Rosewood Villa

Rosewood Villa is a ‘care home’, providing care to a maximum of 17 people. At the time of the inspection 15 people were living at the home.

We found the following examples of good practice:

¿ People were supported to see their friends and relatives in a safe manner. Pod, window, garden visits and in room visits were all taking place safely.

¿ People were admitted in the home safely. Specific rooms, such as bathrooms, were allocated for people to reduce the spread of infection.

¿ There was sufficient PPE available and it was used appropriately by staff. Cleaning had been increased particularly for regular touch points within the home.

¿ Effective protocols for visiting, cleaning and testing were in place. Risk assessments were in place and up to date.

Further information is in the detailed findings below.

Rosewood Villa accommodates 17 older people across two floors in one adapted building. Some of the people were living with a dementia. At the time of our inspection visit there were 15 people using the service.

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

Medicines were managed safely, in line with best practice. External advice was sought where appropriate.

The premises were well maintained and serviced. Appropriate health and safety checks were in place. Risk assessments were in place and well understood by staff.

Staffing levels were safe with people feeling well supported by staff they knew well; the service did not use agency staff.

The care manager worked proactively with external healthcare professionals. They ensured people had access to primary healthcare services.

Meals were varied and there was a creative approach to trying new foods. Specialised diets were well catered for.

People enjoyed a range of individual and group activities on offer. Community links were strong and contributed to a vibrant range of events.

The home felt welcoming, personalised and vibrant. Feedback was positive regarding the compassionate, affectionate and sensitive approach of staff. The culture was strongly person-centred and respectful of people’s individualities.

People were involved in the planning of their care. Residents’ meetings, one to one time and surveys ensured people had a say in how the service was run.

People’s rooms were clean, well decorated and highly personalised. Communal spaces were well designed in terms of space and popular areas for people to mingle.

Staff received training relevant to people’s needs. End of life care plans were in place and staff received training. More was planned to increase skills and confidence in this area.

The care manager worked well with staff, was a visible leader, and there was a strong team ethic. Morale was high and continuity of care was a key strength of the service.

Notifications had been made to CQC when required.

People’s capacity was assumed unless there were reasons to consider otherwise, and staff acted in line with the Mental Capacity Act 2005. 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.

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 requires improvement (published 21 December 2018).

The provider made immediate improvements and provided assurances about their knowledge of requirements to notify CQC of relevant incidents.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Rosewood Villa is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rosewood Villa accommodates 17 people across two floors in one adapted building. Some of the people were living with dementia. At the time of our inspection visit there were 17 people using the service.

At our last inspection we rated the service good. At this inspection we found evidence that some statutory notifications had not been submitted to CQC. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 and as a result the service is now rated requires improvement.

The provider had failed to notify CQC of fifteen DoLS authorisations and two deaths. Notifications for these incidents should have been submitted to CQC in a timely manner.

There were enough staff on duty to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The home was clean and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

The provider had a safeguarding policy in place and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external healthcare specialists.

People, family members and visitors were complimentary about the standard of care at Rosewood Villa.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had a complaints policy and procedure in place, and people, family members and visitors were aware of how to make a complaint.

The provider had an effective quality assurance process in place. People, family members and visitors were regularly consulted about the quality of the service via meetings and surveys.

Rosewood Villa is a residential care home which provides personal care for up to 17 people. Care is primarily provided for older people, including people who have dementia.

Staff knew how to keep people safe and prevent harm from occurring. The staff were confident they could raise any concerns about poor practice in the service and these would be addressed to ensure people were protected from harm. People in the service felt safe and able to raise any concerns.

Staffing was organised to ensure people received adequate support to meet their needs throughout the day and night. Recruitment records demonstrated there were systems in place to employ staff who were suitable to work with vulnerable people.

People’s medicines were managed by staff who were trained and monitored to make sure people received their medicines safely. The temperature control in the medicines storage area was not being regularly checked, the manager agreed to rectify this.

Staff received support from senior staff to ensure they carried out their roles effectively through mentoring and support. Supervision processes were in place to enable staff to receive feedback on their performance and identify further training needs.

People could make choices about their food and drinks and alternatives were offered if requested. People were given support to eat and drink where required. We observed a positive mealtime experience where senior staff and the manager assisted.

Arrangements were in place to request external health and social care services to help keep people well. External professionals’ advice was sought when needed and incorporated into care plans. External healthcare professionals spoke of effective joint work with the staff and manager.

Staff demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005. The service had made applications for people who may be deprived of their liberty. They had yet to create a robust process for the review of deprivations but agreed to do so.

Staff provided care with kindness and compassion; we saw smiles and interaction between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say.

People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and to make choices. The staff team knew the care and support needs of people well and took an interest in people and their families to provide individualised care.

People had their needs assessed and staff knew how to support people according to their preferences and choices. Care records showed that changes were made in response to requests from people using the service, relatives and external professionals.

Staff knew people as individuals and respected their choices. People were supported to enjoy a range of activities. People could raise any concerns and felt confident these would be addressed promptly by the manager and senior staff.

