Archived: Rose House

Rose House is a residential care home providing personal care for up to two people with learning disabilities or autistic people. At the time of our inspection one person was using the service. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. The service is a detached two-storey property with an enclosed garden area at the rear. It is located in a rural area near Redruth, Cornwall.

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

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.

The service had not made sufficient improvement since the last inspection to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: The service remained short staffed. This limited opportunities for the person to be supported to leave the service and meant it had not been possible for the person to engage with activities they were known to enjoy.

Right care: The person was subject to several restrictions to keep them safe. They were unable to access the service’s outdoor spaces or the community without significant staff support.

Right culture: The morale of the staff team had improved, and the person was now being supported to regain some skills they had lost. Relatives recognised staff had developed positive and supportive relationships with the person.

At this inspection we found that although there had been improvements in staffing arrangements since our last inspection, there were still insufficient staff available to meet the person’s support needs. This limited the person’s freedoms and ability to engage with activities.

Low staffing levels in combination with unsuitability of the service’s garden meant the person was unable to go outside without significant restrictions in place. This had prevented the person from engaging in some of the activities they enjoyed.

Fire risks had not been appropriately managed prior to this inspection. Firefighting equipment was serviced promptly once this issue had been identified during the first day of our inspection.

Some improvements had been made to the service’s environment since our last inspection. However, additional works were still necessary. In addition, at this inspection we found the person’s vehicle had not been regularly cleaned, and that a staff bathroom was poorly maintained and lacked appropriate equipment for the disposal of hand washing waste.

Staff now understood how to manage specific risks in relation to the person’s support needs and the manager recognised the importance of, where possible, reducing restrictions within the service.

Medicines were managed safely and staff understood their role in protecting people from abuse.

Staff had received appropriate training and support. They had developed the skills necessary to meet the person’s needs and were gaining confidence in their abilities.

Staff had spent time getting to know the person and now had a good understanding of the person’s individual needs and preferences. They spoke positively of the person they supported and relatives told us, “The staff have done well. [My relative] seems much more settled”.

Information on the person’s individual needs was fully documented. A shortened version of the person’s care plan had been developed to help new staff quickly gain some understanding of their specific needs. Staff now understood the person’s communication needs and were able to communicate effectively with the person. The manager was providing effective leadership to the staff team, whose morale had improved.

Relatives were complimentary of the manager and reported that the service communicated effectively with them. Visiting was actively encouraged and the person had been supported to maintain these relationships.

Although the provider’s systems had driven some improvements in the performance of the service, more work was needed to achieve compliance with the regulations.

We were assured that safe infection control practices were being followed in the service.

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 22 September 2021). At this inspection some improvement had been made but the provider was still in breach of regulations. The service is now rated inadequate in Safe, Responsive and Well led.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. At this inspection although improvements have been identified the service remains in breach breaches of the regulations relating to safety, staffing levels, opportunities to go outside, the environment of the service and governance. 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 until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Rose House is a residential care home providing personal care for up to two people with learning disabilities. At the time of our inspection one person was using the service.

The service is a detached two-storey property with an enclosed garden area at the rear. It is located in a rural area near Redruth, Cornwall.

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.

Based on our review of the Safe, Responsive and Well Led key questions:

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Due to lack of staffing and more recently, a lack of experienced staff, the person’s choices, control and independence were not maximised. They were regularly unable to take part in their preferred activities.

Right care:

The person was subject to several restrictions to keep them safe. Being unable to go out, or use their garden freely, increased the number of restrictions impacting on their life.

Right culture:

The ethos, values and attitudes of senior managers did not ensure the person using the service could lead an inclusive or empowered life. Relatives and staff reported that as a result, the person’s skills and abilities were regressing.

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

The provider had not ensured the person’s needs were consistently met. Low staffing levels at the service meant it had not always been staffed at commissioned levels. When this happened, the person living in the service could not go outside which placed increased restrictions on their liberty. They were unable to regularly take part in their preferred activities and pastimes. Relatives and staff told us this impacted on the person’s wellbeing. At the start of the inspection, the new manager was struggling to find enough staff to cover future rotas. They confirmed that any new permanent or agency staff would have to start supporting the person straight away without any opportunity to shadow experienced staff.

