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Archived: Rose Cottage Requires improvement

Reports


Inspection carried out on 15 October 2019

During a routine inspection

About the service

Rose Cottage is an adapted care home providing accommodation and personal care for seven people living with a learning disability who are aged 18 years and over. At the time of the inspection, six people were living in the service.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

People were safe, two said they were happy living in the service and people were relaxed and comfortable with each other and staff. Relatives said they were very happy with the service their relatives received. However, we found some minor issues around medication management and risk assessment that had not been identified through the services own quality checks. The management team were enthusiastic and motivated to drive improvement and make changes to the service. However, current shared management of the service by the registered manager and deputy were not providing the continuity and oversight needed, to address issues and improve communication. These are areas for improvement.

Staff felt much happier, stating that the turnover of staff had been positive and the culture in the service much improved, with staff more motivated. There was an improving picture around people getting out and leading more active and stimulating lives, achievable goals were being set but more needed to be done to make activities meaningful and to evaluate and review the goals set.

We observed that staff engagements with people, showed kindness, respect and compassion. They handled people’s privacy and dignity well. People respected each other’s private space. People were supported to develop their potential for greater independence and this will benefit from ongoing improvements to setting achievable goals for people to aspire to. Detailed plans of care informed staff support of people in accordance with their personal preferences.

New staff received an appropriate induction to their role and a full range of training was provided to all staff to ensure they developed the right knowledge and skills to support people safely. Overall staff said they were happy and felt supported by the Registered and deputy managers. Risks were appropriately assessed. Staff demonstrated an awareness of safeguarding. They knew how to protect people from abuse.

There were enough staff to support people’s day to day needs safely. A safe system of recruitment was in place to ensure the suitability of new staff. There was a low level of incidents and accidents, but these were analysed to mitigate furthe

Inspection carried out on 27 September 2018

During a routine inspection

This inspection took place on 27 September 2018. The inspection was unannounced.

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

Rose Cottage is registered to accommodate up to seven people with a learning disability. It is a chalet bungalow arranged over two floors, set in a small residential area on the outskirts of New Romney. At the time of our inspection five people were living at the service.

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.

The service had a registered manager. 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.

Rose Cottage was last inspected on 9 February 2018. At that inspection the service was rated as Requires Improvement overall and for each of the five key domain areas, except for Well Led, which was rated as Inadequate. At that inspection, there were not always enough staff to provide the care and support people wanted; people were not consistently protected from the risks of unsafe medicines management and staff had not always acted to monitor people's health. People were not supported to participate in a variety of activities at the service or in the community; one complaint had not been identified or resolved and people were not supported to plan the care they preferred at the end of their life. Significantly, at the last inspection a registered manager was not in post and effective management checks had not been completed on the quality of the service. Staff were not supported to provide service to the standard the provider had set out in their vision of the service. The views of people, their relatives, staff and others had not been reviewed or used to improve the service. The provider did not have processes in operation to work in partnership with other agencies to ensure people's needs were met.

At this inspection on 27 September 2018, a registered manager was in post and had been in place since July 2018. Although significant improvement had been made, further embedding was needed to ensure change was effective, sustained and fully established as daily practice. For example, some management checks did not identify missing information and, while people had opportunities to pursue their hobbies and interests, reviews of people’s goals and aspirations required further development. We have identified these as areas requiring improvement.

Care was delivered in a way designed to promote positive outcomes for people and staff had the knowledge and skills they needed to provide appropriate support. People were supported to eat and drink enough and to have a balanced diet. Suitable steps were taken to ensure people received coordinated care when they used or moved between different services. People had been supported to access healthcare services they needed.

People were supported to have choice and control of their lives. They had been helped to avoid preventable accidents, balanced with promotion of their freedom and choice. The registered manager had taken the steps necessary to ensure people only received lawful care in the least restrictive way possible.

People were safeguarded from situations in which they may experience abuse, including financial mistreatment. Medicines were managed safely. Background checks had been

Inspection carried out on 9 February 2018

During a routine inspection

This inspection was carried out on 9 February 2018 and was unannounced.

Rose Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rose Cottage accommodates seven people with a learning disability in one adapted building. There were five people using the service at the time of our inspection.

The registered manager had left the service in January 2018 and an acting manager was working at the service. 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.

At the last inspection on 15 August 2016, we asked the provider to take action to make improvements to the way they mitigated risks and make care plans, guidance and records more detailed. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, effective and responsive to at least Good. The provider had not ensures that actions taken were sustained and the key questions effective and responsive remain rated requires improvement. The ratings for the key questions safe, caring and well-led have deteriorated. This is the second consecutive time the service has been rated Requires Improvement.

