Archived: Rosewin

Rosewin is a residential care home providing personal care for one person with a learning disability. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall.

Rosewin is located on a main road in a rural area west of Cambourne in Cornwall. The service is a detached two-story building with an enclosed garden area to the rear.

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

At this inspection we again found that the service did not employ sufficient staff to meet the person’s needs. Agency staff were being used to ensure the person’s safety and these staff were working long hours with four agency staff due to work an average of 71 hours each in the week of our inspection. Although agency staff were happy with these arrangements there are inherent risks when staff work excessive hours in care settings.

The use of agency staff had increased the numbers of staff on duty each day. However, there had been a small number of short periods where the service had operated at or below minimum staffing levels in the first two weeks reviewed and one occasion where a staff member had been awake and on shift for 25 hours.

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 safe, responsive and well-led the service was not able to meet some of the underpinning principles of Right support, right care, right culture.

Right support:

• The environment and location of the service disempowered the person. They were unable to go for walks from the service because of the busy road and were unable to access the garden independently because of unmanaged environmental risks.

Right care:

• The location of the service in combination with the limited availability of staff able to drive had restricted the person’s freedom and ability to access the community.

Right culture:

• The instability of the staff team and reliance on agency staff to ensure the person’s safety had prevented the development of a positive and supportive culture. The person’s care plan recognised that staff changes and lack of consistency in approach were likely to impact on their wellbeing.

People received their medicines as prescribed. Staff and the registered manager understood about local safeguarding arrangements.

Risks in relation to the person’s care needs and behaviours had been assessed and staff were provided with clear guidance on how to manage and mitigate these risks.

Risks in relation to the environment of the service had not been appropriately managed and timely repairs had not been completed prior to the inspection. Broken windows had been boarded up and a damaged radiator cover in the person’s bedroom had not been promptly repaired and had exposed the person to risk of harm.

We are assured that risks in relation to the COVID pandemic had been managed appropriately.

The person was comfortable with the support staff and sought reassurance and support from them without hesitation. However, professionals were concerned the high staff turnover had impacted on the quality of communication support provided.

Staff told us they were well supported by the registered manager who provided effective leadership. However, the current registered manager had resigned prior to our inspection and there had been significant management turnover since our last inspection.

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 (report published 10 January 2020).

Why we inspected

We received concerns in relation to the quality of support the service provided. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections 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. 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.

We have identified breaches in relation to safety, staffing, the premises and governance.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosewin is a residential care home providing personal care for one person with learning disabilities.

The service is a detached two-story property with enclosed gardens. It is located in a very rural area near Camborne, Cornwall.

The service has been developed specifically for the person it supported and was 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. Although the service’s rural location limited the person’s assess to the local community it had been selected as it was close to a number of outdoor spaces the person enjoyed visiting regularly. The person received highly personalised support in an environment that had been adapted to their individual needs.

The person was comfortable, relaxed and at home in the service. Staff responded promptly and appropriately to their needs and provided person centred support.

The service was short staffed. The provider had identified a minimum level of staffing that was necessary to ensure the person safety during periods of emergency and travel disruption. Records showed that the provider had been routinely aiming to staff the service minimum safe levels in the month prior to our inspection. Staff told us, “There are not enough staff” and managers said, “We are short staffed at the moment, we have been actively recruiting for the past three months but have had limited success.” Records showed and staff told us that the service had never been staffed below minimum safe levels as they had completed additional shifts to prevent this from happening.

We have recommend the provider reviews current staffing levels and the arrangements place to support the person during recognised seasonal changes in support needs with commissioners and relatives.

The service’s recruitment practices were safe and staff training had been regularly refreshed to ensure they had the skills necessary to meet the person’s needs. Staff had a good understanding of local safeguarding procedures and there were safe systems in place to support the person with medicines. Risks were well managed, and the person was regularly supported to participate in new activities.

Staff knew the person well and had a detailed understanding of their individual needs and preferences. The care plan was detailed and provided staff with enough guidance to enable them to meet the person’s support needs. Records showed the person was regularly supported to participate in a variety of activities and staff told us, “[Person’s name] gets out and about as much as [they] want.”

Relatives were happy with the quality of support the service provided and understood how to raise issues and report any concerns or complaints to managers.

The service was currently led by a registered manager who was supported by full time deputy manager. At the time of our inspection the registered manager was spending half their time supporting another registered service. The provider intended in future that the deputy manager would apply to become registered and that current registered manager would move to the other service. Staff told us they were well supported by their managers who were supportive and approachable.

The service’s quality assurance systems were appropriate and all incidents were fully investigated to identify any areas of learning or where improvements could be made.

Rating at the last inspection

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

Why we inspected

This was a planned initial inspection 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.