The existing staff were leaving and new staff had not had the opportunity for a sufficient handover to fully understand the person’s needs. Some of the new staff working at the service had not completed the required practical training to support the person if they became distressed. On the day of the inspection, the staff present had not had opportunity to read the guidance available on how to support the person when they were distressed and had not had opportunity to gain experience of how to support the person outside or in the community. New staff had not had a sufficient handover period to gain sufficient understanding of how the person communicated.

Information provided by the service had not been used to improve the service or care provided. The provider had not ensured that concerns raised with them by relatives, the staff and registered manager had been fully resolved. All reported that communication with the provider was poor.

The provider had not acted to ensure there were sufficient staff in the service or that a comprehensive handover from the outgoing staff was possible. The provider had not ensured the person living in the service was able to achieve good outcomes or was able to live in a service that was in good repair.

Safe medicines management procedures were in place and were followed by staff. We requested evidence new staff working at the service had up to date medicines training, but none was provided.

We were assured that safe infection control practices were being followed in the services.

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 12 September 2019).

Why we inspected

The inspection was prompted due to concerns received by the commission. These were about the environment in the service, low staffing levels and the impact low staffing levels were having on the person living in the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

At this inspection we identified breaches in relation to safety, staffing levels and experience, the opportunities available to the person living in the service, the environment and the governance of the service.

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.

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.

Rose House is a residential care home providing personal care for up to two people with learning disabilities. At the time of our inspection one person was using the service.

The service is a detached two-story property with an enclosed garden area at the rear. It is located in a rural area near Redruth, Cornwall.

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

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.

This was a targeted inspection that considered staffing levels at Rose House. Based on our inspection of staffing levels, we found the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The service did not always have enough staff with the right skills and experience to maximise the person’s choices. More staff had been recruited so the person living in the service would be able to have greater choice and independence.

Right care:

• The person was not able to go out at all, this placed increased restrictions on them. The staff team was being increased and once trained, would be able to support the person to go out.

Right culture:

• Systems to support staff to fill gaps in the service’s rota were not always effective.

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 inadequate 22 September 2021.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing levels. The overall rating for the service has not changed following this targeted inspection.

The CQC has introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At our previous inspection we identified a breach in relation to staffing. This remains in place. Please see the previous report for details.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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 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.

Rose House is a residential care home providing personal care for up to two people with learning disabilities. At the time of our inspection two people were using the service.

The service is a detached two-story property with an enclosed garden area at the rear. It is located in a rural area near Redruth, Cornwall.

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

People were relaxed and comfortable in Rose House. There were enough staff available to meet people’s needs on the day of our inspection. Records showed that, despite a number of staff vacancies, planned levels of support had routinely been provided. The service’s recruitment practices were safe and interviews were planned for later in the week to resolve the staffing issues.

Staff had received safeguarding training and understood how to protect people from all forms of abuse or discrimination. Risks were well managed and systems in place to support people to manage their anxiety were appropriate. A number of incidents had been reported to the commission prior to our inspection. These were reviewed and we found procedures in place to prevent similar incidents from reoccurring were appropriate.

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.

Staff understood how to meet people’s needs and care plans were accurate and informative. They provided staff with detailed guidance on people’s care needs and communication preferences. These records had been regularly updated and included information about people’s backgrounds, interest and hobbies.

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.

Staff were committed to providing person centred care and enabling people to be as independent as possible. People were supported to access the community when the wished and to engage with a variety of activities, tasks and chores within the service.

Staff were well motivated and had the skills necessary to meet people’s needs.

The service was well led. There was a new manager in the post who intended to apply for registration. Staff told us they were well supported, and records showed supervision had been provided. Quality assurance systems were effective and designed to drive improvements in the service’s performance.

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 registered 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.

Rating at the last inspection

This was the first inspection of the service since it’s registration in November 2018.

Why we inspected

The inspection was prompted in part due a high number of notifications received about incidents within the services. A decision was made to inspect and examine the procedures in place to prevent similar incidents from reoccurring.

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.

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