive a more formal supervision with written records.

Risks to people’s safety were considered and plans implemented to minimise these. However, we have made a recommendation regarding ensuring staff are fully aware of people’s needs. People lived in a safe environment and staff understood their responsibilities in protecting people from potential abuse. People received their medicines in line with prescriptions and had access to a wide range of healthcare professionals.

Staff were aware of people’s past histories and interests and people had access to a range of activities. However, care records and activity plans were not always completed in a detailed manner. The registered manager told us this was in the process of being addressed as part of the implementation of an electronic records system. We have made a recommendation regarding ensuring that activities provided are in line with people’s needs.

People and their relatives told us they were treated well by staff and that the registered manager was accessible. People were supported to maintain their independence and their dignity and privacy were respected. Permanent staff spoke affectionately about the people they supported.

Rating at last inspection: At the last inspection the service was rated Good (report published on 15 October 2016)

Why we inspected: This was a planned comprehensive inspection

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

This inspection took place on 9 August 2016 and was unannounced.

We carried out an unannounced inspection of this service on19 May 2015. During this visit we identified areas of concerns where the provider was failing to comply with the relevant requirements of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014).

We asked the provider to take action to make improvements. The provider sent us an action plan and these actions have been completed. We undertook this comprehensive inspection on 9 August 2016 to review the improvements made and to see if they met the legal requirements. We identified no serious concerns during our inspection.

The provider did not have a robust process that had ensured people finances were managed appropriately which is subject to investigation.

The home had a registered manager who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 supported to take control of their lives in a safe way. Staff had written information about risks to people and how to manage these. Staff we spoke to were aware of individual risks to people. We saw in care plans that risk assessments were up to date and there was information around what to do to minimise the risk. These included mobility, medicines and risk for undertaking certain activities.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. Staff said they would report any concerns to the registered manager. They knew about types of abuse and where to find contact numbers for the local authority’s safeguarding team if they needed to raise concerns.

Staff were available for people when they needed support in the home and in the community. Staff told us that they had enough time to support people in a safe and timely way. Staff recruitment records contained information that demonstrated that the provider took the necessary steps to ensure they employed people who were suitable to work at the home. Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis.

Processes were in place in relation to the correct storage and management of people’s medicines. All of the medicines were administered and disposed of in a safe way.

Rosetta was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. People also went out for lunch when they chose too.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed interactions and it was evident that people enjoyed talking to staff. People were able to see their friends and families as and when they wanted and there were no restrictions on when people could visit the home.

People took part in community activities on a daily basis; for example trips to the shops. The choice of activities were specific to each person needs and interests and had been identified through the assessment process and regular house meetings held.

People had an individual care plans, detailing the support they needed and how they wanted this to be provided. We read that staff ensured people had access to healthcare professionals when needed. For example, the doctor or optician.

People were able to make a complaint if they needed to. The complaints procedures were up to date and people and relatives told us they would know how to make a complaint. Confidential and procedural documents were stored safely and updated in a timely manner.

The home had a system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, and decided if any actions were required to make sure improvements to practice were being made.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction surveys.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe, and how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding and power cuts.

During the inspection visits we spoke with the registered manager, five staff and another manager employed by the provider. The second manager's role was to provide support to the registered manager of the home. We spoke with three of the people who lived in the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The service had not submitted applications under DoLs. Relevant staff had not been trained to understand when an application should be made, and how to submit one. Staff had not received training on the Mental Capacity Act. Policies and procedures had been developed by the registered provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). We found the home was not meeting the requirements of the Deprivation of Liberty Safeguards.

The premises were suitable to meet the needs of the people living at the service. Special adaptations had been put in place to support people to remain independent.

There were not appropriate management systems in place to protect people from poor practices or alleged abuse. The majority of staff we spoke with had an understanding of the different types of abuse that could occur and how to refer any concerns however staff were not aware of how to report these concerns following the local authority safeguarding protocol.

Is the service effective?

Feedback received from people was positive and confirmed people were happy with the standard of care provided. We looked at customer satisfaction surveys and people had been supported to complete them. The provider had an analysis of the information in the form of a graph but they had not put in place any actions in response to this feedback.

People had an individual care plan which set out their support needs. We could not find any evidence of how people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

Is the service caring?

The atmosphere in the home was calm and relaxed. People were observed to be comfortable and relaxed in their home environment and were able to follow their own plans and preferred routines. Staff were attentive to the diverse needs of the people and were noted to communicate and engage with the people they supported in a respectful, dignified and caring manner.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

We observed people participate in a range of activities both in the home and the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests.

We saw evidence in notes from house meeting that people wanted to go on holiday. On the day of our inspection five people were being supported to go on a caravan holiday.

We had concerns about errors made with a person's medication which we raised with the local authority.

Is the service well- led?

Some people's personal care records, and other records, were accurate and complete. Although reviews of people's care had been completed we noted that three people's care plans were not up to date and did not reflect their current needs.

The staff worked well with other agencies and services to make sure people received their care in a joined up way. We noted this when we viewed peoples annual reviews and noted that outside agencies had been involved in the person's review process.

We found improvements were required to the quality monitoring and assessing of the service and records. Records were not always up to date or directly accessible as they were stored at the providers head office such as financial records for people and monthly management audits.

We found that although there were areas of compliance under previous outcomes assessed and good practice also identified at this inspection, there were still some shortfalls under some of the new outcomes looked at.

People who use the service told us the food was alright and they got enough to eat. They said the staff were ok, they liked their rooms and their rooms were warm enough.

People who use the service also told us about activities they enjoyed and one person told us they used to have more activities at their last home and not much goes on at this home. Another person in the conversation agreed on both points.

One person told us how they were responsible for making sure the rubbish was thrown out as they didn't like dirty areas and the kitchen dustbin was overflowing from the previous day. They later showed us how they liked to set up and tidy away after meals.

We observed staff had a good knowledge of people's needs and communications methods and demonstrated this through their positive interactions with the people who use the service. For example, during breakfast they supported people directly where needed without rushing them or supported people to be as independent as possible, for example, laying the table and clearing up after.

We noted that information was included in formats and languages people would understand better so the person's consent would be better informed. However, where people did not have capacity to consent, the provider did not always act in accordance with legal requirements in seeking consent to care, medication, treatment and restrictions of liberty placed on the people they provided a service to.

We found that people who use the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises because the provider had not risk assessed all windows that presented a hazard to establish the need for restrictors, had not maintained the water supplies to safe working temperatures, had not managed the risk of Legionella in the hot water supply safely, had left unsupervised areas that contained hazards accessible to people, and was not following fire safety precautions and policies.

We also found that files containing information about staff were kept securely and confidentially, but people who used the service were not protected against the risks of unsafe or inappropriate care and treatment. This was because an accurate record in respect of each person's care records was not kept, and their records were not kept confidentially and securely and in line with the data protection act and could not be located promptly when required.

We reviewed care plans that were clear and provided good guidance for staff to follow when assisting the individuals who live at the service. It was noted however that the pre admissions assessments of the most recent people who have moved into the service in October 2012 were not on file at Rosetta.

Care plans recorded the social and leisure preferences of people using the service and a review of the day records for a three week period indicated that activities had happened as per individual schedules.

People were protected from the risk of abuse, the provider had taken steps to identify the possibility of abuse and prevent it.