This inspection took place on 8 November 2018 and was unannounced.

RoseLea House is a ‘care home’. 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. RoseLea House is registered to accommodate nine people living with learning disability. At the time of our inspection there were nine people living in the home.

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.

At our last inspection on 23 March 2016 we rated the service good overall. We rated the key question Effective `requires improvement’. This was because information in people’s assessments of their mental capacity was not always consistent with information about their capacity in parts of their care plans. At this inspection we found that improvements had been.

At this inspection we found that evidence continued to support a rating of `Good’ for the key question Safe and that the service had improved to being ‘Outstanding’ in key questions Effective, Caring and Responsive. The overall rating was therefore ‘Outstanding’.

Feedback from people who used the service, health and social care professionals and staff was consistently and unanimously positive. People spoke enthusiastically about how much they enjoyed living at RoseLea House. A healthcare professional attributed the success they had achieved with the treatment of a person to the service. They wrote, “I am sure that the success of this situation is down to the staff at RoseLea.’ The register manager and staff are proud to work at the service and equally proud that people had achieved ‘golden aspirations’ and greater levels of independence. People’s diversity is celebrated through innovative and creative activities.

The service has built an outstanding model of care and support. The registered manager was invited to speak about the outstanding success of activities at a forum organised by a local authority. All the staff continually looked to find ways to improve the service. They are driven by their passion for caring for people. Staff supported people to develop skills, confidence and self-esteem beyond what they thought possible.

The registered manager and staff had an excellent understanding of people’s needs. Staff found ways to improve people’s lives by introducing creative activities that opened new possibilities for people. Innovative ways were found to support a person with access to healthcare that was essential to them but which they at times were reluctant to do.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The service had staff who were designated ‘champions’ for dignity, the Mental Capacity Act (MCA) 2005, end-of-life care and infection control. These champions continue to play an essential role in developing best practice, sharing learning and acting as role models for other staff. Staff had training from healthcare professionals to understand about health conditions that people lived with. This meant there was an exceptionally strong team of staff who worked at the service.

Staff have a good safeguarding matters and excellent understanding of behaviours that are challenging to others. Staff viewed people’s behaviours that were challenging as behaviours that require ‘positive support’. This meant that people were always treated with dignity and their behaviours understood. We saw people receiving excellent support with their medicines. Staff explained to people what their medicines were for

We carried out an unannounced inspection of the service on 23 March 2016. RoseLea House is registered to accommodate up to 9 people and specialises in providing care and support for people who live with a learning disability. At the time of the inspection there were 9 people using the service.

On the day of our inspection there was a registered manager in place. 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 risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Risk assessments had been completed in areas where people’s safety could be at risk. People had the freedom to live their lives as they wanted to and they did not feel staff placed unnecessary restrictions upon them. Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out. Plans to evacuate people in an emergency were in place although these were not personalised to people’s individual needs. People’s medicines were stored, handled and administered safely. Checks on the competency of staff administering medicines were in the process of being put in place.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. Staff felt supported by the registered manager.

The registered manager had the processes in place to apply the principles of the Mental Capacity Act (2005) when decisions had been made for people. We identified some areas where assessments had not been conducted. However, staff ensured people were given choices about their support needs and day to day life. Deprivation of Liberty Safeguards had been applied for and where applications had been granted, appropriate safeguards were in place.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

Staff understood people’s needs and listened to and acted upon their views. Staff supported people in a kind and caring way and responded quickly to people who had become distressed.

People were able to contribute to decisions about their care and support needs although recorded evidence of this in care records was limited. People were provided with the information they needed if they wanted to speak with an independent advocate to support them with decisions about their care. Staff understood how to maintain people’s dignity. People’s friends and relatives were able to visit whenever they wanted to.

People’s care records were person centred and focused on what was important to them. Care records were regularly reviewed. People were encouraged to take part in activities that were important to them. People were able to complete college courses if they wished to. People were provided with the information they needed if they wished to make a complaint and all felt their complaint would be acted on.

