This inspection was carried out on 11 October 2018 and was unannounced.

Life Opportunities Trust-15 Rosevale is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one CQC contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation and personal care for up to eight older people, some of whom have learning disabilities. There were seven people living at the service on the day of our inspection.

At their last inspection on 12 January 2016 we found the service Good, however at this inspection we found that some of the areas of the service needed improvement.

Recruitment procedures were not as robust and the provider`s recruitment policy had not been developed to ensure it was fully compliant with the regulations. Candidates were not asked to provide a full employment history and the registered manager had no sight of the references received so they could effectively assess the suitability of their staff because recruitment files had not been kept at the home only at the provider`s head office.

Staff were responsible for maintaining a clean environment; however, we saw that tis had not been done. There were stained carpets and walls as well as cobwebs on lamp shades.

Staff received training in subjects considered mandatory by the provider, however more specialist training for staff to develop skills to meet people`s changing needs was not proactively planned.

Staff told us they felt supported to carry out their roles effectively, however they told us staffing was at times a problem and agency staff had to be used to ensure people had their needs met.

People felt safe and were happy with the support they received. Care plans were in place to give guidance for staff on how to meet people`s needs. However, people`s end of life care needs were not assessed and there were no clear processes or systems for staff to follow of when and how they had to approach these conversations with people or their relatives where appropriate.

People were supported to have maximum 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. Staff discussed with people the care and support they received and obtained their consent.

People`s dignity and privacy was promoted and respected by staff. Staff enabled people to maintain and develop relationships and stay safe.

People told us staff were kind and caring and their dignity was protected. People had been involved in planning and reviewing their care and support by staff who used pictorial documents where it was needed to aid people`s understanding.

Risks to people`s well-being were assessed and measures were in place to mitigate risks. Staff were knowledgeable about risk to people and how to minimise risks.

People were positive about the service they received, however relatives told us some aspects of the care and support people received needed improvement. These areas included cleanliness of the building and opportunities for people to take part in meaningful activities as well as access the community more often.

The registered manager used a range of audits to check the quality and safety of the care provided. We found that where issues were found, remedial actions were not always recorded and monitored to ensure these were completed.

This inspection was carried out on 12 January 2016 and was unannounced.

Life Opportunities Trust-15 Rosevale provides accommodation and personal care for up to 8 people older people, some of whom have learning disabilities. There were 7 people living at the service on the day of our inspection.

At their last inspection on 5 November 2013, they were found to be meeting the standards. At this inspection we found that they had continued to meet the standards.

There was a manager in post who had been at the service since April 2014. However, the previous manager was still registered with the commission although they had left the service in 2013 and we had not been notified in accordance with the registration regulations. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager of the service submitted their application the day following our inspection. However, this was an area that required improvement.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which some were pending an outcome.However, where DoLS applications had been authorised, the sevice had not submitted statutory notifications to the commission as required.

People received care that met their needs and care plans were up to date and person centred. People received the appropriate support to eat and drink and had access to health and social care professionals. People had access to day centres and in house activities and there were opportunities to go out regularly if they wished. Risks were well managed and staff knew how to keep people safe. Accidents and incidents were reviewed to minimise the risk of a recurrence.

Staff knew people well and involved them in planning and reviewing their care. Staff had been recruited through a robust procedure and received regular training and supervision. Staffing levels were sufficient to meet people’s needs and where agency staff were used, they tried to ensure the same staff attended to help provide continuity of care.

People, their relatives, staff and professionals were positive about the manager and their leadership style. There were systems in place to identify and resolve any issues and improve the quality of the service.

Most people who lived at Rose Vale had complex needs and were unable to tell us about their experience in detail. However, it was clear that people were happy and well supported. The three relatives we spoke with told us the care was good. One relative told us, “We could not be happier. We feel so fortunate to have found somewhere like Rose Vale."

Care plans contained information about how people liked to be supported and were regularly reviewed. We also found that people were supported to make decisions about their care. However, we found that annual reviews of people's care were not up to date.

Staff told us they enjoyed their work and felt well supported. Records showed that supervision meetings took place regularly. However, staff had not recently received an appraisal.

We saw that a number of different systems were in place to monitor the quality of care provided. Feedback from people who use the service and their relatives was regularly sought and the provider took action as a result.

Many of the people living in 15 Rose Vale had complex needs which meant they were not able to tell us about their experiences. People responded to us with smiles when we spoke with them. We noted staff members engaging with people and offering choices as to what activities they wanted to do and what they wanted to drink.

Subsequent to the inspection visit we spoke with relatives of three people living in the home to gather their views about how people were supported and cared for at the home. People told us that they felt their relatives were being cared for in a safe and appropriate manner. A relative told us the communication was good. They said that staff told them if the person's needs changed. One person stated, "if I had any concerns I would talk to staff, I know they would sort things out.”