Rosewood House

About the service

Rosewood House is a residential care home providing personal and nursing care to up to 16 people. The service provides support to people with a learning disability. At the time of our inspection, there were 15 people using the service, some of whom had complex nursing needs.

The service is adapted to meet the needs of people with physical disabilities. It is on a site outside of the local village, along with three further residential care homes run by the same provider. There is a swimming pool and restaurant on the same site.

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

Right Support:

The model of care and setting did not consistently maximise people’s choice and independence. The service did not ensure people had a fulfilling and meaningful everyday life. There was little evidence of people’s aspirations and goals or what support they needed from staff to achieve them.

People did not have the same level of contact with their local community as any other citizen.

People received their medicines as prescribed, but medicines were not always managed safely.

People were not supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service were in line with the Mental Capacity Act.

People’s care and support was provided in a safe, clean, well equipped, well-furnished, and well-maintained environment. A new kitchen had been installed which increased people’s opportunities to participate in choosing and preparing some meals. People had a choice about their living environment and could personalise their rooms.

Relatives and staff told us people were safe living at Rosewood House. People could access specialist health and social care support in the community and were supported by staff who understood how and when to highlight concerns they had about people’s health.

Right Care:

People’s care plans were not holistic and did not consistently promote people’s wellbeing and enjoyment of life. The support people received did not always focus on their quality of life or enable them to undertake activities or interests that were tailored to them.

Opportunities to increase people’s skills and independence were not always used.

People had access to good quality nutritious food but were not as involved as possible in planning their menu, buying food or cooking.

People were able to communicate with staff who understood peoples’ communication needs.

People were protected from abuse. Staff understood how to raise any concerns and said they were listened to.

New staff were recruited safely and completed an induction.

Right Culture:

The provider had not ensured best practices for people with a learning disability had been embedded in the way the service operated.

Staff knew people well but there was a lack of guidance to enable staff to support people to achieve their aspirations and to live a quality life of their choosing.

The service’s governance arrangements had not identified all the areas for improvement highlighted during the inspection.

Staff received regular updates to their training. They told us they also attended team meetings and one to one supervision.

Relatives gave positive feedback about the service.

Staff turnover was low, which meant people received care from staff who knew them well.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 October 2022). We found breaches relating to the governance of the service and treating people with dignity and respect.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 4 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance and how they treated people with dignity and respect.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same.

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

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.

Enforcement and Recommendations

At this inspection we found the provider remained in breach of regulations. We found ongoing breaches in relation to the governance of the service and treating people with dignity and respect.

Please see the action we have told the provider to take at the end of this report.

At our last inspection we recommended that the provider followed national guidance when recording the administration of medicines and sought advice and guidance about each of the steps outlined in the duty of candour. At this inspection we found further concerns about medicines management but found the provider had made improvements in relation to how they followed the steps to meet their obligations regarding their duty of candour.

At this inspection we made a recommendation about the emergency evacuation information held in the service.

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.

About the service

Rosewood House is a nursing home providing accommodation, nursing and care for up to 16 people with learning disabilities or physical disabilities and/or people with autism. At the time of the inspection 15 people were living at the service, about half of those people had complex nursing needs. Rosewood House is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in three further registered residential homes on the same site and in the nearby village of Polyphant.

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

Based on our review of safe, effective and well-led.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The premises had not been designed to meet everyone’s sensory needs at all times.

People were not supported to pursue their interests or identify meaningful goals. There were limited opportunities to try new activities.

There were limited opportunities for people to engage with the local community and pursue their interests outside of Rosewood House.

The environment was clean and well maintained. Corridors and shared areas were set up to enable people in wheelchairs to move around without restrictions. Bedrooms were well-equipped with equipment to meet people’s physical needs.

There were plans in place for people to have more privacy when being supported with medicines.

Right Care

People’s care, treatment and support plans reflected their clinical needs and staff told us guidance was clear and gave them the information they needed.

People received kind and compassionate care. Staff understood and responded to their individual care needs.

Staff understood how to protect people from poor care and abuse. They had received training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to support people in line with their commissioned hours and keep them safe.

Right Culture

Due to people’s complex health needs care plans focused on their medical needs. There was limited information about people’s goals and aspirations and how to ensure they experienced a good quality of life.

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 19 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about risks associated with people’s clinical support. As a result, 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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective sections of this full report.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective sections of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the management of the service.

We have made a recommendation in relation to the Duty of Candour.

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.

Rosewood House is a nursing home providing accommodation, nursing and care for up to 16 people with mental health needs, learning disabilities or physical disabilities. At the time of the inspection 15 people were living at the service, about half of those people required some nursing care. Rosewood House is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in six residential homes on the same site and in the nearby village of Polyphant.

