Rose Cottage

Rose Cottage is a residential care home for four people with learning disabilities. Rose Cottage is a detached building in the rural village of Mersham outside Ashford. The accommodation is spread between two floors. People had individual bedrooms and use of a shared bathroom, lounge kitchen and separate dining room.

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 using the service can live as ordinary a life as any citizen.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good

People continued to be protected from potential harm and abuse by a staff team who were trained to identify safeguarding concerns. Where risks to people and the environment were identified, staff took action to mitigate the risk, whilst promoting people to take positive risks. There were sufficient numbers of staff to meet people’s needs. We reviewed recruitment files, the provider had completed the necessary pre-employment checks before staff worked unsupervised. Medicines were stored, administered and disposed of safely. People were protected by the prevention and control of infection. Lessons had been learned when things went wrong.

People’s needs were assessed before they moved into the service, and regularly thereafter in line with best practice. People were supported by a staff team that had received sufficient training and on-going supervision, and worked internally and externally to provide effective care and treatment. People were supported to eat and drink sufficient levels to maintain a balanced diet and were supported to access healthcare professionals as and when required. People lived in an environment that was suitable for people with learning disabilities and where required the provider had made the necessary adaptations to the service. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with kindness, compassion and respect. Staff knew how to recognise changes in people, and provided emotional support where necessary. People were supported to make their views known. Staff adapted communication according to each individual. People’s privacy, and dignity was respected. Staff supported people to be as independent as they could be.

People received personalised care responsive to their needs. People were supported to spend time doing meaningful activities. There had been no concerns or complaints raised since our last inspection, however people and their relatives knew how to raise concerns. At the time of our inspection no one was being supported with end of life care.

There was a clear culture of empowerment and openness within the service. People and their relatives told us the service was well-led and achieved good outcomes for people. The provider governance systems ensured that shortfalls in service delivery were identified and improvements actioned. The provider sought feedback from their stakeholders. The registered manager had formed links with the external agencies including the local authority safeguarding team.

Further information is in the detailed findings below.

Rose Cottage is registered to provide accommodation and personal care for up to four people who have a learning disability. Rose Cottage is in the semi rural village of Mersham which has a general store. Three people were living at the service, each had their own bedroom. People had access to a communal lounge, dining room, kitchen/diner, laundry room and a shared bathroom. There is a well maintained garden and outside area. There is off street parking within the grounds and easy access to public transport.

The service has a registered manager, who was present throughout the 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.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted. They were waiting for the outcome from the local authorities who paid for the people’s care and support. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people moved into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. The care and support needs of each person were different, and each person’s care plan was personal to them. People had in depth care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way which demonstrated that they cared about people’s welfare. Staff knew people and their support needs well.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other basic training provided by the

company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. The complaints procedure was on display in a format that was accessible to people.

Staff told us that the service was well led and that they had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with the registered manager. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

Rose Cottage can provide accommodation for up to four people. There were two people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the manager:

Is the service safe?

The service was safe. When people had accidents the most appropriate and safe action was taken to make sure they received the treatment they needed. There were systems in place to make sure that the manager and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Practices in the service protected people using the service, staff and visitors from the risk of harm. The design and layout of the home was suitable for the needs of the people using the service. We found that the building was being adequately maintained.

Assessments had been undertaken to ensure that people received safe and appropriate care. The relevant people were consulted with regard to people's mental capacity and the deprivation of people's liberty was taken into account.

People using the service had a care plan which detailed their care and support needs. We saw there was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible.

We saw records that showed what people could do for themselves and how they preferred to be supported. Risk assessments were in place, reviewed and kept up to date.

Is the service effective?

The service was effective. Care was consistently planned and delivered in response to people's changing needs. People's health and care needs were assessed with them and / or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

Staff support was consistent and structured. A core staff team was used across two of the services run by the provider. Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people and promoted their independence. People we spoke with said they like the staff.

One person who used the service told us, 'I'm going out today. I like it here'.

Is the service responsive?

The service was responsive. Staff with whom we spoke told us they felt they would be listened to if they raised any concerns.

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led. There was a clear management structure in place and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.

We saw evidence which showed that the service worked well with other agencies and services to make sure people received their care in a joined up way.

At our inspection on 22 July 2013 we found that incidents of behaviour that could be described as challenging were not always shared with relevant social care professionals, in order for them to be able to monitor the planning and delivery of care for one person who had recently moved into the service. At this inspection we saw that there were processes in place to inform health and social care professionals who provided support to people living at the service of these matters for them to be able to monitor people's progress.

At our inspection on 22 July 2013 we found that guidance for staff about responding appropriately and consistently to meet one person's needs was not available. At this inspection we found that written guidance was now available to staff and staff knew what action to take to support the individual effectively. At our inspection on 22 July 2013 we found that people who needed to have their weight monitored for health reasons did not always have their weight checked regularly. At this inspection we found that these checks now took place regularly.

At our inspection on 22 July 2013 we found that not all incidents of physical conflict between people who lived at the service had been referred to the appropriate authorities under safeguarding guidelines. At this inspection we found that a recent incident of threatening behaviour between people living at the service had not been referred to the relevant local authority under safeguarding guidelines, in a timely manner in order for them to be able to be able to decide what action to take.

At our inspection on 22 July 2013 we found that the systems in place to regularly assess and monitor the health and safety of the service were not always used effectively to ensure people's safety. At this inspection we found that the operating system in place to monitor the health and safety checks being undertaken were not always used effectively to ensure people's safety living at the service.

We saw that the provider had systems in place to obtain consent from people in relation to people's care and support.

People's needs were assessed before they moved into the service. However, incidents of behaviour that could be described as challenging were not always shared with relevant social care professionals. Information about people's needs was not always updated in response to incidents to include guidance for staff to know how to respond appropriately and consistently to meet the individual's needs.

Staff knew how to recognise potential abuse and the action to take in response to it. However, we saw that not all incidents of physical assault between people who lived at the service had been referred to the appropriate authorities under safeguarding guidelines.

Staff were offered appropriate support for their roles and one staff member told us that they knew where to find further information at the service about matters related to their role. We saw there were systems in place to monitor staff training and development.

We saw that the systems in place to regularly assess and monitor the health and safety of the service were not always used effectively to ensure people's safety.