People, relatives and staff spoke highly of the registered manager and there was a positive atmosphere at the home. The registered manager had an ‘open door’ policy and welcomed people’s and staff’s views on how to improve and develop the service. The registered manager understood their responsibilities and ensured staff were aware of what was required of them in their role. There were a number of quality assurance processes in place that regularly assessed the quality

We considered all of the information we hold about this service before we did this inspection and this did not raise any concerns. We had not received any information of concern from stakeholders in relation to this service.

We saw people’s needs were assessed and planned for. We spoke with four people who were using the service during our visit and received positive comments about the support provided. One person told us, “I like it here. I have my own room and I like going for pub lunches.”

People were protected from the risk of abuse and staff had guidance and training to ensure they responded appropriately to any incident which might require a referral to safeguarding vulnerable adult’s teams. People we spoke with felt safe with the staff working in the home.

There were effective recruitment processes in place to ensure staff working in the home were suitable to work with vulnerable adults.

People knew who to speak with if they had any concerns and they felt they would be listened to. There was a complaints procedure in place and staff knew how to respond to concerns.

We spoke with three people who use services. The people we spoke with told us that they had been involved in the development of their care plans. People had also been involved in choosing activities they would like to take part in and choosing food for their menu. A person said, “I like the staff here and the staff look after me. I have an action plan within my care plan and the staff listen to me and I get support. I like living here.”

People told us that they felt they were well cared for. One person told us that they sometimes like to do activities other than those which have been scheduled and the home was flexible to accommodate this individual choice. One person said, “If the others go into town, they sometimes arrange something different for me which is good. We all get to go to [a holiday centre] and I really enjoy that.”

People told us they felt safe living at the home. One person said, "I feel safe here and I can talk to staff." People told us that they liked the staff and staff were able to meet their needs. They also told us they felt they could speak to the manager or staff and they would be listened to.

We found people were treated with dignity and respect and received care that met their needs. We found that people were safe and that staff were supported to provide care that met people's needs. We also found that the provider took steps to assess the quality of the service being provided.

RoseLea House is a care home providing accommodation for up to nine people. There were nine people living there when we visited. The service provides care and support to adults who have a learning disability, a mental health illness or physical disability. There is a manager registered at the service.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. People were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements for staff to respond appropriately to people with behaviours which might challenge the service.

People were supported to take informed risks to ensure they were not restricted. One person said, "It is lovely. I get to go out all over the place and have my own money and mobile." Where people lacked capacity to make decisions, the Mental Capacity Act (MCA) 2005 was being adhered to so that staff made decisions based on people’s best interests.

We found that there were systems in place to ensure people received their medicines as prescribed. Staff were recruited through safe recruitment practices.

There were processes in place to gain the views of people in relation to their care and support. People’s preferences and needs were recorded in their care plans and staff followed the plans in practice. People were supported to maintain good health. Records and observations showed that the risks around nutrition and hydration were monitored and managed by staff to ensure everyone received adequate food and drink.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them. There was a clear set of values in place to support staff to respect people’s privacy and dignity. People were supported to attend meetings and complete questionnaires to express their views about the home. People told us they got on with the staff. We asked people whether staff treated them with dignity and respected their privacy. They all told us that staff did. One person said, "Of course they do."

Staff were able to describe examples of where they had responded to what was important to individuals living in the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to concerns.

The registered manager told us there had not been any written complaints made by people living in the home or their significant others. Information was available for people who used the service regarding advocacy services. Advocates are trained professionals who support, enable and empower people to speak up.

There were effective systems in place to monitor and improve the quality of the service provided. Staff were supported to challenge when they felt there could be improvements and there was an open and transparent culture in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The deprivation of liberty safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.

We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The registered manager told us there was one person who needed to be on an authorisation. We saw that they had made the correct application and notified the CQC of this. We saw no evidence to suggest that anyone else living in the home was being deprived of their liberty. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.