Archived: Rosamar

Rosamar is a residential care home providing accommodation and personal care for up to ten people with a learning disability. At the time of this inspection there were seven people in residence.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service

did not support this practice. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.

Right Support

There was no evidence people were given choice and had an opportunity to pursue goals and aspirations. Staff training was not up to date and staff competency in administering medication had not been checked. People’s needs were assessed and monitored. Staff enabled people to access health and social care support in the community although this was not based around people’s individual preferences. Staff communicated with people in ways that met their needs. The provider ensured the home's environment was well equipped and well-furnished. People had a choice about their living environment and were able to personalise their rooms.

Right Care

People had not always been supported to take part in activities and pursue interests based on their individual preferences. People and relatives said they were happy with the care and support received. Staff protected and respected people's privacy and dignity. Staff understood and responded to people’s individual needs. Staff understood how to protect people from poor abuse.

Right Culture

People were not always supported in a way which ensured they had choice and control in their daily lives. There was a lack of oversight from the registered manager regarding quality assurance within the service. Risks relating to the home environment had not been mitigated to keep people safe. There was no formal process to ensure staff had supervision and appraisals. There was no evidence to demonstrate staffing levels on a day to day basis.

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 (published 26 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the premises and equipment, staff training and supervision and a lack of robust governance and quality assurance processes.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection was undertaken due to concerns we had received around people’s finances and safeguarding incidents, which required further investigation. The team inspected the service against two of the five questions we ask about services: is the service safe and well led. This is because the information we received related to these two key areas.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last comprehensive inspection of the sevrice in January 2018, the service was rated Good. At this inspection we found the service remained Good.

Rosamar 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.

Rosamar supports up to 10 people with a learning disability, who may also have additional complex needs. At the time of the inspection there were nine people living at the service. The service has two lounges, a dining area, kitchen, two laundry rooms, office and bedrooms. There is a driveway and back garden, which people could use.

There was 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.

Staffing levels met people’s needs. Staff were consistent, experienced and knew people well.

People’s finances were managed safely. Regular audits and checked were conducted.

Safeguarding concerns were reported in line with the provider’s policy.

Further information is in the detailed findings below.

Rosamar is a care home which provides accommodation and personal care for up to 10 people with a learning disability, who may also have additional complex needs. At the time of the inspection there were nine people living in the home. It has two lounges, a dining area, kitchen, two laundry rooms, office and bedrooms. There is a driveway and back garden.

There was 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.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

Staff received regular training in topics the provider considered mandatory and were knowledgeable about their roles and responsibilities. Staff had guidance for people’s complex health needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

People received their medicines safely. The manager completed regular checks to ensure medicines were safe. People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Relatives and staff told us the registered manager was accessible and approachable. Everyone felt able to speak with them and provided feedback on the service. Staff told us they felt supported and listened to.

The registered manager employed a consultant who undertook regular audits and spot checks to review the quality of the service provided. Any improvements identified were made.

Rosamar is a care home which provides accommodation and personal care for up to 10 people with a learning disability who may also have additional complex needs. At the time of the inspection there were nine people living at the home. The home is a terraced house situated in a residential area of the town. It has two lounges, a dining area, kitchen, two laundry rooms, office, and bedrooms. There is a drive way and back garden.

There was 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.

We carried out an unannounced comprehensive inspection of this service on 27 and 29 April 2016. A breach of legal requirements was found as the provider was not always taking action after their audits identified areas for improvement. ¿Where actions had happened these were not always fully documented. Records were not always accurate or up to date and some risk assessments had not been reviewed and updated. We also found where complaints had been raised there was no record of outcomes taken and no system in place to identify trends.

After the comprehensive inspection, we used our enforcement powers and served a Warning ¿Notice on the provider on 21 June 2016. This was a formal notice which confirmed the provider ¿had to meet one legal requirement by 21 September 2016.¿

We undertook this focused inspection to check they now met this legal requirement. This report ¿only covers our findings in relation to this requirement. You can read the report from our last ¿comprehensive inspection, by selecting the 'all reports' link for Rosamar on our website ¿at www.cqc.org.uk

We found action had been taken to improve the governance of the service. ¿

A new system for auditing the service, which identifies risks and concerns, had been set up. The new system was proactive in spotting risks and concerns early so action could be taken to prevent incidents from occurring.