The home had a manager who was visible and hands on. There were systems in place to make sure the service learnt from events such as accidents and incidents, complaints and investigations. The provider had notified us of all incidents that occurred as required.

People and relatives views were sought by the service through surveys and day to day contact. People, relatives and staff spoken with all felt the manager was caring and responsive.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

All the people we spoke with told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I do feel safe here.' Another person told us, 'I can go to the staff if I am worried about anything.'

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. The manager told us that there had been no applications submitted. They also told us they had received training in making an application and showed us the policy and procedures they followed. They told us some staff had received relevant training and all staff had access to the policy and procedures.

People told us the home was comfortable. They told us that it was always clean and we saw that the home was well maintained and serviced regularly to ensure people's safety.

Is the service effective?

People's needs were properly assessed and appropriate care plans were drawn up to meet those needs. Comments from people included, 'I have a care plan to meet my needs. If I need anything or something changes I can speak with the staff about it.' Another person told us, 'I have been here for a couple of years now. The things I can't do for myself are in my care plan. Staff always know where I need help. I also have all the equipment I need to help with my mobility.'

People explained how their care and welfare needs were met. People told us they had support with health appointments and felt the service was flexible. One person told us, 'The staff have helped me if I needed to see a doctor.' Another person told us, 'We are alright here. Today there is an exercise class; it's good to keep active.'

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. People were not rushed when care was delivered and we saw staff interactions with people were caring. All the people we spoke with said they felt the care was very good. One person told us, 'It's nice and homely here. The staff are lovely.' Another person told us, 'The staff are very good with me.'

We saw staff treated people with respect and dignity. One person told us, 'The staff are very respectful, they treat us well.' All the people we spoke with told us they were very happy with the care they received.

Is the service responsive?

All the people we spoke with told us staff would respond to any of their requests for support. One person told us, 'I like to go out for fish and chips regularly.' Another person told us, 'I have a car and the staff take me out for day trips.' A third person told us, 'It's very nice living here. The staff treat me well and I am well looked after.'

All people we spoke with told us they were involved in decisions about their care. They said staff were flexible and responded to their requests promptly. We saw staff responded to people's requests for help in a timely manner.

We saw there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaints.

People's care needs had been reviewed at least every four weeks. We saw when people's requirements had changed the provider had responded appropriately and reviewed the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The service had a registered manager in post who showed us they had developed a quality assurance system which included, medication audits, care records and care practice standards. People had been consulted about their views on the service. The manager used this quality assurance system in order to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been taken into account.

We saw the home had systems in place which ensured the manager and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

We found staff had gathered detailed information about each person they cared for during the initial assessment. This information was used to develop personalised care plans. Care plans were based around people's preferences and how they wanted their care to be delivered.

People were involved in making decisions about their care. People said, 'They (the staff) say It is this ... do you want it or what would you like instead?', and, 'They talk to you about what you need. I don't like being on my own. I like company. It's really, really nice here.'

We observed that staff interacted positively with people. People commented: 'The girls are nice when they speak to you. They're genuine people who talk to you nicely. They don't just pretend'; 'They're a happy lot of people. We all talk to each other. There's never any trouble, or anything like that'; and, 'You can't fault it. I love being here. Nothing seems to bother them. They get on with things and we all join in.'

We found people had access to health professionals and specialists when they needed them. This included behaviour specialists, GPs, physiotherapists, occupational therapists and specialist nurses.

The home was provided with detailed information from referrers, such as social workers prior to people being admitted. The manager told us that detailed written information, tailored to each individual, was provided when a person with dementia was admitted to hospital.

The provider had systems in place to enure people received good quality care. This included audits of care records and observations of care practice. One family member commented, 'I regularly see the staff talking to residents in a friendly caring manner. The staff seem to be a team who will not tolerate any member of staff who does not meet their high standards.'

The provider undertook assessments to ensure people were protected from risk or harm. Staff had completed specific training in relation to caring for people with dementia and the environment had been adapted to make it easier for people to maintain their independence.

People told us they were happy with the care they received. One person said, 'If I was worried about anything, I'd talk to someone who was working in the house. I would tell them what was on my mind.' Other people said, 'If you feel you've got a grievance, it's an open book. They're very soothing, very concerned', and, 'I'd talk to the boss. But there's never anything to worry about. We're treated very well.' 21 people left comments on our comment cards. They were all very positive about the quality of the care provided at the home and of the care staff.

During our observation we saw people were treated with consideration and respect. People and their relatives told us the care which was provided was good. One person said, "I'm very happy here. There is always lots going on, staff put on games and quizzes, we go out for walks when the weather is good and we're getting a gardening box so we can potter around in the garden too. I'm well looked after and kept entertained too. It's wonderful. '

A relative said, "I've been impressed with everything. If people need something, anything at all, they don't have to wait, staff are there checking if they need help."

We reviewed three care records and saw people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about people's care needs and what they should do to support them.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

We found there were appropriate arrangements in place to manage medicines. There was an effective system in place to monitor and assess the quality of the service provided.