Care service description

Rosemere is a care home that provides care, support and accommodation for a maximum of six adults with learning disabilities, one of whom was living with dementia. The service is managed by Avenues, a 'not for profit' provider of housing and support for people with learning disabilities, autism and/or mental health needs. At the time of the inspection six people were living at the service.

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

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good

People were safe with and staff and staff were aware of the safeguarding procedure. There were sufficient levels of staff on duty to ensure that people’s needs were met. Recruitment was robust to ensure that only appropriate staff were employed.

Risks to people’s care was managed well by staff and people received their medicines in a safe way. Regular health and safety checks of the premises and equipment were carried out. The provider had up-to date procedures to help ensure people remained safe in an emergency.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported with their health needs. People were encouraged to eat and drink in a healthy way and people had choices of what they wanted to eat and drink.

People's needs had been assessed both before and after admission to the service. Care plans reflected people's needs and preferences. Care plans were evaluated regularly so they contained information about people's current needs. People chose how they spent their time and could take part in activities if they wanted to. Staff worked well together and communicated changes to people’s needs to each other.

People told us that they would speak to staff if they had any concerns. There was a complaints procedure should anyone wish to complain. There had been no complaints received since we last inspected.

The provider carried out quality assurance checks to ensure people received a good standard of care. Staff consulted with outside professionals to ensure the best delivery of care. People and staff had provided feedback when they were consulted about the service. Notifications were sent to the CQC where appropriate.

Further information is in the detailed findings below

The inspection took place on 3 March 2016 and was unannounced.

Rosemere is a purpose-built care home providing accommodation and personal care for up to six adults with learning disabilities.

There was a registered manager in post, although they were not present on the day of our inspection. 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 and associated Regulations about how the service is run.

People were safe because there were always enough staff on duty to meet their needs. Risks to people had been assessed and action taken to reduce these risks. Health and safety checks were carried out regularly and plans were in place to ensure that people would continue to receive their care in the event of an emergency. People were protected by the provider’s recruitment procedures. Staff were aware of their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. People’s medicines were managed safely.

People received their care from staff who had the training and support they needed to fulfil their roles. Staff had an induction when they started work and ongoing refresher training. They met regularly with their managers for supervision and had opportunities for continuing professional development.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which meant that people’s care was provided in the least restrictive way.

Staff enabled people to make informed choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals which ensured people received the care and treatment they needed.

Staff were kind and caring. They treated people with respect and supported them in a way that maintained their privacy and dignity. Staff encouraged people to be independent and to learn new skills. They promoted people’s involvement in their local community and to develop and maintain relationships with their friends and families.

People’s needs had been assessed before they moved into the service and were reviewed regularly. The service actively sought people’s views about their care and support and responded to their feedback. Care plans were person-centred and reflected people’s individual needs, preferences and goals. They provided clear information for staff about how to provide care and support in the way the person preferred.

There was an open culture in which people, their relatives and staff were able to express their views and these were listened to. Staff understood the values of the service and demonstrated these in their work. They met regularly as a team to discuss any changes in people’s needs, which ensured that they provided care in a consistent way.

The provider had implemented effective systems of quality monitoring, which meant that key aspects of the service were checked and audited regularly. Records relating to people’s care and to the safety of the premises were accurate, up to date and stored appropriately.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

We considered our inspection findings to answer 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 what we found-

• Is the service safe?

People were cared for in a safe, clean, homely environment. There were enough staff on duty to meet people’s needs and staff had access to on-call management support 24 hours a day. Care plans demonstrated that people’s healthcare needs were addressed and that people had access to medical advice and treatment when they needed it.

• Is the service effective?

Records, including care records, were well organised and up to date. There were clear standard operating procedures in place, which were known and understood by staff.

Guidance was provided for staff in the way people preferred their care and support to be delivered. Staff communicated important information about people’s needs effectively and provided care and support in a consistent way.

The provider sought the input of professionals, relatives and advocates when people needed support in making important decisions about their care. People had access to activities, to their local community and were supported to maintain relationships with their friends and families.

• Is the service caring?

All the staff on duty had worked with the people living at the home for many years and clearly knew their needs well. This meant that people received consistent care from staff who understood their needs. We observed that staff engaged positively with people who used the service and treated them with respect. Staff were observant of people’s needs and provided care promptly when it was required.

• Is the service responsive?

People’s needs had been assessed before they began to use the service to ensure that the home was suitable for them. People received a personalised service based on their individual needs and preferences. People’s needs were reviewed regularly and the provider responded appropriately if their needs changed.

The provider sought the advice of other health and social care professionals when appropriate to ensure that people received the care and treatment they needed. One healthcare professional told us, “I’ve been really impressed with the staff here. They’ve made themselves aware of all the new guidance and they’re really good at following any guidelines we put in place.”

• Is the service well-led?

Staff had a good understanding of the ethos of the home and had access to the training they needed to do their jobs. Staff had opportunities to discuss their professional development needs and told us that they received good support from their line managers.

The provider had developed systems to monitor the quality of the service, including seeking the views of people living at the home and other stakeholders. The service had access to support in functions including quality assurance, human resources and health and safety through the provider’s nearby head office.

During our inspection we spoke with four members of staff as well as the registered manager. We carried out some observations as we were not able to speak to most people who used the service due to their complex communication needs.

However, two people were able to tell us that they liked living at Rosemere and that staff were kind.

We saw that staff asked people for their consent before providing any care or support. We observed the care that people received and saw that this was appropriate and was in line with their care plan. For example, we saw that one person's food was pureed so that they were able to eat it without the risk of choking.

The home was clean and tidy. However, we noted that some people's bedroom sinks were in need of cleaning. Staff gave examples of good practice such as using gloves and washing their hands regularly.

We saw records that showed that the provider had followed a recruitment process and had completed relevant checks on staff before they started work.

We looked at other records held by the provider and saw that these were up to date and kept securely.

Some of the people who used the service had complex learning disabilities therefore they were not able to respond to our questions independently. We spoke with three people one of who was supported by a member of staff during our discussions. We observed staff interaction with those who were not able or willing to communicate with us.

People who used the service told us that they made choices every day. They stated that they attended activities that they liked, chose their food and undertook chores that they liked to do. One person told us, “I do the tables because I like doing them.” Another person told us, “I choose porridge for my breakfast.” People told us that they had been on holiday this year that they had chosen. People who used the service told us that they had a care plan and they had seen them. They said, “We call them folders.” They told us that they were happy living at the home and if they were upset or afraid they said they “Would tell the team leader” if anyone had treated them badly.

We found that people were not protected from the risks of unsafe or inappropriate care and treatment as accurate records were not kept.