Environmental risk assessments had been reviewed and had been either updated or action had been taken to remove the risk from the home completely. People’s individual risk assessments had been updated to reflect changes in their needs.

Mental capacity assessments had been reviewed and updated where needed. The way of recording complaints had been reviewed and improved.

Rosamar is a care home which provides accommodation and personal care for up to ten people with a learning disability who may also have additional complex needs. At the time of the inspection there were nine people living at the home. The home is a terraced house situated in a residential area of the town. It has two lounges, a dining area, kitchen, two laundry rooms, office, and bedrooms. There is a drive way and back garden. There was 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. The registered manager was present during the inspection.

People could be at risk due to staff not following correct procedures for washing soiled and contaminated laundry. Some areas of the home required improvement where one bathroom had water damage and a bedroom where there wall was damp from the guttering outside. People felt safe in the home and incidents and accidents were recorded with actions taken although actions were not always recorded. People received their medicines safely and when required by staff who had received training. Most people had detailed risk assessments and guidelines in place for staff to follow although one person’s risk assessment had not been updated following some falls.

People were supported by staff who had appropriate checks in place prior to commencing their employment. People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff demonstrated they knew people well and felt supported and were able to raise any concerns with the registered manager. People undertook activities that were important to them and had opportunities to voice what days trips they wanted. People had choice about when they ate and choose their menus weekly although people only had a choice of one type of biscuit and this was placed directly onto the table.

People were involved in their care planning along with professionals who were identifying outcomes for people’s future. Changes to people’s needs were identified with referrals to the appropriate health professionals when required. Where people were unable to consent to care and treatment records were not always accurate and best interest decisions paperwork did not always record the involvement of professionals and significant others. People’s care plans were not always written in an enabling, person centred way and some environmental risk assessments were old and required reviewing.

People were able to receive visitors whenever they wished and relatives were able to visit as often as they liked. People were supported by staff who received regular supervision and training to ensure they were competent and skilled to meet their individual care needs.

People, relatives, staff and external stakeholder’s views were sought so that improvements could be identified although there was not always a clear action plan confirming actions taken. People felt happy to raise a complaint with the registered manager and there was an easy read policy in place. Quality assurance systems were in place but were not always effective at identifying areas for improvement. There was no recorded action or outcome so that improvements could be monitored in their process.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, relatives, staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider knew people well as some people had lived at the home for a long period of time. One person had lived at the home for 30 years. The service aimed to provide an environment to people, which was similar to that of a family. This ethos had been effectively transferred to the staff team and was established practice. However, familiarity of people's needs meant that some processes such risk assessments were relaxed at being changed.

We saw the home sought assistance from relevant external professionals when needed to ensure people's safety. For example one person's records showed their Physiotherapist had recently been contacted due to a change in their mobility.

There was safeguarding adults training available and in place for most staff. This ensured staff knew how to identify abuse and what they should do if they suspected abuse. Staff had a good understanding of keeping people safe and the procedure they should follow for visitors to the building.

There were clear behaviour plans identifying risks and any triggers which could affect behaviours. Staff were knowledgeable of these triggers and made visitors aware.

Incidents were recorded and filed and there was clear evidence when action had been taken. However some accidents haven't been reported to CQC, we have asked for these to be sent to us.

Staff all received initial Criminal Records Bureau (CRB) or Disclosure and Baring service (DBS) checks, however there was no system in place to check risks which arose after these initial checks were done.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place. 90% of staff had been trained to understand when an application should be made, and how one should be submitted.

Is the service effective?

Relatives we spoke with all said they were happy with the care and they felt their family members needs had been met. It was clear from our observations and from speaking with staff they had a good understanding of people's care and support needs and that they knew them well. One person told us 'I am happy here'.

