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Inspection carried out on 21 September 2017

During a routine inspection

The service is registered to provide accommodation and personal care to six people who have a learning disability. This may include people who also have a significant physical disability. There were five people living at the service at the time of the inspection. The service is a purpose built property and accommodation is provided on one level. It is set in a rural area on the outskirts of Woodchurch village on Highlands Farm, which is a tourist attraction and where the provider has other registered services located. Each person has a single room and there is a communal bathroom, separate wet room with bath, kitchen, lounge/diner and sensory room. There is an accessible garden with a paved seating area at the back of the bungalow.

Rating at last inspection

At the last inspection, the service was rated Good overall and Outstanding in the ‘Caring’ domain.

Rating at this inspection

At this inspection, we found the service remained Good and outstanding in the ‘Caring’ domain. .

Why the service is rated Good

People’s care was exceptional: People knew their needs and wishes were understood by staff because they were always met. Staff looked for creative ways to ensure people’s needs were met, and ensured obstacles were overcome when possible. People were relaxed in staff’s company and staff listened and acted on what they said or gestures and body language. People were consistently treated with dignity and respect and their privacy was respected. Staff were very kind and patient in their approach, but also used good humour. People received care and support from a dedicated team of staff that put people first and were able to spend time with people in a meaningful way. Staff had built up relationships with people and were familiar with their life stories and preferences.

People were protected from abuse, as staff understood how to recognise and report any suspicions of harm or abuse. People received their medicines safely and when they should. Risks were assessed and staff took steps to keep people safe whilst encouraging their independence wherever possible.

People were involved in the planning of their care and support. Care plans contained clear and detailed information about people’s wishes and preferences. They showed people’s skills in relation to tasks and what support they required from staff, in order that their independence was maintained. People had reviews of their care and support where they and/or their representatives were able to discuss any concerns or aspirations.

People were encouraged and supported to make their own decisions and choices and staff respected these. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were protected by safe recruitment procedures. New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent to work on their own. Staff received training relevant to their role and people’s needs. Staff had opportunities for one to one meetings and team meetings, to enable them to carry out their duties effectively. The majority of staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff and staff rotas were based on people’s needs, activities and health appointments.

People had a varied diet and were involved in planning the menus. Staff supported people’s special dietary needs. People had a programme of leisure activities and went out and about, as they wished.

People had complex health needs and were supported to maintain good health and attend appointments and check-ups. Appropriate referrals were

Inspection carried out on 4 June 2015

During a routine inspection

The inspection took place on 4 June 2015, and was an unannounced inspection. The previous inspection on 8 January 2014 found no breaches in the legal requirements.

The service is registered to provide accommodation and personal care to six people who have a learning disability. This may include people who also have a significant physical disability. There were five people living at the service at the time of the inspection. The service is a purpose built property and accommodation is provided on one level. It is set in a rural area on the outskirts of Woodchurch village on Highlands Farm, which is a tourist attraction and where the provider has other registered services located. Each person has a single room and there is a communal bathroom, separate wet room, kitchen, lounge/diner and sensory room. There is an accessible garden with a paved seating area at the back of the house.

At the time of the inspection people had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Each person had a learning disability; complex health needs and most also had significant physical disabilities.

There was an established 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People had lived in the service for many years and were involved in the planning of their care and support. Care plans contained individual detailed information about people’s wishes and preferences and used pictures and photographs to make them more meaningful to people. They detailed people’s skills in relation to tasks and what help they may require from staff, in order that their independence was fully promoted. People had regular reviews of their care and support where they were able to discuss any concerns or aspirations. Risks assessments were centred on the needs of the individual and processes were in place to keep people safe and promote their independence.

People benefited from living in an environment and using equipment that was well maintained and met their needs. People’s needs were such that they required specialist equipment, such as powered wheelchairs, height adjustable beds and baths and specialist easy chairs. There were records to show that equipment and the premises received regular checks and servicing. The environment was well maintained and work was on-going to maintain the environment both inside and out. People freely accessed the service and spent time where they chose.

People were protected by safe recruitment procedures. New staff underwent an induction programme, which included specific induction around people’s individual support and health needs and shadowing experienced staff, until staff were competent to work on their own. Staff training included courses relevant to the needs of people supported by the service and specialist training had been delivered by health care professionals. Staff had gained qualifications in health and social care.

People felt safe in the service. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns.

People had their needs met by sufficient numbers of staff. Rotas were based on people’s needs, activities and health appointments. People received care and support from a dedicated team of staff that put people first and were able to spend time with people in a meaningful way.

People were very happy with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were very caring and kind. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively.

People told us their consent was gained through discussions with staff. People were supported to make their own decisions and choices and these were respected by staff. Staff understood their responsibility under the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make specific decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People had complex health needs and were supported to attend appointments and check-ups, such as doctors, dentist and opticians. People’s health needs were kept under constant review and appropriate referrals were made when required. Recently assessments had been undertaken by physiotherapists and an occupational therapist.

People planned their meals and had adequate food and drink. They liked the food and enjoyed their meals. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Special diets were well catered for and people were supported by staff with eating and drinking whenever they needed this help.

People felt staff were very caring. People were relaxed in staff’s company and staff listened and acted on what they said. People said they were treated with dignity and respect and their privacy was respected. Staff were individual and kind in their approach and knew people and their support needs very well.

People had a varied programme of suitable activities in place, which they had chosen. People participated in work based activities, such as horticulture and art and craft, which they enjoyed as well as leisure activities. People talked animatedly about social events they had done or were planning. People’s family and friends were very important to them and contact was well supported by staff.

People were put at the heart of the service. They told us they received person centred care that was individual to them. They felt staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves. People’s individual religious needs were met.

People felt comfortable in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been very positive.

People felt the service was well-led. The registered manager was approachable and sometimes worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly. Staff felt the registered manager motivated them and the staff team.

The provider had a vision, to be a leading organisation providing quality care and support for adults with learning disability. Their mission was to provide a safe and fulfilling life for adults with learning disabilities. Staff were very aware of these and they were followed through into practice.

Inspection carried out on 8 January 2014

During a routine inspection

We spoke with four people who used the service, the manager and four staff.

People were satisfied with their care and support and �liked� living at Rosemary Cottage. People knew about their care plans and the information they contained as staff had read and explained their content to them.

People received safe and coordinated services where more than one provider of services was involved in their care and treatment.

People told us they received their medicines at the times they needed them, and in a safe way.

People received care and support from staff who were supported and trained. People told us all the staff were �nice� and helped them when they needed help.

People had opportunities to raise concerns and give feedback about the service provided.

Inspection carried out on 25 February 2013

During a routine inspection

We spoke with three people who used the service, the manager and three staff.

People had consented to their care and support. They were satisfied with their care and support and liked living at Rosemary Cottage. People told us they knew about their care plans and the information they contained as staff had read and explained their content to them.

People liked their own rooms and had chosen the colour scheme. They said the home and equipment were well maintained. People said they �liked� the new extension as it gave them �more room�. People talked about how they helped with some of the household chores and that the home was always clean and tidy. One person said, �I do dusting�.

People felt there were sufficient staff on duty to meet their needs. They said staff were always on hand to help them when they needed help.

People had no concerns. However they knew who to speak to if they had. One person told us they did speak to a staff member about a concern and they �sorted it out�.