Archived: Rosehill House

About the service

Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall. At the time of the inspection three people were living at the service. The service was based in a large detached house with an annex. The service is in a rural setting on the edge of a village.

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

The provider had was using one part of the location to provide accommodation for a member of staff from another service. We have made a recommendation relating to the risk management associated with this practice.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

• Two people shared the annex and another person lived in the house. One person had moved to the annex enabling them to remain in their home as their needs changed.

• People were supported to have choice and control over their own lives. 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 did support this practice.

• Staff focused on people’s strengths and interests. They promoted what people could do and supported them to pursue their interests.

• People were supported in ways that reduced periods of distress. People were clearly relaxed with staff and reassured by their presence.

• People lived in a home that reflected their personalities, needs and interests. Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

• Staff supported people to take part in home based activities and pursue interests in their local area if they enjoyed this. One person was keen to get out on a walk they had chosen when we visited.

• Staff enabled people to access health and social care support in their community. People were starting to return to activities that had been paused during the pandemic.

• Staff supported people to make choices and communicated with people in ways that met their needs.

• Staff supported people safely with their medicines and worked with health professionals to achieve good health outcomes.

Right care:

• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

• Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. People were relaxed with their staff.

• The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People could communicate with staff. Staff understood their individual communication needs and were consistent in their approach. Where people needed staff to use specific language this was communicated clearly in their care plans.

• People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), and pictures could interact comfortably with staff because staff had the skills to understand them.

• People received care that supported their needs and goals; staff were focused on their quality of life. One person had a delivery of new bedroom furniture, staff supported them to be engaged in the process, to enjoy their new acquisition. Their interaction about this was familiar and enthusiastic.

• People pursued individual interests and staff sought opportunities to try new activities that may enhance people’s lives.

• Staff promoted equality and diversity in their support for people. They sought to understand people’s histories and backgrounds and provided appropriate care.

Right culture:

• The staff at Rosehill House were committed to ensuring people were leading the lives they wanted. People were treated with dignity, respect and care.

• People led lives that reflected their personalities and preferences because of the ethos, values, attitudes and behaviours of the management and staff.

• People received good quality care, support and treatment because staff had the skills they needed and supported each other effectively.

• People were supported by staff who understood the wide range of strengths, impairments or sensitivities autistic people may have. This knowledge informed assessments and care plans and meant people received compassionate care that was tailored to their needs.

• Staff knew and understood people well and were responsive to them. They supported people to live a life of their choosing.

• Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

• People and those important to them, including advocates, were involved in planning their care.

• Staff valued and acted upon people’s views and understood that these were expressed through how people presented themselves and their actions.

• People’s quality of life was enhanced by the staff team’s commitment to ensuring a respectful and inclusive culture. Systems were in place to monitor the quality of the care and support people received.

• The registered manager and staff team were open and transparent and acted on feedback given, and queries raised, throughout the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was Good. (Published March 2018)

Why we inspected

The inspection was prompted in part due to concerns in relation to staffing levels across the provider organisation and the impact on people’s support. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

Enforcement and Recommendations

We made a recommendation in relation to good governance.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This unannounced comprehensive inspection took place on 20 February 2018. We last inspected Rosehill House in May 2017, we had no concerns at that time. However, due to concerns identified at a previous inspection in January 2017 the service was rated Requires Improvement. At this inspection we found the service was Good.

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.

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 requires a registered manager and there was one 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 premises had been organised to enable people to have their own private spaces as well as opportunities to spend time together when they wished. The service was split into three separate living spaces; a self-contained annexe, the main house and a separate one bedroom apartment. Each had its own front door, kitchen and living area. Appropriate safety checks were completed to help ensure the building and utilities were safe. The environment was clean and well-decorated.

We spent some time with people and staff. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. When staff spoke with people they spent time to check people were engaged with them. Relatives were positive about the staff team and the management of the service. One commented; "We're very happy and [person's name] is the happiest there she has been."

Care plans identified how people preferred to be supported and how much support they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Technology was used to help improve the delivery of effective care. Spectrum had introduced an electronic system for the recording of daily notes, appointments and incidents and accidents. This meant information could be more effectively and accurately captured and was accessible to senior management as well as staff at the service.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. There were enough staff to support people safely and allow them to take part in individual activities. The staff team were willing and able to shift their working hours in order to ensure people could take part in events outside of normal shift hours.