Most staff were trained with more identified training being booked over the next few months.

There were risk assessments and behaviour assessments in place which identified areas which could trigger changes to behaviour. Staff knew these triggers well and informed visitors of them when entering the home.

Care plans had clear likes and dislikes in them and activities which people enjoyed doing. This ensured people were effectively supported.

Is the service caring?

We saw staff were polite and respectful to people. We observed staff took their time with people and give them reassurance when required. All staff we spoke with told us this was people's home and they made sure people had choice. We saw staff visually show people options so that they could make an informed choice.

Is the service responsive?

Relatives told us that staff responded to people's needs well and they felt confident they were being cared for appropriately. One person told us 'I have good contact with the manager of the home and staff are pleasant and easy to talk to'.

We saw one person had been referred to a Health and Social Care professional. We saw that after this assessment there was a change to their physiotherapy programme and mobility around the home. We saw that appropriate paperwork was completed to make sure that the individual had the capacity to make this decision.

Is the service well led?

The home had a registered manager in place. Relatives and staff all felt confident they could discuss any concerns or problems with the manager.

There were some quality audits in place for medication and room's. However the building was in a poor state of repair in some areas. We raised these points with the manager and they said there were plans to undertake the work to the front of the property.

Everyone we spoke with was happy with the home and the care provided. There were questionnaires in place for people and relatives to give their views about the service but these had not been filled in and returned.

There was regular supervision in place for new staff however those who had worked at the home for a number of years received less formal supervision. This was not documented and in their files.

We had received information of concern about the laundry arrangements in the home and overall cleanliness. We found there were appropriate and safe arrangements for the management of laundry particularly where there were potential risks of cross infection. The standard of cleanliness was good in all parts of the home with robust arrangements for the regular cleaning of all the facilities and areas of the home. However we noted a lot of dog faeces in the garden.

We looked at the maintenance of the building because this had been raised as part of the information of concern we had received. We found there were parts of the home internally and externally which were not of the appropriate standard. This included areas of the kitchen and a communal toilet. Some ceilings had been subject to flood damage and an insurance claim had been made to repair and restore these areas. The condition of the front and entrance of the home was not satisfactory with flaking paintwork and damaged plasterwork.

People's rooms and communal lounges were personalised and in good decorative order. They provided a homely and welcoming environment.

We found staff had received some essential training however this had not included moving and handling.

The staff interacted well with the people, showing good knowledge and understanding of their needs. They showed they were quick to respond to any changes in the health and wellbeing of the people in their care.

We observed that all people were able to move around the house as they wished to, having both quiet places and communal areas available at all times. People were asked if they wanted to go out and their decisions respected. We saw how one person wanted to go out alone and how this was enabled, we saw another person who desired to stay in their own room rather than join the other people in the minibus outing.

Staff told us "We are here to support our people"

We saw evidence of training in relevant aspects of the Mental Capacity Act [MCA], and Deprivation of Liberties Safeguards [DOLS], which staff showed a good understanding of. We saw evidence of consultation with all parties concerned in a recent DOLS issue, where decisions had been taken in the person's best interest and was well documented. A relative told us that they were happy "The right thing would always be done for their relative"

The atmosphere was very relaxed, very much the people's own home.

Staff had a good working knowledge of people and were quickly able to recognise changes when people became unwell or were unhappy with their care. We saw that people responded positively to staff interactions.

People were able to move freely around the home and were protected from unexpected callers. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Records showed that decisions had been made in people's best interests and that the appropriate parties had been consulted.

Staff were able to meet people's individual needs and when a person changed their mind at the last minute about going on an outing, they said "This is never a problem as we have our own mini bus and we arrange the trips around the person when ever we can".

We saw examples of where people's mental and physical abilities had improved since they had been admitted to the home. One family member said "They were now able to have a open conversation on the telephone with their relative which had never happened before".

The atmosphere in the home was relaxed and inclusive.