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Rosekeys Requires improvement


Inspection carried out on 3 September 2019

During a routine inspection

Rosekeys is a residential care home providing accommodation and personal care to people with learning disabilities and autism.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles. However, shortfalls were identified as training had not been refreshed for all staff in in this area.

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 13 people. Seven people were using the service. This is larger than current best practice guidance. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

Some areas of the home were clean, however we found some areas were poorly maintained. We also identified poor infection control practices which hadn’t been identified by the providers audits.

The property was large and spacious but needed redecoration and the gardens needed attention.

Staff were trained and knowledgeable in safeguarding people. We identified a shortfall in the safeguarding of one person’s finances.

There were shortfalls in the audits which the provider needed to strengthen and embed into practice.

Risks to individuals and the environment were assessed and monitored. Fire equipment was serviced and regularly tested however, not all staff had taken part in a fire evacuation.

Refresher training had expired for a number of staff meaning they may not have been able to effectively carry out their role in supporting people with behaviours which challenge others. Staff told us they received regular supervision and support.

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.

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.

There were enough staff on duty to meet people's needs and we saw staff were effectively deployed. There was a recruitment system in place that helped the employer make safe recruitment decisions when employing new staff.

Safe systems were in place for medicines and we saw people were receiving them on time and as they were prescribed. Staff received appropriate training and competency assessments in administration of medicin

Inspection carried out on 14 December 2016

During a routine inspection

This inspection took place on 14 December 2016 and was unannounced. Rosekeys provides accommodation, and personal care for up to 13 people. On the day of our inspection 10 people were using the service who had a variety of needs associated with a learning disability or an autism spectrum disorder.

The service had 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

Staff had a good understanding of their role and responsibilities in protecting people from harm or abuse and followed correct procedures in relation to raising concerns. The registered manager shared information with the Care Quality Commission and the local authority when needed. Risks to people’s safety were clearly identified and assessed, and measures were in place to ensure people were safe. People received their medicines as prescribed and the management of medicines was safe.

The staffing levels were sufficient to support people’s needs and, although the service did use agency staff at times, the staff were well supported and underwent appropriate employment checks. Staff received regular and appropriate training and supervision to assist them in their roles.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People’s health needs were managed with referrals made to health care professionals when required. People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care, and were treated in a caring and respectful manner by relaxed and considerate staff.

People’s care plans contained up to date, relevant information and they received care from staff who understood their care needs. People who used the service or their representatives felt they could report any concerns to the management team and felt they would be taken seriously.

The registered manager ensured there were systems in place to continually monitor the quality of service provision.

Inspection carried out on 26 January 2015

During a routine inspection

This inspection took place on 26 January 2015 and was unannounced. Rosekeys provides residential care for up to 13 adults with a learning disability or an autistic spectrum disorder. There was accommodation for up to ten people in the main house and three more people could be accommodated in two adjoining bungalows. On the day of our inspection eight people were using the service, six of whom were in the main house and two in the bungalows.

The service had a registered manager at the time of our inspection. 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 and associated Regulations about how the service is run.

Staff knew the procedures they should follow to raise any concerns if someone was at risk of harm, but there had been a recent occasion where these had not been followed when they should have been. Staff recognised their error and said they had learned from this. Staff understood the risks people could face through everyday living and how they needed to ensure their safety. People did not always receive their medicines as prescribed.

People had staff available to support them when they needed this. More staff were being recruited to enable cover at short notice to be provided for any unexpected absences from work.

People were supported by staff who received training and support to deliver appropriate care. However there was a risk people may not receive the healthcare they require because the system in place to ensure this was planned and provided when needed was not followed.

People had their liberty restricted without the appropriate authorisation. However people were supported to make some choices and decisions about what they did and how they were supported. If they were not able to make a particular decision about their care and welfare the decision was made in their best interest. People’s dietary needs were catered for, and people were encouraged to have a healthy diet and to eat well.

We observed people being treated with dignity and respect and enjoying interaction with staff. Staff knew how to communicate with people and involve them in how they were supported and cared for. People were encouraged to be independent where they were able to be.

People’s care plans were not always kept up to date so they did not provide staff with the direction about people’s care that they should. People had individual routines and they were supported to follow their individual hobbies and interests both in and out of the service. People could rely on any complaints or concerns they had been listened to and acted upon.

The systems in place to monitor the quality of the service provided, and identify any improvements that were needed were not always effective. People felt able to approach managers and discuss things with them, including any problems or difficulties. Staff were able to speak up if anything was not right.

Inspection carried out on 5 February 2014

During a routine inspection

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and asked them for their views. We also spoke with two care workers, a team leader, the home manager, who had the day to day responsibility of running the home, and the registered manager. We looked at some of the records held in the service, including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us, �If we are capable of doing it they watch over us, they are like a safety net, they reassure us.� Another person said, �I don�t like the risk assessments, but they are there to keep me safe.�

We found that suitable arrangements were in place to manage people�s medication and ensure they received any medication they needed. A person who used the service told us, �They manage my medication. I read the information pack.�

We found the staff team were supported through training and the provider had an effective complaints procedure. A person who used the service told us, �I feel they listen to me, I am not afraid to say anything. They act on it straight away.�

Inspection carried out on 6 March 2013

During a routine inspection

We spoke with three of the six people who lived at the home when we visited. Some people living at the home had complex needs and were not able to or chose not to communicate their views and experiences with us. The staff helped us to communicate with some people because of this.

One person confirmed they liked living at the home and they liked the staff. They told us they enjoyed being outside and liked to keep the garden nice. Another person confirmed they made their own decisions about how they spent their day and what activities they did.

We saw people being supported in their activities of daily living and staff encouraged people to make their own decisions about how they spent their time and how they structured their day.

People who spoke with us said they were happy and had lots of things to do. A person said "I love painting and baking. I do what I want to do when I want."

A person's relative visited and when we spoke with them they said, "This is the best thing that could have happened for my relative. They go out to play golf, snooker, shopping and for meals. They have been happy here all the time. I visit every week and feel very welcome. I know they are well looked after and I have no worries or concerns at all."