We undertook an inspection of Rose Meadow on 12 and 17 December 2018. The inspection was unannounced. Rose Meadow has been registered since October 2011. The service provides accommodation, personal care and support for up to ten people in Misterton, North Nottinghamshire. At the time of our inspection, seven people were using the service. The service is focused on supporting people with a diagnosis of a learning disability.

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.

Since October 2015, government policy has aimed to develop care services in line with 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. Rose Meadow was registered with the Care Quality Commission before the ‘registering the right support policy. Rose Meadow does not currently fit within best practice models for ’registering the right support’

At the last inspection, on 4 February 2016, we rated the service as ‘Good’. During this inspection we found concerns about the safety of the service. This included breaches of regulations 11, 12, 17 and 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. This is the first time the service has been rated as ‘Inadequate’.

At the time of our inspection there was no registered manager in place, however a newly recruited manager was in the process of registering. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons.” Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

There was no clear strategy and governance to ensure good outcomes for people. The registered manager had left in February 2018. A provider audit was completed seven months later, and had highlighted concerns about the service. Despite an action plan with the Local Authority we saw minimal evidence of change in the service. We were concerned that there were multiple areas of unsafe care, and the provider had failed to address these issues promptly and effectively.

During this inspection we found the service was not safe. Care plans did not guide staff on how to respond to people’s needs. Records showed us that staff responses were varied, ineffective and at times harmful to people’s wellbeing. Incidents had not been appropriately referred to the Local Authority when safeguarding criteria had been met.

The risk of fire and legionella disease had not been assessed and managed appropriately. This put people at risk of living in an unsafe environment. The home was unclean. Medicines were not stored and recorded appropriately. This put people at risk of medicines not being managed effectively.

Staff were not deployed effectively around the home to ensure people’s needs were met. People’s one to one care support needs were not clearly assessed and people were sometimes left alone.

People’s diverse needs were not recorded accurately or recognised by staff. Short-term activities were provided and we saw people enjoy these. Longer term goals required embedding in the service.

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; the policies and systems in the service did not support positive practice. Formal complaints were responded to and a new accessible complaints procedure had been created to encourage peop

We carried out an unannounced inspection of this service on 17 December 2015. Rose Meadow is registered to provide accommodation and personal care for up to 10 people with a learning disability. The home is located in Misterton, Nottinghamshire. On the day of our inspection 7 people were using the service.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service in October 2015. 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 felt safe in the service and the risk of abuse was minimised because the provider had effective systems in place to recognise and respond to any allegations or incidents.

Medicines were managed safely and people received their medicines as prescribed. Staffing levels were sufficient to support people’s needs and people received care and support when required.

People were supported to make decisions and where there was a lack of capacity to make certain decisions; people were protected under the Mental Capacity Act 2005.

People were supported to maintain their nutrition and the support of external healthcare professionals was sought when required. However, improvements were required to ensure that care plans contained up to date information to enable staff to respond in the most appropriate way to any changes in people’s health.

People were treated in a caring and respectful way and staff delivered support in a relaxed and supportive manner.

Staff were knowledgeable about people’s likes and dislikes and what support people required. People who used the service and their relations knew who to speak with if they had concerns and were confident that these would be responded to.

People were involved in giving their views on how the service was run and involved in decisions about the service. Regular audits were undertaken within the service and action was taken where required.

Prior to our visit we reviewed all the information we had received from the provider and from other organisations.

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation.

During the visit we spoke with four people who used the service, three care workers and the registered manager.

The manager told us about weekly meetings with the people living at the service. These were arranged to enable them to discuss things on an informal basis and to make decisions about menu’s, activities and other issues that affected them as a group. One person told us, “We meet up and talk about lots of things that affect us all.”

We undertook a partial tour of the building to observe care practice and general cleanliness. We saw that the home was well maintained and clean.

We looked at some people’s rooms and saw they were personalised and decorated in the colours and style the person had chosen.

One person said, “I like my room very much and keep it clean and tidy.”

During our visit we spoke with three staff members and the registered manager. We spoke with four people who used the service and observed the support they received from staff. We also looked at some of the records held in the service including the care files for three people.

We looked to see how people gave their consent to care and treatment. We saw information in people’s care files that showed they had given their consent to their care. People had signed their care plans to show this.

We looked at the care and welfare people received. People received care and support as described in their plan of care. One person told us about the activities they liked to do. Another person told us, “I am going to college later.” One person also showed us some exercises they liked to do and said they did these to help them stop getting angry.

We looked at the safety and suitability of the premises. We found the home was clean well maintained. People who used the service had large personalised rooms. One person told us they were getting a new bed soon.

We looked to see whether there was sufficient and suitable staff available. We found there were enough staff to provide people with the support they needed. A person told us, “Staff stay with me.”

We looked at how service provision was assessed and monitored. We found people who used the service were able to put their views forward.

We spoke with two people who live at Rose Meadow. We asked if people were happy with the care that they were receiving, and we were told that: “I like living here, the staff are really nice.” “I think it’s alright.”

The two people who we spoke with were unfortunately unable to give any clear insight into the care that they were receiving. Observations during the sight visit showed that the staff were caring, respectful and friendly in their approach to people at the home.

Both people told us that they thought there were enough staff to meet their needs.

We asked people if they thought they were safe. Both people said that they thought they were. Neither person was able to give any insight or view into staff training in vulnerable adults that had taken place at the care home.

On the day of our visit to Rose Meadow there were seven people living at the care home.

We spoke with two people who live at Rose Meadow. Both people told us that they were happy living at the care home and also they were happy with the care that they were receiving.

We asked people if they thought they were safe. They said that they thought they were.