Archived: Rose Cottage

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.

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.

Rose Cottage is registered to accommodate up to seven people with a learning disability. It is a chalet bungalow arranged over two floors, set in a small residential area on the outskirts of New Romney. At the time of our inspection five people were living at the service.

The care 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.

The service had a registered manager. 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.

Rose Cottage was last inspected on 9 February 2018. At that inspection the service was rated as Requires Improvement overall and for each of the five key domain areas, except for Well Led, which was rated as Inadequate. At that inspection, there were not always enough staff to provide the care and support people wanted; people were not consistently protected from the risks of unsafe medicines management and staff had not always acted to monitor people's health. People were not supported to participate in a variety of activities at the service or in the community; one complaint had not been identified or resolved and people were not supported to plan the care they preferred at the end of their life. Significantly, at the last inspection a registered manager was not in post and effective management checks had not been completed on the quality of the service. Staff were not supported to provide service to the standard the provider had set out in their vision of the service. The views of people, their relatives, staff and others had not been reviewed or used to improve the service. The provider did not have processes in operation to work in partnership with other agencies to ensure people's needs were met.

At this inspection on 27 September 2018, a registered manager was in post and had been in place since July 2018. Although significant improvement had been made, further embedding was needed to ensure change was effective, sustained and fully established as daily practice. For example, some management checks did not identify missing information and, while people had opportunities to pursue their hobbies and interests, reviews of people’s goals and aspirations required further development. We have identified these as areas requiring improvement.

Care was delivered in a way designed to promote positive outcomes for people and staff had the knowledge and skills they needed to provide appropriate support. People were supported to eat and drink enough and to have a balanced diet. Suitable steps were taken to ensure people received coordinated care when they used or moved between different services. People had been supported to access healthcare services they needed.

People were supported to have choice and control of their lives. They had been helped to avoid preventable accidents, balanced with promotion of their freedom and choice. The registered manager had taken the steps necessary to ensure people only received lawful care in the least restrictive way possible.

People were safeguarded from situations in which they may experience abuse, including financial mistreatment. Medicines were managed safely. Background checks had been completed before new staff were appointed. Arrangements were suitable to keep the service clean and prevent and control infection risks. The accommodation was adapted and decorated to meet people’s needs and expectations. Accidents and incidents were reviewed and analysed by managers which helped reduce the chance of recurrence.

People were treated with kindness and had been given emotional support when needed. They had been helped to express their views and, as far as possible and be actively involved in making decisions about their care. This included access to advocates when needed. The service had not supported anyone at the end of their life, although end of life care planning was in place.

Person-centred care promoted people’s independence, including having access to information presented in an accessible way. The registered manager and care staff recognised the importance of promoting equality and diversity. Suitable arrangements were in place to resolve complaints to improve the quality of care. Private information was kept confidential.

The registered manager had promoted a person-centred culture. The views of people, their relatives and members of staff were used in developing the service. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Services providing health and social care to people are required to inform CQC of important events that happen in the service, this is so checks can be made that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner and had done so.

Rose Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rose Cottage accommodates seven people with a learning disability in one adapted building. There were five people using the service at the time of our inspection.

The registered manager had left the service in January 2018 and an acting manager was working at the service. 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.

At the last inspection on 15 August 2016, we asked the provider to take action to make improvements to the way they mitigated risks and make care plans, guidance and records more detailed. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, effective and responsive to at least Good. The provider had not ensures that actions taken were sustained and the key questions effective and responsive remain rated requires improvement. The ratings for the key questions safe, caring and well-led have deteriorated. This is the second consecutive time the service has been rated Requires Improvement.

The provider did not have adequate oversight of the service. Checks and audits on all areas of the service had not been completed as the provider required and the shortfalls we noted during the inspection had not been identified. Staff had not been held accountable for their responsibilities. Checks on the building and equipment had been completed regularly. Arrangements were not in place for the provider to work in partnership with local authority multidisciplinary team and others, to support and develop the service. Action to reduce the amount of paperwork and repetition in records had not been effective and staff were not able to quickly find information we asked for.

At our last inspection we found that changes in people’s health had not been identified and staff had not contacted their health care professionals quickly. At this inspection we found that staff had identified when people were unwell and obtained care and treatment for them. However, one person was eating and drinking less than they usually did. Staff had not followed guidance in the person’s care plan to weigh them monthly and did not know that they person had lost a significant amount of weight.

The views of people’s relatives, staff and community professionals had been requested but information received had not been reviewed and acted on to continually improve the service. People had not been supported to share their views. One person had made a complaint but this had not been investigated and resolved to the person’s satisfaction. No other complaints had been received.

Most medicines were managed safely. However, the provider’s process for the safe checking and storage of medicines that require special storage had not been followed. Guidance for staff about people’s ‘when required’ medicines was not consistently accurate but staff knew when the medicine should be used. People received their medicines in the way they preferred and as their healthcare professional had prescribed.

