Rosewood

At the last inspection of Rosewood in December 2015, the service was rated Good. At this inspection we found the service remained Good.

Rosewood 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.

People were safe at the service. Staff had been trained in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to report any concerns in line with the registered provider’s procedures. The managers took appropriate actions to safeguard people from abuse. People’s needs were met by sufficient number of staff who had undergone safe recruitment checks. Risks were assessed and comprehensive management plans developed to mitigate risks identified.

Medicines were administered to people in a safe way. Records for the administration of medicines were maintained and medicines were stored safely. The environment was safe, clean and hygienic. Health and safety systems of building and environment were well maintained. Staff followed good infection control procedures. Staff kept record of incidents that occurred at the service. These were reviewed by the registered manager and actions were discussed with staff so that lessons could be learned.

People’s individual care needs had been assessed and their support planned with input from their relatives and relevant professionals. Regular reviews took place to ensure support delivered to people continued to meet their needs.

Staff were trained, supervised and had the skills and knowledge to meet the needs of people. People had food and drinks to meet their nutritional and dietary needs. Staff worked effectively with health and social care professionals to ensure a well-coordinated service for people. People received support to attend health appointments and to maintain good health. The service had systems in place to enable smooth transition when people moved between services. There were suitable facilities and adaptations in the home for people to use.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had completed the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. The service ensured appropriate consent was obtained before a decision was made for people. When required relatives were involved in decision making about people’s care and support. Staff and the registered manager understood their responsibilities under MCA and DoLS.

Staff understood people’s needs and treated them with respect, kindness and dignity. Staff communicated with people in the manner they understood and in an accessible format. Staff supported people to express their views. People’s relatives were involved in their care planning and their views respected.

People received care tailored to meet their requirements and preferences. People took part in activities they enjoyed and were encouraged and supported to socialise. People were supported to maintain relationships which mattered to them. People knew how to make a complaint if they were unhappy with the service.

The service sought feedback from people and their relatives and used them to improve the service. Staff received the support, direction and leadership they needed. There were a range of systems in place to monitor and assess the quality of service provided. The service worked in partnership with both internal and external organisations to develop and improve the service.

We spoke with four members of staff and the home manager. There were no relatives available for us to speak with during our inspection. We utilised the results of surveys and the comments book to ascertain their views on the service. One person using the service was able to speak with us but they decided not to as they were involved in the day's activities. We looked at four care files for people who used the service, four staff files and an extensive range of audits and monitoring data.

Is the service Safe?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Mental Capacity Assessments had been completed as required and the provider had acted in accordance with legal requirements. The manager showed us the Deprivation of Liberty applications made to the local authority for people who used the service. These had been completed correctly and procedures followed correctly. There was one person subject to the court of protection and staff were able to explain what deprivation of liberty meant in terms of choice in the daily life for the people concerned. All staff had undertaken Mental Capacity and Deprivation of Liberty training.

All staff had undertaken annual training in both safeguarding vulnerable people and whistleblowing requirements and procedure. We spoke with staff and they were able to articulate the different types of abuse and apply this knowledge to the people who used the service. We noted the relevant procedures were clearly available in the office along with a flowchart of how to report a safeguarding incident within the Trust.

There were effective recruitment and selection processes in place. We looked at four staff files including the different levels of seniority. All paperwork was present as expected including professional registration documents for the nurses. Police checks and health screening were required before the person began their induction.

Is the service Effective?

People who use the service and their relatives where appropriate were given appropriate information regarding care and treatment. The manager told us about the challenge for some people who were not able to read or understand the 'easy read' versions of care plans. The provider had begun creating audio versions of important documents. So far they had created an audio version of the service user guide and statement of purpose.

Is the service Caring?

We observed staff engaging with people who used the service in a caring, friendly and respectful manner. All the language used was friendly and appropriate to the care being provided. People who used the service appeared to be relaxed and comfortable with staff, responding spontaneously with no signs of distress or fear. Some of the people who used the service had difficulties with communication and we noted staff altered their approach accordingly. They used pictures, key words and gestures to assist people to understand what was happening to them.

The compliments book and completed surveys in reception included comments such as 'the staff were welcoming and friendly', 'The home has a relaxed and peaceful atmosphere. My relative is very happy here' and 'the staff are vibrant, passionate about care and very helpful'. We saw evidence of relative's views contributing to the care provided both initial care plans and ongoing reviews of care.

Is the service Responsive?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. The manager undertook a comprehensive assessment of the person's needs. This included information from allied professionals such as the physiotherapist and specialised wheelchair services, consultants, dieticians/nutritionists and occupational therapists in addition to the care staff.

The provider was able to demonstrate they had responded appropriately to an allegation of abuse.

As a result of our previous inspection, a number of concerns had been raised. The manager showed us evidence of the actions taken in response to remedy the situation. This included additional training, unannounced checks on practice (including 'out of hours'), supervision of staff, team meetings and an additional lock to the front door.

Is the service Well Led?

The manager told us that they were developing audio versions of key documents to help people who used the service understand their care. We saw a comments/compliments book in reception which had been used regularly and a survey file containing completed surveys. Staff told us that the relatives of people who used the service were always involved in decisions about people's care, especially where the person lacked capacity. This was evidenced in the care files for both risk assessments and care plans.

Previous concerns related to the potential difference in practice out of hours. The manager undertook spot checks at various times of day. The Trust had implemented a programme of unannounced night visits designed to identify areas of concern. We saw the documented results of this.

We saw comprehensive audits relating to maintenance of the building including utilities, water supply and legionella, transport and machinery including the hoists and assisted baths. Specialist services had been engaged to monitor and service equipment which included wheelchairs.

One person told us and another indicated that staff did ask before providing support.

We found that peoples' needs were assessed and care and treatment was delivered in line with their care plan, and where people did not have the capacity to consent, the provider acted within legal requirements.

On the 27th of June, one week after our first visit to Rosewood, we visited a home from the trust next door. We could not find a parking space so parked at Rosewood and went to ask if we could park there until we could get a space next door. However we could see a number of security and dignity regulatory breaches so decided to enter, investigate and take action to ensure people were left in a safe environment. We have therefore included the two additional outcomes that we saw breaches in on that day in this report. Outcome 1 privacy and dignity and 10 Safety and security of the environment.

We found that people who use the service, and staff, were not protected against the risks of unsafe premises and people who use the service were not always treated in a way that respects their privacy and dignity, and human rights.

Before leaving we ensured the shift leader had secured the medication and building, then immediately contacted the trust who sent down managers to ensure our concerns were fully addressed and people were safe and there rights upheld.

People's relatives told us that there were enough staff and their relative was looked after well.

One person's relative told us they felt their relative was safe there. They had not needed to raise any formal complaints, but if they needed to raise any minor concerns, they felt listened to and action would be taken to address the situation.

One person told us the building was ideally suited to maintain their relative's mobility.

We found the home to be well maintained hygienic and clean.

We saw that there were enough staff to meet people's needs in a timely manner and that staff received appropriate professional development and support.