Rosewood House has a registered manager who was responsible for all the services on the complex. 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. In addition to the registered manager, the service had a deputy manager and team leaders who oversaw the day to day running of the service.

The care service was established before the development of the CQC policy, 'Registering the Right Support' and other current best practice guidance. This guidance includes the promotion of values including choice, independence and inclusion. The service was working with people with learning disabilities that used the service to support them to live as ordinary a life as any citizen. For example, people’s bedrooms offered space and privacy. There was access to activities both on site and outside of the organisation. Changes to way meals were organised were planned which would allow people to become more involved in this aspect of their life.

People and their relatives spoke highly of the care and support provided at the service. Comments included “We have no concerns at all, staff know [Person’s name] very well.” Most people were unable to verbally express their views of the service. We observed people were at ease with staff and comfortable in their environment.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Where restrictions were in place in order to keep people safe the best interest process had been followed to check the restrictions were necessary, proportionate and the least restrictive practice.

People’s records were comprehensive and relevant to their specific needs. Photographs were used to support written information so staff had a clear understanding of how to support people in specific circumstances. Any identified risks were recorded and guidance given on how to minimise the risk. All records were reviewed regularly and staff were alerted to any changes in people’s needs.

There were sufficient staff to meet people’s needs and support their choices and preferences. The atmosphere was vibrant and staff were able to support each other and work as a team to help ensure people’s needs were met.

People’s medicines were stored, administered and disposed of safely. People were supported to maintain good health through regular access to healthcare professionals such as GPs, speech and language therapists and consultants.

Staff knew people well and had a good understanding of both their health and social needs. Bedrooms were personalised and reflected their tastes and interests. People took part in a range of activities both within the service and wider community.

There were effective quality assurance systems in place. The deputy and registered manager had a range of quality assurance processes in place. People, staff and relatives had opportunities to make suggestions about how the service could be improved. Staff described the management team as approachable and supportive.

Rosewood House is a residential service providing accommodation, nursing and care for up to 16 people with mental health needs, learning disabilities or physical disabilities . At the time of the inspection 14 people were living at the service. Rosewood House is one of four houses which are part of the larger complex, Bowden Derra Park.

Rosewood House has a registered manager who was responsible for all the services on the complex. 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. In addition to the registered manager, the service had a deputy manager and a team leader who oversaw the day to day running of the service.

People and their relatives spoke highly of the care and support provided at the service. Comments included “I love it here”, “There is nothing they could do better. People come here and stay here. They love it” and “I can share my concerns with staff and I now have peace of mind when I leave my relative, It’s amazing”.

People’s records were comprehensive and personalised. This meant staff had the information they required to support people in the way they needed and preferred.

There were sufficient staff to meet people’s needs and support their choices and preferences. Staff said they were happy in their work and this was evident in the calm and relaxed atmosphere at Rosewood House. Positive working relationships had developed between people and staff and people were made to feel valued and well cared for.

People’s medicines were stored, administered and disposed of safely. People were supported to maintain good health through regular access to healthcare professionals such as GPs, speech and language therapists and consultants.

Staff were knowledgeable about the people they cared for and their right to privacy and dignity was upheld. People’s bedrooms were personalised and they had been involved in decorating them. People took part in a range of activities both within the service and wider community. People were supported to remain as independent as possible.

There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance processes with involvement from people, staff, relatives and professionals and was committed to continually improving the service. Staff described the management as approachable and supportive.

People received a healthy and varied diet, which was monitored so that any concerns could be followed up in a timely manner.

The home environment was suitable for the needs of the people living there and it was well maintained, clean, warm and light. However, safety could be further promoted through more effective policy and procedure.

There were sufficient support workers to meet people's needs and those support workers received regular and ongoing training. Support workers knew people who used the service well and said they felt well trained and that there were enough staff to support people.

Record keeping at Rosewood House was improved in that all records were found to be kept confidentially and records were more detailed and provided better information to inform support workers about people's needs.

People received support in a respectful way and staff were able to describe their needs and how they were met. There was a relaxed atmosphere and staff engaged with people at the person's own pace. However, there had been times when staffing numbers had affected the number of activities available and staff were not always receiving ongoing training to provide the support and care needed.

People's personal care and health needs were fully understood, monitored and met. People were supported to make decisions and be involved in their care. Vulnerable people had their rights upheld and appropriate people were involved in best interest decisions on their behalf.

One person told us that he liked his room. The home was warm, clean, fresh and safe. Another person said they she liked crayoning and we saw that she did this often. There were a lot of activities for people to choose from, both on site and off site, some therapeutic, some just fun.

Some records were detailed, current and fit for purpose. Some were not. This had already been identified as needing attention. The provider had arrangements in place to monitor and improve the service for people.