Staff were not always deployed to the level the provider had assessed as being required to meet people’s needs at the service and out in the community. People were supported to attend healthcare appointments but had not been supported to take part social trips out which they enjoyed. People were not supported to take part in a wide range of activities at the service.

People had not been supported to plan their end of life care, in the way they preferred with their representatives and healthcare professionals.

Staff knew what people were able to do for themselves and supported them to complete these tasks as independently as possible. However, plans were not in operation to support people to further develop their independence, for example in relation to household tasks.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff gave them privacy. People were not discriminated against and generally received care tailored to them. Staff knew people’s preferences about the gender of the staff member who supported them. However, the gender of staff working at the service had not been planned to meet people’s preferences.

Assessments of people’s needs and any risks had been completed. People had planned their care with staff and received support to meet their individual needs and preferences. Processes were in place to analyse any accidents and incidents that occurred and take action to stop them happening again.

People were offered a balanced diet, which met their needs and preferences. Staff helped people who needed support at mealtimes to have as much independence as they wanted.

People were supported to have 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. Assessments of people’s capacity to make decisions had been completed. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well. The conditions of Deprivation of Liberty Safeguards (DoLS) had been complied with.

Staff knew the signs of abuse and were confident to raise any concerns they had with the acting manager and provider. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff had completed the training they needed to fulfil their role.

The service was clean. The building was well maintained and all areas of the building and grounds were accessible to everyone.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating under their previous legal entity in the entrance hall of the service and on their website.

At our inspection August 2016 we found the service was in breach of two regulations and required the provider to make improvements. At this inspection we found the provider was in continued breach of two regulations and in breach of three further regulations. This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

The previous inspection on 21 July 2015 found one breach of regulation 12, an overall rating of requires improvement was given at that inspection. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

Each person had a single room and there was one shower room and a bathroom, kitchen, dining room and lounge. There was a large accessible garden at the rear of the service.

The service 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.

There was insufficient guidance in place to ensure people’s healthcare needs were always met and people were not always supported well to monitor their healthcare in a responsive way. This posed a risk to people’s health and safety.

Some staff supervision had lapsed although staff said they felt able to approach the registered manager at any time for support and help.

Care plans were difficult to navigate due to the vast quantity of paperwork, some documentation was repetitive and out of date. However, staff could demonstrate a good knowledge and understanding or people’s individual needs, meaning the impact this had on people was minimal.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff. Regular audits were conducted on medicines to check errors had not occurred.

There were enough staff to meet people’s needs and staff responded to people quickly in an unhurried and patient way. People were protected by the service using safe and robust recruitment processes.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment. Accidents and incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people.

Staff had a good understanding of how to keep people safe and contact names and numbers were available should concerns of peoples safety needed to be raised.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a clear understanding of the people who lived there.

People had choice around their food and drink and were encouraged to help staff prepare and cook meals. People could choose alternative meal options when they wished.

Staff demonstrated caring attitudes towards people. People felt confident and comfortable in their home and staff were easily approachable. Interactions between people and staff were positive and encouraged engagement, staff spoke to people kindly. People’s choices were respected and staff spent time engaging people in communication and activities suitable for their current needs.

People were protected by a robust complaints procedure. There was a complaints procedure in place for people and their representatives and complaints were responded to in a timely way.

Staff felt positive about the future of the service and were positive in the feedback they gave about the registered manager who they found supportive and approachable. The registered manager had started to implement changes to improve the service people received.

People’s feedback was obtained, listened to and analysed to improve the service they received. The provider conducted observational audits to look at the quality of care people were in receipt of.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

People we spoke with told us they were satisfied with the care they received and said that staff had discussed care and support needs with them. People told us they were asked which activities they enjoyed, what they would like to do and what they thought about living at Rose Cottage.

People told us that they were encouraged to do things that they could for themselves and felt confident they were supported by staff when they required help. People felt there were enough staff on duty to support them with their activities.

When we looked around the service, it was clean and tidy. People said that the service was kept clean and that they liked living there. Some people told us how they were able to choose paint, wallpaper and carpet when their bedroom was redecorated.

The name of a previous registered manager appears in this report, who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because it had not been removed from the register as manager of this location at the time of our inspection.

People we spoke with who lived at the service told us they did not have any concerns about the care they received. Some people told us that staff asked them if they were happy living there and sometimes discussed their care and support needs with them. People said there were generally enough staff on duty and that staff came when they needed them. They said all the staff were friendly and helpful.

The service was being managed by managers from other services owned by the provider until a permanent manager is appointed. The name of a former manager appears on this report because they continue to be accountable until they deregister.

Prior to this inspection we considered information received about the service which helped to inform our inspection.

During our inspection we found some concerns that related to care plans and risk assessments. The service could not evidence that care planning was regularly reviewed and up to date or that staff were always aware of all risks when supporting the people who lived at the service. This raised the potential that planned and delivered care did not continue to meet the complex needs of the people it was intended to support.