The registered manager had a positive approach to risk management. They worked with the staff team to identify the least restrictive way of supporting people and enabling them to access the community.

The staff team felt valued and morale was good. One commented; “We’re a team, we help each other.” They told us the registered manager was approachable and available for advice and support. We observed the registered manager thanking staff for their input. They told us; “The team are amazing, really flexible.” There were clear lines of accountability and responsibility within the staff team. One member of staff was the lead for Positive Behaviour Support (PBS) and the safeguarding champion.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the registered manager and a member of the senior management team.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosehill House on our website at www.cqc.org.uk.

Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

Although there was a registered manager in post they were no longer 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. The service was being overseen by a manager who told us they were applying to be the registered manager for Rosehill House. We will monitor the situation to check the registered manager requirement is met in a timely manner.

New staff had been recruited to the service which was fully staffed at the time of this inspection. There were sufficient staff to help ensure people’s health and social needs were met according to their preferences. People were supported to take part in a range of activities which were in line with their interests and preferences. Staff were pro-active in encouraging people to try new experiences and visit different places to widen their experiences. Staff helped people take part in day to day tasks such as household chores and baking. This meant people were active both in and outside of the service.

Risk assessments were in place and new ones were developed as people tried new activities. Learning logs were kept to record what worked well for people and where improvements could be made.

Staff were confident about reporting any safeguarding concerns both inside and outside of the organisation. We found there was an open culture amongst the staff team which enabled them to raise any concerns and question working practices if they wished to. Staff told us they were well supported by the manager and could ask for guidance at any time. There was a system of regular supervisions and staff meetings in place to help facilitate open discussion.

Training was updated regularly. The manager had completed a recent audit of staff training needs and was arranging for any identified gaps in training to be addressed. Most staff were booked to receive training for people's specific health needs the following month.

People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental capacity Act 2005 (MCA). The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). One person was subject to a DoLS authorisation. There were conditions attached to the authorisation regarding the recording of activities the person had taken part in. These conditions were now being met.

Care plans were informative and regularly reviewed. They were very focused on people's individual needs, describing their likes and dislikes, communication preferences and styles and personal histories.

Regular audits were carried out to monitor the quality of the service provided. Where these identified areas for improvement action was taken appropriately. The manager was working to improve communication with families and help ensure they were kept up to date with what their family member had been doing throughout the week.

We found the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our comprehensive inspection in January 2017 were now being met.

Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. The people living at Rosehill House had previously lived at another Spectrum service which has now closed. They had moved into Rosehill together in November 2016. Staff and relatives told us the move had been well managed and people had settled in well.

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.

People's social needs and preferences were not being met. There were four staff vacancies at the time of the inspection. The registered manager told us this was being addressed and two new members of staff, plus a new deputy manager, were due to start working at Rosehill House in the next few weeks. However, the rotas for December showed there had been several occasions when staffing levels had dropped below the minimum identified as necessary to meet people's needs when they were at home. Additional staff were required to support people to access the community and take part in individual pastimes. People's daily records showed they were seldom going out to take part in activities which had been identified as meaningful and important to them. The records showed three of the four people frequently went on drives as a group but staff told us people usually stayed on the bus as there were not enough staff to support people safely in the community.

Records of the care and treatment people received were kept. Some of these records were incomplete. For example, we found gaps in daily records and records of when one person had received prescribed topical medicines. This meant we were not consistently able to establish the care people had received. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental capacity Act 2005 (MCA). The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). One person was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation. There were conditions attached to the authorisation regarding the recording of activities the person had taken part in. These conditions were not being met.

Care plans were informative and regularly reviewed. They were very focused on people's individual needs, describing their likes and dislikes, communication preferences and styles and personal histories.

Staff knew people well and understood their communication styles and how they preferred to be supported. We saw examples of positive interactions during the inspection when staff supported people in line with their care plan. People were encouraged to do things for themselves and staff showed compassion and patience in their approach.

Regular audits were carried out to monitor the quality of the service provided. However, these had not highlighted the problems identified at this inspection.

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