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.