This inspection was carried out on 02 August 2017. The inspection was unannounced.

Rose House is registered to provide accommodation and personal care for up to 18 people with a learning disability. There were 15 people living at the service on the day of our inspection who were of younger and older age groups. People had varying levels of care and support needs; some required staff support with their personal care needs and others required encouragement and prompts. The accommodation was spread over two floors with a lift to help people move between the floors easily.

At the last inspection, on 25 August 2015, the service was rated as Good. At this inspection we found the service had remained Good.

Staff spoke positively about the support they received from the manager and from the provider organisation. Although a manager was employed by the provider, they were not registered with the Care Quality Commission (CQC). The manager made the application during the inspection and this was now progressing. The provider had not returned a provider information return, requested by CQC prior to the inspection.

Risks were assessed and there were measures in place to minimise the risk to help keep people safe. Medicines continued to be administered by trained staff and administration processes were managed well.

People had the support they needed to access the appropriate help and advice to maintain their health and well-being. People said they were happy with the food and snacks available to them. People were involved in choosing the menus for the week.

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 support this practice.

Care plans were person centred and included people’s life history and their personal preferences.

People were supported to get involved in a range of activities to suit their needs and abilities both inside and outside of the service.

People were comfortable in the company of staff, chatting and laughing together. Staff knew people well and supported them to gain greater independence. People had their own bedroom and could choose freely to spend time with others in the communal areas or on their own in their bedroom.

There were staff vacancies that the manager was in the process of recruiting to, however, staff worked extra hours at times to make sure people received the support they needed. The provider had robust recruitment processes in place to make sure only suitable staff were employed to work in the service.

Staff one to one supervision meetings had not been carried out as regularly as the provider’s policy stated they should. However, the manager had a plan in place with dates booked for the rest of the year. Training continued to be provided to enable staff to gain the knowledge required to support people on a day to day basis.

Further information is in the detailed findings below.

The inspection was carried out on 25 August 2015 and was unannounced.

The service provides care and support for up to 18 people with a mild to moderate learning disability. At the time of our inspection there were 12 people using the service. The accommodation was situated over three floors. A lift between floors was available for people to use if they needed to.

There was a registered manager employed 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The registered manager and care staff used their experience and knowledge of caring for people with learning disabilities effectively. Staff assessed people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed within the service, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Where people could retain the information, they had been supported to understand what their medicines were for and when they needed to take them. This was reinforced by staff who administered medicines.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy and diabetes. People had been supported to understand their health conditions and had been given information to help them manage their own health and wellbeing.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. We observed people being consulted about their care and staff being flexible to request made by people to change routines and activities at short notice.

The registered manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. People could involve relatives or others who were important to them when they chose the care they wanted. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained to promote safety.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The registered manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities. New staff and existing staff were given extensive induction and on-going training which included information specific to learning disability services.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills. Staffing levels were kept under constant review as people’s needs changed. The registered manager ensured that they employed enough staff to meet people’s assessed needs.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. Pictures of healthy food were displayed for people and dietary support had been provided through healthy eating plans put in place by dieticians.

The registered manager produced information about how to complain in formats to help those with poor communication skills to understand how to complain. This included people being asked frequently if they were unhappy about anything in the service. If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The registered manager and the deputy manager have been in post for several years. They had demonstrated a desire to deliver a good quality service to people with a learning disability by constantly listening to people and improving how the service was delivered. People and staff felt that the service was well led. They told us that managers were approachable and listened to their views. The registered manager of the service and other senior managers provided good leadership. The provider and registered manager developed business plans to improve the service.

This was a follow-up inspection. At our inspection in April 2014 we found the service was not meeting all of the regulations in the Health and Social Care act 2008. The manager sent us an action plan telling us what actions they would take to become fully compliant with the regulations.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People who used the service, their relatives and staff were asked for their feedback about the quality of the service. The manager analysed people's views and responded to request made to improve people's experience's. People had opportunities to participate in residents and key worker meetings. Complaints were monitored and responded to effectively.There were audit processes in place to monitor risks, safety and wellbeing. People's care plans had been reviewed and updated.

This inspection was carried out by one inspector over seven hours who worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and people we talked with told us that they felt safe; staff knew people who used the service well. We saw that the risks associated with carrying out the care, support and treatment had been assed and minimised. There was a plan in place to enable people’s care to continue should a foreseeable emergency occur, for example a power failure.

We found that care and treatment records contained all of the information required to ensure that people who used the service were protected from the risk of receiving unsafe or inappropriate care or treatment. We found that people’s records were being completed in such a way as to enable health issues to be followed up and to keep staff informed of a person’s most up to date care needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst proper policies and procedures were in place and the registered manager had a good understanding of their responsibilities around protecting people’s rights. We noted that the registered manager of the service needed to do more to ensure that staff understood the guidance within the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The registered manager responded positively to our comments.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. People we talked with who used the service were happy with living there; one person said, “The staff are nice, I get out and do things like bowling, I like living here”. Another person said “I like my room, staff talk to me about what I want to do”. This meant that there was a relaxed and respectful choice based culture within the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We saw that staff interacted positively with people who used the service and people we talked with about the service told us that staff were caring and friendly; we observed staff offering people choices. We talked with three people who used; they were happy with the care they had received; one person said “I do like the staff, they help me when I need them”. Another person said “I like the staff they are nice”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw that each person had a named key worker and that systems were in place that enabled care plans to be reviewed and updated. We observed that staff asked people for their views and permission before providing any care or treatment. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded, people had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. We found that the registered manager was not having regard to comments made and views expressed by service users, persons acting on their behalf and persons who are employed for the purpose of the carrying on of the regulated activity about their experiences of care and treatment. We have set compliance actions for this.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw that people who used the service were asked for their feedback about the service they received, that they had opportunities to participate in residents and key worker meetings and people could be confident they would be listened to if they complained. One person told us that “I can go to any member of staff if I am upset”. There were audit processes in place to monitor risks, safety and wellbeing.

The inspection was carried out by one Inspector over six hours. During the visit we talked with seven people living in the home, and met others briefly. We talked with four staff as well as the manager, the responsible person and the operations manager; and we met other staff.

We found that people were relaxed and comfortable, and said they were happy living there. One said she liked “having lots of things to do”.

The staff that we spoke to said that the home’s ethos had changed since a recent change in the management. They said that people who lived in the home were now far more involved in making decisions about their day to day lives, and their choices were actively sought and respected. The staff said that their own training had been improved, and this meant that they were more confident with delivering care.

We found that people were provided with a variety of food and drinks and were enabled to have suitably nutritious diets.

We saw that medication was managed appropriately, and discussed ideas that the manager had for further improvements with medication storage.

We examined staff training records and saw that systems were in place to keep mandatory training up to date. There was opportunity for additional training subjects.

We found that record-keeping had improved and was of a satisfactory standard.

The provider had informed CQC after the last inspection of arrangements which were put in place to manage the home during the manager’s absence.

People told us that they are happy in their home. One person said, “I like it here, the staff are very nice and they know how to support me.” Another person said, “I wouldn’t change it here, I’m looked after well.”

People said that they knew the individual members of the care staff team well and they referred to them with affection.

Some people told us that they liked to spend a lot of time at home and others that they liked to go out. Everyone that had recently been on holiday said that they had enjoyed it a lot.

People told us that care staff spoke to them and if they were upset, they made them feel less worried.

People told us that they were satisfied with the food that was on offer in the home.