Rosekeys

Updated 15 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Rosekeys is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Rosekeys is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The manager in place had submitted an application to register. We are currently assessing this application

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people using the service. We spoke with the area manager, the manager, the deputy manager and 7 staff members. We spoke with professionals who work with the service.

We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We completed observations of people being supported. We reviewed a range of records including staff recruitment files, care plans, medicine records and management audits.

Updated 15 February 2024

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

About the service

Rosekeys is a residential care home providing accommodation and personal care to people with learning disabilities and autism. The service can support up to 13 people. There were 9 people using the service at the time of the inspection.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The provider failed to ensure people were not subject to the least restrictive practice. Physical restrictions did not always follow care planning guidance.

Staffing levels did not support people to receive their assessed support. Staff did not always have the right training and knowledge to support people effectively and achieve good outcomes.

Governance processes failed to identify risk and improve the quality of the service.

Right Care:

Care was not person-centred and did not promote people's dignity, privacy and human rights. The service environment did not facilitate good care or promote people’s dignity and privacy. Positive person-centred outcomes were limited, and this was not a focus at the service.

People were not supported to follow professional advice, sometimes putting them at serious risk of harm.

Staff and the management team did not understand how to mitigate risks and protect people from the risk of abuse.

Care plans and risk assessments failed to consistently outline people’s needs and the staff team did not always understand the level of care people required.

People and most relatives we spoke with felt the care provided was safe.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. People’s rights were not always respected and people were not free from unwanted restrictions.

Ineffective governance systems and a lack of effective partnership working meant there were closed culture concerns at this service. The provider did not have effective oversight of the actions of the management of the service and were not aware of widespread risks.

The manager was not always available for relatives and some staff told us were not always confident in the manager’s approach.

People’s rooms were personalised and areas of the service had decorations people could interact with.

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 29 November 2021).

Why we inspected

We received concerns in relation to incident reporting, safeguarding, governance and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We inspected and found there was a concern with deprivation of liberty (DoLS), so we widened the scope of the inspection to include the key questions of effective.

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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

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

Enforcement and Recommendations

We have identified breaches in relation to people’s health and safety, safeguarding, staffing, dignity and governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.