The provider did not have adequate oversight of the service. Checks and audits on all areas of the service had not been completed as the provider required and the shortfalls we noted during the inspection had not been identified. Staff had not been held accountable for their responsibilities. Checks on the building and equipment had been completed regularly. Arrangements were not in place for the provider to work in partnership with local authority multidisciplinary team and others, to support and develop the service. Action to reduce the amount of paperwork and repetition in records had not been effective and staff were not able to quickly find information we asked for.

At our last inspection we found that changes in people’s health had not been identified and staff had not contacted their health care professionals quickly. At this inspection we found that staff had identified when people were unwell and obtained care and treatment for them. However, one person was eating and drinking less than they usually did. Staff had not followed guidance in the person’s care plan to weigh them monthly and did not know that they person had lost a significant amount of weight.

The views of people’s relatives, staff and community professionals had been requested but information received had not been reviewed and acted on to continually improve the service. People had not been supported to share their views. One person had made a complaint but this had not been investigated and resolved to the person’s satisfaction. No other complaints had been received.

Most medicines were managed safely. However, the provider’s process for the safe checking and storage of medicines that require special storage had not been followed. Guidance for staff about people’s ‘when required’ medicines was not consistently accurate but staff knew when the medicine should be used. People received their medicines in the way they preferred and as their healthcare professional had prescribed.

Staff were not always deployed to the level the provider had assessed as being required to meet people’s needs at the service and out in the community. People were supported to attend healthcare appointments but had not been supported to take part social trips out which they enjoyed. People were not supported to take part in a wide range of activities at the service.

People had not been supported to pl

Inspection carried out on 15 August 2016

During a routine inspection

This inspection took place on the 15 and 16 August 2016 and was unannounced. Rose Cottage provides accommodation and support for up to seven people who may have a learning disability and autistic spectrum disorder. At the time of the inspection six people were living at the service.

The previous inspection on 21 July 2015 found one breach of regulation 12, an overall rating of requires improvement was given at that inspection. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

Each person had a single room and there was one shower room and a bathroom, kitchen, dining room and lounge. There was a large accessible garden at the rear of the service.

The service had a registered manager in post. 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.

There was insufficient guidance in place to ensure people’s healthcare needs were always met and people were not always supported well to monitor their healthcare in a responsive way. This posed a risk to people’s health and safety.

Some staff supervision had lapsed although staff said they felt able to approach the registered manager at any time for support and help.

Care plans were difficult to navigate due to the vast quantity of paperwork, some documentation was repetitive and out of date. However, staff could demonstrate a good knowledge and understanding or people’s individual needs, meaning the impact this had on people was minimal.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff. Regular audits were conducted on medicines to check errors had not occurred.

There were enough staff to meet people’s needs and staff responded to people quickly in an unhurried and patient way. People were protected by the service using safe and robust recruitment processes.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment. Accidents and incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people.

Staff had a good understanding of how to keep people safe and contact names and numbers were available should concerns of peoples safety needed to be raised.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a clear understanding of the people who lived there.

People had choice around their food and drink and were encouraged to help staff prepare and cook meals. People could choose alternative meal options when they wished.

Staff demonstrated caring attitudes towards people. People felt confident and comfortable in their home and staff were easily approachable. Interactions between people and staff were positive and encouraged engagement, staff spoke to people kindly. People’s choices were respected and staff spent time engaging people in communication and activities suitable for their current needs.

People were protected by a robust complaints procedure. There was a complaints procedure in place for people and their representatives and complaints were responded to in a timely way.

Staff felt positive about the future of the service and were positive in the feedback they gave about the registered manager who they found supportive and approachable. The registered manager had started to implement changes to improve the service people received.

People’s feedback was obtained, listened to and analysed to improve the service they received. The provider conducted observational audits to look at the quality of care people were in receipt of.

We found two

Inspection carried out on 21 July 2015

During a routine inspection

The inspection took place on 21 July 2015, and was an unannounced inspection. The previous inspection on 23 April 2013 was to follow up on breaches and found no breaches in the legal requirements at that time.

The service is registered to provide accommodation and personal care to seven people who have a learning disability or autistic spectrum disorder. People were aged 19 years to 65+ years. There were no vacancies at the time of the inspection. The service was previously a bungalow, but people’s accommodation is now on two levels. It is a short walk from New Romney town. People accommodated had a learning disability and some also had a physical disability. As only one bedroom is on the second level the service is suitable for those with physical mobility problems. There is very limited parking with additional on street parking. Each person has a single room and there are two bathrooms and a shower room, large kitchen and a lounge/diner leading through to a conservatory. There are two accessible gardens, one large, which is mainly laid to lawn with trees and shrubs and paved patio areas with tables and seating, which leads to another smaller garden with an apple tree and vegetable patch.

