Rosedale House

Rosedale is a small residential care home providing personal care to a maximum of 2 people. The service provides support to people with learning disabilities and autism. At the time of our inspection there were 2 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The model of care and setting did not consistently maximise people’s choice, control and independence. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The manager and staff team were aware of people’s strengths and had considered possible goals for people, but they needed to involve the person more in the planning, identifying and developing the steps they needed to take to achieve them and work towards leading as independent life as they could.

People were supported to take part in activities and interests in the local area. Some inhouse opportunities had been developed with a summer house for arts and crafts and involvement in the decisions for the imminent redecoration of some of the home.

Right Care:

There was a permanent staff group who worked consistently with people, so they knew them well, which helped ensure they received the care they needed, which was person centred and promoted people’s dignity and privacy.

Staff had been given training in signing to help ensure they had the skills to be able to communicate, which needed embedding into the support provided.

Right Culture:

The manager’s responsibilities were too great as they covered other homes and had a lack of support due to vacancies in senior staff. This had impacted on the quality assurance and governance processes and had led to a lack of oversight and gaps in monitoring, involving families and other professionals in reviews of care plans, as appropriate. However, this had been identified by the provider and there were plans in place to improve the situation.

People received support from trained specialists where necessary, who helped staff understand people’s needs and encouraged consistent support.

Staff and the management team at the service spoke positively about people within the service and wanted people to live their best lives.

There were plans in place to redecorate and upgrade the accommodation, which was needed. Health & safety checks and servicing of facilities were carried out.

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 on 08 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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.

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 well-led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider and manager took action following our inspection to address the concerns we raised and submitted evidence to show actions they had taken.

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

Enforcement

We have identified a breach in relation to quality assurance and governance at this inspection.

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.

Rosedale House provides accommodation and support to a maximum of two people with a learning disability or autistic spectrum disorder. At the time of our inspection there were two people living at the service.

The service consisted of one house, with separate bedrooms, bathrooms and living areas, and a shared kitchen and garden. The first-floor lounge was used as a bedroom by night staff.

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.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People living at Rosedale House participated in activities and were actively involved in their local community. Staff showed empathy, kindness and compassion; they placed value on their caring roles and involvement in people’s lives.

People were offered a choice of meals and staff monitored people assessed to be at risk of poor food and fluid intake. The care provided was flexible to meet people’s needs and preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good working relationships with the local GP practice and learning disability healthcare professionals. The service worked in partnership with people and encouraged feedback on the care provided. Staff told us they enjoyed working at Rosedale House and spoke highly of the support and encouragement provided by the manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout, however, some risks were identified, but the manager put measures in place immediately after the inspection to address and mitigate these. The service was in the process of developing their governance arrangements and completion of internal quality checks and audits was ongoing.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection

The last rating for this service was Good (published 15 November 2016).

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Rosedale House provides accommodation and support to a maximum of two people with a learning disability or autistic spectrum disorder. It does not provide nursing care. At the time of our inspection there were two people living in the home.

There was 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.

People were safe living in the home. Risks to people were identified and well managed, this included risks associated with the environment and premises. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. Incidents and accidents were reported and the service worked to ensure the likelihood of reoccurrences was reduced.

There was enough staff to meet people’s needs. People were supported by a stable and consistent staff group, who knew them well. New staff received an induction that supported them to carry out their role. Staff worked together to ensure they could meet people’s needs effectively.

Medicines were managed and stored safely. There was guidance in place so staff knew how to administer medicines. Regular audits were taken on medicines to check and ensure they were managed safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the management team understood the MCA DoLS and its impact on the support they provided. The service was following the legal requirements.

People were supported to maintain their health, this included supporting people to eat healthily and address nutritional risks. Staff ensured people received the health care they required.

People were supported by staff that cared for them, knew them as individuals, and treated them respectfully. People living in the home had complex communication needs. The service had in place communication systems to help people express their wishes and feelings. There were opportunities for people to discuss their support and relatives felt involved in decisions.

The care provided was responsive and timely, it met people’s individual needs and preferences. Relatives told us they knew how to complain and felt comfortable and able to do so. Where issues had been raised action had been taken to respond to them.

People were supported to maintain important relationships and participate in activities. Although some relatives felt at times more opportunities could be sought out.

There was an open culture in the home. Relatives felt the registered manager was transparent and honest. Staff felt supported and issues were dealt with in a constructive and motivating manner. Relatives and staff were positive about the support and leadership of the registered manager. There were quality monitoring processes in place to help monitor and identity issues that might affect the quality of the service provided.

The provider put new systems in place to ensure that improvements were made.

We saw that people were supported to be involved in activities which interested them such as, taking walks to get the daily paper, going on train trips and using a trampoline. At the time of our inspection we observed a person using the service jumping on the trampoline which was in the garden of Rosedale House. We saw that they were happy, continually smiling and enjoying themselves.

Appropriate arrangements were in place in relation to obtaining people's medication. However, there were no arrangements in place for stock checking people's boxed medication.

Appropriate checks were undertaken before staff began work and there was an appropriate recruitment process in place.

People were given support by the provider to make a comment or complaint.

Our observations demonstrated that care and support was delivered in line with people's care plans. For example, in one person's personal hygiene plan we saw that they required prompting with tasks such as washing their hands. During this inspection, we saw staff prompting this action. Comments from the last relative survey included, 'The team provide a quality service my [relative] is very well cared for and has a wonderful life. I am very grateful.' Another relative commented, 'My [relative] has improved greatly since moving to Rosedale House."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff were provided with appropriate training to ensure that they could meet the needs of the people they were caring for. They were also supported through a regular system of supervision.

The provider had an effective quality monitoring system in place which allowed them to identify areas for improvement and take appropriate action.