Rose Meadow

Rose Meadow has been registered since October 2011. The service provides accommodation, personal care and support for up to ten people in Misterton, North Nottinghamshire. At the time of our inspection, seven people were using the service. The service is focused on supporting people with a diagnosis of a learning disability.

Since October 2015, government policy has aimed to develop care services in line with values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Rose Meadow was registered with the Care Quality Commission before the ‘registering the right support policy. Rose Meadow does not currently fit within best practice models for ’registering the right support’. This is due to the size of the property and amount of people currently supported. Despite the property being large, 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.

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

Improvements to records and staff knowledge, meant people now lived in a safe environment. Risks were safely managed, and people were kept safe from abuse. The provider and manager had clearly learnt from previous concerns and this had resulted in a safer service.

People’s needs were effectively assessed and there was evidence of multi-agency professional involvement. People received effective care. People reported positively about the food, and people were provided with a balanced diet. Staff had received increased training and they now had excellent knowledge of the people they supported.

People were supported to have maximum choice and control over their lives. Staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Our previous inspection found that staff had not been guided on how to respond to incidents at the service. Unskilled staff had then responded in non-caring ways. Staff had reflected that they wished to improve their work but were unsure how to respond to people. This inspection found that staff had now received clear guidance and support. They responded appropriately and compassionately to people. There was a caring ethos at the service.

There was an improved approach to personalised care. People’s individual needs had been considered and care was designed to promote people’s goals. There was a focus on improving people’s independence. People now received a responsive service which was led by their preferences.

The previous inspection was rated inadequate. This was mostly due to poor oversight in the absence of a registered manager. This poor oversight had resulted in poor quality care. After our report, we received a clear action plan explaining how the service planned to improve. This inspection found the service had followed this plan and substantial improvements had been made. There was also improved auditing structures to try to prevent a reoccurrence of previous concerns. While we were reassured, we require ongoing evidence that the service has sustained these improvements. This will ensure that people continue to receive a good level of care.

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

Rating at last inspection (and update):

The last rating for this service was Inadequate (published 9 March 2019).

At the last inspection, we were concerned about the safety of the service. This included breaches of regulations 11, 12, 17 and 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service was in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Since October 2015, government policy has aimed to develop care services in line with values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Rose Meadow was registered with the Care Quality Commission before the ‘registering the right support policy. Rose Meadow does not currently fit within best practice models for ’registering the right support’

At the last inspection, on 4 February 2016, we rated the service as ‘Good’. During this inspection we found concerns about the safety of the service. This included breaches of regulations 11, 12, 17 and 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. This is the first time the service has been rated as ‘Inadequate’.

At the time of our inspection there was no registered manager in place, however a newly recruited manager was in the process of registering. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons.” Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

There was no clear strategy and governance to ensure good outcomes for people. The registered manager had left in February 2018. A provider audit was completed seven months later, and had highlighted concerns about the service. Despite an action plan with the Local Authority we saw minimal evidence of change in the service. We were concerned that there were multiple areas of unsafe care, and the provider had failed to address these issues promptly and effectively.

During this inspection we found the service was not safe. Care plans did not guide staff on how to respond to people’s needs. Records showed us that staff responses were varied, ineffective and at times harmful to people’s wellbeing. Incidents had not been appropriately referred to the Local Authority when safeguarding criteria had been met.

The risk of fire and legionella disease had not been assessed and managed appropriately. This put people at risk of living in an unsafe environment. The home was unclean. Medicines were not stored and recorded appropriately. This put people at risk of medicines not being managed effectively.

Staff were not deployed effectively around the home to ensure people’s needs were met. People’s one to one care support needs were not clearly assessed and people were sometimes left alone.

People’s diverse needs were not recorded accurately or recognised by staff. Short-term activities were provided and we saw people enjoy these. Longer term goals required embedding in the service.

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; the policies and systems in the service did not support positive practice. Formal complaints were responded to and a new accessible complaints procedure had been created to encourage people’s voice. Further work was required to ensure people were involved with care planning

Staff did not work effectively with other organisations and professional guidance had not been effectively recorded to guide staff. Staff were not sufficiently trained. Safeguarding and mental capacity training had expired, staff had limited knowledge in these areas and care had not followed evidence based guidelines.

People were supported to maintain a balanced diet. People appeared to enjoy the meals given to them, we saw people were included in meal time decisions.

Staff were caring in their approach and treated people with kindness and dignity. However, a lack of guidance meant a non-caring approach to challenging incidents. Staff expressed a desire to learn more about responding to incidents but this had not been addressed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Following the inspection, we received an action plan from the provider. We also received some evidence that some concerns had been resolved. The provider has agreed to continue sending us action plans and an analysis of their progress. We intend to inspect this service again to ensure these improvements are embedded in the service. We remain concerned that these issues were not resolved prior to our inspection visit.

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation.

During the visit we spoke with four people who used the service, three care workers and the registered manager.

The manager told us about weekly meetings with the people living at the service. These were arranged to enable them to discuss things on an informal basis and to make decisions about menu's, activities and other issues that affected them as a group. One person told us, 'We meet up and talk about lots of things that affect us all.'

We undertook a partial tour of the building to observe care practice and general cleanliness. We saw that the home was well maintained and clean.

We looked at some people's rooms and saw they were personalised and decorated in the colours and style the person had chosen.

One person said, 'I like my room very much and keep it clean and tidy.'

We looked to see how people gave their consent to care and treatment. We saw information in people's care files that showed they had given their consent to their care. People had signed their care plans to show this.

We looked at the care and welfare people received. People received care and support as described in their plan of care. One person told us about the activities they liked to do. Another person told us, 'I am going to college later.' One person also showed us some exercises they liked to do and said they did these to help them stop getting angry.

We looked at the safety and suitability of the premises. We found the home was clean well maintained. People who used the service had large personalised rooms. One person told us they were getting a new bed soon.

We looked to see whether there was sufficient and suitable staff available. We found there were enough staff to provide people with the support they needed. A person told us, 'Staff stay with me.'

We looked at how service provision was assessed and monitored. We found people who used the service were able to put their views forward.