The service has an established 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.

The registered manager was unable to locate details of the provider’s aims and objectives on the day of the inspection. The registered manager agreed these needed to be more readily accessible and embedded into the service.

People told us they received their medicines safely and when they should. However we found shortfalls in some areas relating to medicine management.

Most risks associated with people’s care and support had been assessed and in most cases procedures were in place to keep people safe. However some guidance for staff to help keep people safe required more detail.

People said they had a say in the planning of their care and support. Care plans contained information about people’s wishes and preferences and some pictures and photographs to make them more meaningful. They detailed people’s skills in relation to tasks and what help they may require from staff, in order that their independence was maintained, but could better support people developing their independence skills. People had regular reviews of their care and support where they were able to discuss any concerns.

New staff underwent an induction programme, but these were not fully signed off to show staff were competent to work on their own. Induction records examined did not meet induction standards, which are competency based and in line with government training standards. Staff training included courses relevant to the needs of people supported by the service. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively.

People had limited opportunities to undertake activities and access the community. People attended local centres and enjoyed the activities undertaken, such as going out for a coffee and art and craft. Some people had family that were important to them and contact was supported by staff.

People felt safe in the service and out with staff. 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 in order to keep people safe.

People had their needs met by sufficient numbers of staff. Rotas were based on people’s needs. People received care and support from a small team of staff and the registered manager worked on rota alongside staff at times. People were protected by safe recruitment procedures.

People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were kind.

People benefited from living in an environment and using equipment that was well maintained. There were records to show that equipment and the premises received regular checks and servicing. Over recent times the premises had benefited from refurbishment and redecorating work. People freely accessed the service and spent time where they chose.

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 (MC) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Deprivation of Liberty Safeguarding applications had been made or were in place where people did not have the capacity to consent to living at Rose Cottage. When people were assessed as not having the capacity to make a decision, a best interest decision had been made involving people who know the person well and other professionals, where relevant, but the people involved in this decision making had not always been recorded.

People were supported to maintain good health and attend appointments and check-ups, such as doctors and opticians. Some people had complex health needs and these were kept under constant review. Appropriate referrals were made when required and assessments had been undertaken by a physiotherapist and an occupational therapist.

People had access to adequate food and drink. They told us they liked the food and enjoyed their meals. People were involved in preparation of some 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.

People felt staff were 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 kind in their approach and knew people and their support needs well.

People 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 and preferences. 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 been mostly positive.

People felt the service was well-led. The registered manager adopted an open door policy 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Inspection carried out on 23 April 2013

During an inspection looking at part of the service

Our last inspection in December 2012 identified some concerns that related to care plans and risk assessments. The service could not evidence that care planning was regularly reviewed and up to date. This raised the potential that planned and delivered care did not continue to meet the needs of the people it was intended to support. We carried out this inspection to check that improvements had been made.

People we spoke with told us they were satisfied with the care they received and said that staff had discussed care and support needs with them. People told us they were asked which activities they enjoyed, what they would like to do and what they thought about living at Rose Cottage.

People told us that they were encouraged to do things that they could for themselves and felt confident they were supported by staff when they required help. People felt there were enough staff on duty to support them with their activities.

When we looked around the service, it was clean and tidy. People said that the service was kept clean and that they liked living there. Some people told us how they were able to choose paint, wallpaper and carpet when their bedroom was redecorated.

The name of a previous registered manager appears in this report, who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because it had not been removed from the register as manager of this location at the time of our inspection.

Inspection carried out on 13 December 2012

During an inspection in response to concerns

While some of the people who lived at Rose Cottage were able to speak with us, to help us fully understand the experiences of all of the people who used the service, we also looked around the service and observed how staff interacted with people.

People we spoke with who lived at the service told us they did not have any concerns about the care they received. Some people told us that staff asked them if they were happy living there and sometimes discussed their care and support needs with them. People said there were generally enough staff on duty and that staff came when they needed them. They said all the staff were friendly and helpful.

The service was being managed by managers from other services owned by the provider until a permanent manager is appointed. The name of a former manager appears on this report because they continue to be accountable until they deregister.

Prior to this inspection we considered information received about the service which helped to inform our inspection.

During our inspection we found some concerns that related to care plans and risk assessments. The service could not evidence that care planning was regularly reviewed and up to date or that staff were always aware of all risks when supporting the people who lived at the service. This raised the potential that planned and delivered care did not continue to meet the complex needs of the people it was intended to support.

Reports under our old system of regulation (including those from before CQC was created)