Archived: Rose Cottage

Updated 17 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Rose Cottage 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced. Site visit activity started on 15 October 2019 and ended on17 October 2019 when we visited briefly to gather additional information from speaking with staff. Calls to relatives and health professionals were undertaken on 22 October 2019.

What we did before the inspection

Before we inspected we made attempts to contact four social care professionals who support people placed in the service. We also contacted the local authority commissioning team. We reviewed all the information and notifications we had received since the last inspection.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection

During the inspection

We met all the people currently living in the service. Most people were unable to tell us about their experiences, so we made observations throughout the day when people were in communal areas with staff to help us understand the experiences of those who could not talk to us. We spoke with a member of the senior management team who was present throughout the inspection. We spoke with the deputy manager. We also spoke with six staff over both days and a visiting relative.

We looked at the care records of two people living in the service, this included risk information and daily records. In addition, we reviewed how medicines were managed and reviewed records relating to the operational management of the service. This included two staff recruitment files, staff rotas, records of staff training, supervision and appraisal. Staff meetings, engagement with people using the service, and quality assurance information.

After the inspection

We sought and received feedback from a further three relatives and one social care professional.

Updated 17 December 2019

About the service

Rose Cottage is an adapted care home providing accommodation and personal care for seven people living with a learning disability who are aged 18 years and over. At the time of the inspection, six people were living in the service.

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.

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 positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

People were safe, two said they were happy living in the service and people were relaxed and comfortable with each other and staff. Relatives said they were very happy with the service their relatives received. However, we found some minor issues around medication management and risk assessment that had not been identified through the services own quality checks. The management team were enthusiastic and motivated to drive improvement and make changes to the service. However, current shared management of the service by the registered manager and deputy were not providing the continuity and oversight needed, to address issues and improve communication. These are areas for improvement.

Staff felt much happier, stating that the turnover of staff had been positive and the culture in the service much improved, with staff more motivated. There was an improving picture around people getting out and leading more active and stimulating lives, achievable goals were being set but more needed to be done to make activities meaningful and to evaluate and review the goals set.

We observed that staff engagements with people, showed kindness, respect and compassion. They handled people’s privacy and dignity well. People respected each other’s private space. People were supported to develop their potential for greater independence and this will benefit from ongoing improvements to setting achievable goals for people to aspire to. Detailed plans of care informed staff support of people in accordance with their personal preferences.

New staff received an appropriate induction to their role and a full range of training was provided to all staff to ensure they developed the right knowledge and skills to support people safely. Overall staff said they were happy and felt supported by the Registered and deputy managers. Risks were appropriately assessed. Staff demonstrated an awareness of safeguarding. They knew how to protect people from abuse.

There were enough staff to support people’s day to day needs safely. A safe system of recruitment was in place to ensure the suitability of new staff. There was a low level of incidents and accidents, but these were analysed to mitigate further risks and to learn from. People lived in a clean, comfortable, homely and well-maintained environment, and were supported to personalise their own space to their tastes.

Relatives said they felt able to express concerns and were confident of these being addressed.

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 the Mental Capacity Act 2005 (MCA) impacted on their support of people and how people could be helped to make decisions.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 Requires Improvement. (Published 1/12/2018)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. The provider acted to mitigate these risks during the inspection and we will check if this has been effective when we next inspect. Please see the Safe, Responsive and Well led sections of this full report.

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.