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Reports


Inspection carried out on 2 March 2020

During a routine inspection

About the service

Roselea is a residential care home providing accommodation and personal care for up to 11 people with a learning disability and/or autism. At the time of our inspection there were 11 people living at the service. The property is an adapted cottage with bedrooms available on the ground and first floor. First floor rooms were accessed by stairs. On the first floor there were three self-contained flats for people who wanted and could live more independently. There was garden space for people to access at the rear of the premises.

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 service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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 were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff available to safely meet people’s needs. Staff were recruited safely, as the provider carried out the required checks prior to employing applicants. People had support from staff who had been trained and were supported by management. Staff told us they felt they had the skills to carry out their roles effectively.

People had their medicines as prescribed and staff made sure medicines were reviewed regularly. People’s risks were safely managed with risk management plans in place to give staff guidance.

The service was clean and well maintained. Safety checks regarding the environment were carried out regularly such as testing fire systems. People had their own rooms or self-contained flats which they could personalise if they wanted.

People had support to plan and prepare their own meals if they wanted. People’s health needs were recorded in a health action plan. Staff made timely referrals to healthcare professionals when needed. Staff worked as a team to make sure people’s needs were met. They used handovers to share information with each other.

People’s relatives told us staff were caring. People had a key worker who took time to get to know them and their needs well. People were involved in their care. They had care reviews to discuss their support and talk about how well it was working for them. People had their own personalised care plan which was reviewed when needed.

There was an open and positive culture at the service. Staff told us management were supportive and approachable. Team meetings were held regularly, and staff could share their ideas for improvements. Quality monitoring was carried out by the manager and the provider to assess and monitor quality and safety. Any improvements were added to an action plan for the service, which was monitored until actions were completed.

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

Rating a

Inspection carried out on 26 April 2017

During a routine inspection

Roselea is a care home registered to accommodate up to 12 people with a range of learning and physical disabilities. The accommodation includes self-contained flats on the top floor for people who are able to live more independently. Nine people were using the service at the time of our inspection.

This inspection was unannounced. This meant the provider did not know we would be visiting.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 our last comprehensive inspection in January 2015 we found, a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not always received the necessary training to meet people's health needs. We rated the service overall as ‘Requires Improvement’ at that time. The provider sent us an action plan telling us the action they would take to make the required improvements. We carried out a focussed inspection in July 2015 and saw those improvements had been made. We were able to change the overall rating of the service to ‘Good’ as a result of that inspection.

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Why the service is rated good.

People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed.

The service was effective in meeting people’s needs. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People’s views were sought and they were involved in making decisions about their care and support. People were supported to maintain relationships with family and friends. People’s independence was promoted.

The service was responsive to people’s needs. People received person centred care and support. Staff monitored and responded to changes in people’s needs. They were offered a range of activities both at the service and in the local community. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was well led. The registered manager and senior staff maintained a clear focus on continually seeking to improve the service people received. A comprehensive quality assurance system was in place. This system was based upon regular, scheduled audits which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Inspection carried out on 21 July 2015

During an inspection looking at part of the service

We carried out a comprehensive inspection of Roselea on 15 January 2015. One breach of the legal requirements was found at the time of the inspection. This related to staff not receiving training to meet the needs of people effectively. After the inspection, the provider sent us a report of the actions they would take to meet the legal requirements.

We undertook a focussed inspection on 21 July 2015. This was to check if the provider had followed their plan and to confirm if the legal requirement was now being met. We also looked at whether the service provided was effective and caring. This was because when we visited on 15 January 2015 these areas required improvement.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for ‘Roselea’ on our website at www.cqc.org.uk.

Roselea is a care home registered to accommodate up to 12 people with a range of learning and physical disabilities. The accommodation includes self-contained flats on the top floor for people who are able to live more independently. One person had moved to another service since our last inspection. Ten people were using the service at the time of our inspection.

This inspection was unannounced.

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.

At our focussed inspection on 21 July 2015, we found the provider had followed their plan and legal requirements had been met.

The provider had ensured ten staff had received additional training on caring for people with complex epilepsy. A clear plan was in place for the remaining 12 staff to undertake this training. Staff said they felt more confident in their ability to provide care and support to people. A health care professional told us they were more confident the staff could effectively meet people’s needs.

The provider had also ensured staff received training on understanding and responding to people’s anxieties and behaviours. Staff said they felt more confident in supporting people when anxious and distressed.

A system to ensure the service complied with the requirements of the Deprivation of Liberty Safeguards (DoLS) had been put in place. This meant people were protected from the risk of their freedom and liberty being deprived without the correct authorisations being in place.

People told us staff were caring. Additional arrangements to ensure people’s confidentiality was protected had been put in place.

The ratings from our inspection on 15 January 2015 were prominently displayed in the lobby of the service.

As a result of this inspection we have been able to change the rating of the service.

Inspection carried out on 15 January 2015

During a routine inspection

Roselea is a care home registered to accommodate up to 12 people with a range of learning and physical disabilities. The accommodation includes self-contained flats on the top floor for people who are able to live more independently. Eleven people were using the service at the time of our inspection.

This inspection was unannounced.

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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to training of staff. We completed this inspection at a time when the Health and Social Care Act 2008 (Regulated Activities) 2010 were in force. However, the regulations changed on 1 April 2005, therefore this is what we have reported on. You can see what action we told the provider to take at the back of the full version of this report.

We have made a recommendation about how the service monitors Deprivation of Liberty (DoLS) authorisations.

Staff received training, supervision and appraisal. We found the service required improvement to effectively meet people’s needs. Staff were not sufficiently well trained in providing care and support to people with epilepsy. The service had in place deprivation of liberty safeguards (DoLS) for people. However, we found one had lapsed. This meant one person was being deprived of their liberty without authorisation. However, action had been taken by the registered manager on the day of our visit.

People were safe because the registered manager and staff team understood their role and responsibilities to keep people safe from harm. They knew how to raise any safeguarding concerns. Accidents and incidents affecting people were closely monitored and appropriate action taken to reduce the likelihood of a reoccurrence. People were supported to take appropriate risks and promote their independence. Risks were assessed and individual plans put in plans to protect people from harm. People were protected from the risks associated with medicine because the provider had clear systems in place and staff had received the appropriate training.

There were sufficient skilled and experienced staff to meet people’s needs. Staff underwent employment checks before working with people to assess their suitability.

People were supported to eat and drink to maintain an appropriate body weight and remain hydrated. Where people were at risk of poor nutrition or hydration, measures were in place to monitor this. Arrangements were made for people to see their GP and other healthcare professionals when they needed to do so.

People living at the service and staff had positive and caring relationships. People were involved in making decisions about how they wanted to be looked after and how they spent their time. People’s confidentiality was not always respected.

People received person centred care and support. People were actively involved in a range of activities both within their local community and at the service. People were encouraged to make their views known and the service responded by making changes.

The registered manager and deputy manager provided good leadership and management. The vision and culture of the service was clearly communicated. The quality of service people received was continually monitored and where shortfalls were identified they were addressed.