About the service:

Rose Meadow is a residential care home that was providing care and support to 37 older people. At the time of this inspection, 34 people were living in the home.

People’s experience of using this service:

The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. Records confirmed that robust recruitment procedures were followed.

Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were able to choose what they wanted from the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Staff treated people with kindness, respect and compassion. People also received emotional support when needed. People were involved in planning the care and support they received and were supported to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and have a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement.

People who used the service and staff spoke very highly of the management team and told us they felt supported. The Care Quality Commission’s (CQC) registration requirements were met and complied with. Effective quality assurance procedures were in place.

Rating at last inspection:

At our last inspection (report published 18 August 2016) all the key questions were rated Good and the service was rated as Good overall. This rating has not changed and the service remains Good.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

The inspection took place on 14 and 15 July and was unannounced.

Rose Meadow provides residential care for up to 34 older people. At the time of this inspection there were 32 people living within the home. The accommodation is over two floors with a number of communal areas. Sinks are available in all rooms and there are bathroom facilities throughout the home.

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.

The service had processes in place to ensure that only those suitable to work in the home were employed. New staff received an induction to prepare them for their role. Staff received ongoing training which was delivered in a variety of forms and that was relevant to their job role.

People benefited from receiving care and support from staff that felt supported and were happy working at Rose Meadow. Staff morale was good and team work evident. Staff supported each other.

People had mixed views on whether there were enough staff to meet people’s individual needs. Some people said they felt that more staff were needed in the evenings, as they sometimes had to wait for assistance to retire to bed.

Care and support was delivered in a kind, courteous and respectful manner. People’s dignity and privacy was maintained and their independence encouraged. People had choices in most areas of their daily lives. However, some people felt the flexibility around what time they received assistance to retire to bed and get up in the mornings was not always as they would like.

Staff understood the importance of safeguarding the people they supported. They understood the different types of abuse and knew what signs could indicate when a person may be being abused. Staff knew how to report any concerns they may have both inside, and outside, of the service. Processes were in place to analyse any safeguarding concerns and these were monitored by the registered manager and senior management team.

The risks to the people who used the service, staff and visitors had been robustly assessed and recorded. Appropriate measures were in place to minimise risks and these had been reviewed on a regular basis. Accidents and incidents had been recorded and analysed to identify any trends or contributing factors. Actions had been taken to reduce the risk of future occurrences.

People received their medicines as the prescriber intended. Medicines management followed good practice and any medicines administration errors were fully investigated and appropriate action was taken. Staff had their competency to administer medicines assessed to ensure they were safe to do so.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff had a good knowledge of the MCA and knew how it applied to their role and those they supported. An appropriate application to legally deprive a person of their liberty had been made and the service had taken the correct steps to manage the needs of this person.

People had been fully involved in the development of their care plans and regular reviews had taken place. Care plans were accurate and person-centred. These provided staff with relevant and detailed information about how to support people and meet their individual needs.

People had had the opportunity to develop a document about their life history, which helped staff to develop meaningful relationships with them. Activities also took place that people enjoyed.

Access to a wide range of healthcare services was available to people and referrals were made promptly. The healthcare professionals we spoke with told us that the service followed advice and were respon

A single inspector carried out this inspection. The purpose of this inspection was to follow up areas of concern regarding cleanliness and infection control identified during our previous inspection which was undertaken on 28 April 2014. We needed to establish whether improvements had been made.

As part of this inspection we looked around the premises, spoke with the registered manager and reviewed the service’s records in relation to cleanliness and infection control.

This is a summary of our findings which relate to a key question we always ask: Is the service safe? If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

Our walk around the premises showed us that improvements had been made. For example, the upstairs sluice room had been cleaned thoroughly.

We spoke with the manager who told us about the actions they had taken following our April 2014 inspection. These steps helped ensure that people were protected against the risks of cross-infection by the procedures followed and actions taken by staff within the home.

We reviewed the evidence we had obtained during our inspection and used this to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

People told us they felt safe living at Rose Meadow. They felt they could rely on staff. Several staff members had worked at the home for many years. “I’ve no worries being here” one person stated.

Whilst the majority of the home was clean we found that some areas of the home required attention, in particular the waste arrangements and the upstairs sluice room. Although people living at Rose Meadow were unlikely to accidentally ingest harmful substances security arrangements needed to be reviewed to ensure these were kept secure.

We spoke with the manager about the Deprivation of Liberty Safeguards. They told us they had no concerns about anyone in the home coming under the criteria which would necessitate an application to deprive someone of their liberty. The provider had policies and procedures in place regarding this.

Is the service effective?

People told us that they were happy with the care and support that they received. Two people referred to the care they received as ‘first class.’ Those we spoke with told us that there was plenty for them to do if they wished. Some told us about trips they had been on or about those that were coming up. We observed one person helping to lay the table for tea. They told us they enjoyed doing this and liked to be busy.

Is the service caring?

People felt that staff knew them well and treated them with kindness and consideration. We observed staff chatting with people in a relaxed manner whilst routine support tasks were being carried out calmly and competently. The service regularly sought the views of people living at Rose Meadow and kept them informed about what was going on.

Is the service responsive?

We found that the service was organised to meet people’s needs and requests. For one person whose needs had recently increased we found that the service had engaged the support of various health professionals and reviewed and amended the care they provided for the person. Where possible outings suggested by people had been organised.

Is the service well led?

The service worked with other agencies and services to ensure that people received care and support in a co-ordinated way. The provider had an established quality assurance system and sought the views of staff to help determine the most effective ways of delivering care and support to people.

The people living at Rose Meadow told us they enjoyed living there and felt well cared for. One person said, “I like living here, there’s lots of good company and different things to do. The girls (staff) are wonderful and the manager is fantastic too”. Another person described the service as ‘wonderful’.

People’s care records showed that they were fully involved in making decisions about what care and support they needed. The people we spoke with all confirmed that they were asked for their consent before the carers gave them any assistance.

Care records were detailed, up to date and person-centred. People had individual risk assessment and these were reviewed appropriately.

There was choices from the menu at meal times and the people we spoke with said they had no complaints about the food. People’s nutrition and hydration needs had been assessed and there was evidence that these were being met.

We saw that there were enough suitably trained and experienced staff to meet the needs of people using the service. The staff said they felt well supported and happy working at the home.

During our visit we saw evidence that medicines were managed appropriately and safely. The majority of people using the service self-administered their medication and this was regularly audited by the care staff. Rose Meadow had adequate procedures in place to ensure people’s records, staff records and service records were accurate and kept safe and confidential.

During our visit we spoke with two visitors who told us that they were happy with the care and support that staff provided. They also told us that they felt well informed about their relative’s care and had discussed this with staff at most visits. We were further told us that they felt that the staff understood people’s individual needs and were able to meet them. They said that staff were very patient and caring, even when very busy.

People living in the home who we spoke with told us that they felt able to choose the way they lived their lives. They said that they liked living at Rose Meadow and that staff were kind and understanding. One person told us that staff “know what they are doing” and were able to meet their needs.

People and their relatives said that they felt able to raise any concerns they had with staff and felt confident that their concerns would be addressed.