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Inspection carried out on 21 March 2018

During a routine inspection

This unannounced inspection of Rosewood Care Home took place on 21 March 2018. Rosewood is a ‘care home’. 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. Rosewood care home accommodates eight people with learning disabilities in one adapted building. There were eight people using the service when we visited. The service has been developed and designed in line with the 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.

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.

Inspection carried out on 16 December 2015

During a routine inspection

Rosewood provides accommodation, care and support for a maximum of eight adults with complex and profound learning disabilities. At the time of our inspection eight people were living in the home.

The inspection took place on 16 December 2015 and was unannounced.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

Staff endeavoured to keep people safe because they understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. For example, if people were at a risk of choking they had been assessed by an appropriate professional and guidance was in place for staff. Accidents and incidents were recorded and the registered manager and provider monitored these for trends in order action could be taken to prevent reoccurrence.

There were enough staff on duty to meet people’s needs, both within the home and when people wished to go out. People were cared for by staff who knew them well. Although agency staff was used to cover staff absence, the registered manager tried to ensure the same agency staff worked in the home.

Staff were enabled to meet with their line manager on a regular basis and they had access to relevant and ongoing training to help them to feel confident in their role. Staff worked both independently and together as a team. We saw this ensured the smooth running of the home.

The provider’s recruitment procedures helped ensure that only suitable staff were employed to work in the home. People’s medicines were managed safely. Medicines records were completed in full and the storage of medicines was carried out following best practice.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been submitted where restrictions were imposed to keep people safe. People’s best interests had been considered when they needed support to make decisions.

People’s nutritional needs were assessed and any dietary needs were managed effectively. People were involved in the meals they ate. They were provided with a range of home cooked meals in order to help ensure they received a good balanced diet. People were supported to maintain good health and to obtain treatment when they needed it.

Staff were kind and caring. They treated people with respect and supported them in a way that maintained their privacy and dignity. Visitors were welcomed into the home and people had access to the community to help maintain any friendships they had outside of the home.

People’s needs were assessed before they moved to the home and people’s individual care plans reflected the most up to date care people required. Care plans were person-centred and focussed on the individual and their specific needs. People had access to a wide range of activities which were both individualised as well as meaningful for people.

The registered manager and provider had effective systems of quality monitoring, which helped ensure that all areas of the service were working well. There was a contingency plan in place should the home have to close in an emergency and staff carried out regular fire drills.

People were given access to information on how to make a complaint, however we were told no formal complaints had been received. People, relatives and staff were involved in the running of the home. We read regular meetings were held to discuss all aspects of the home and feedback was sought from relatives routinely to help ensure they were happy with the care being provided for their family member.

The registered manager had good management oversight of the home and it clear that she led by example and created a positive, hard-working but relaxed culture within the staff team.

Inspection carried out on 20 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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.

Inspection carried out on 19 June 2013

During a routine inspection

One person who uses the service wanted to be involved in the inspection and feedback and staff supported this.

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.

Inspection carried out on 12 February 2013

During a routine inspection

All the people we spoke to appeared confident and free to express their wishes or displeasure. For example, one person felt confident to express that they were unhappy that they were not included in the inspection, and we saw staff listen and then supported them to join in.

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.

Inspection carried out on 7 September 2011

During a routine inspection

All the people we spoke to appeared happy, relaxed.

We saw people involved in activities around the home, and returning form activities in the community. We saw that staff were attentive to people, and responded to people with a good understanding of their communication styles or body language and were seen to offer support in a sensitive knowledgeable, and caring manner.

Reports under our old system of regulation (including those from before CQC was created)