Rosewood Lodge and Brook House provides care and accommodation for up to 20 people with mental health needs. At the time of our inspection, 19 people were living at the home.

At our last inspection we rated the service as overall good, with the key question of is the service caring rated as require improvement. At this inspection we found the evidence continued to support the rating of good and the rating for caring had also improved to good. 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.

The service was safe. There were sufficient numbers of staff to support people safely and meet their needs. People received support with their prescribed medicines according to their needs. There were risk assessments in place to ensure people were supported in a safe way.

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 supported this practice. Staff received good training and support to carry out their roles effectively. People were supported nutritionally and encouraged to eat healthily.

People were supported by staff who were kind and caring. Work had been done since our last inspection to improve the condition of the bathrooms. People were able to maintain contact with their families and loved ones.

The service was responsive to people’s individual needs and preferences. People had the opportunity to take part in activities both organised by staff and those taking place in the community.

The service was well led. There was a registered manager in place supported by four team leaders and five seniors. Staff all reported feeling well supported in their roles and that the service was a good place to work.

Further information is in the detailed findings below

This inspection was unannounced and took place on 12 July 2016.

Rosewood Lodge and Brook House is registered to provide accommodation and care to up to 20 people. The home specialises in the care of people who have mental health needs and/or a learning disability. At the time of this inspection there were 18 people using the service.

The last inspection of the home was carried out in May 2014. No concerns were found with the service provided at that inspection.

There is 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 registered manager had managed the home for a number of years and had a good knowledge of the needs of the people who used the service. Everyone described the manager as extremely open and approachable. People and staff said they felt able to discuss any issues with them.

Some communal bathroom facilities did not promote people’s dignity and independence. Bathrooms were not well decorated and maintained so did not provide a pleasant environment for people or encourage people to take pride in their appearance or hygiene. Shower facilities were not easily available to everyone and some people told us they had to go to another floor if they wished to have a shower. We have recommended that the provider reviews these facilities.

People were supported by kind and caring staff who had the skills and experience to monitor their health and provide appropriate support. Staff had good access to training to make sure they kept their knowledge up to date.

People were fully involved in planning their care and support. Each person had a care plan which was very personal to them. They provided clear guidance for staff to follow and indicated how to identify if a person was becoming unwell. This ensured people received prompt support and treatment.

There were safe systems in place for the administration of people’s medicines. Where people choose to take responsibility for their own medicines risk assessments were carried out to enable them to do so.

People were able to make choices about all areas of their day to day lives and staff respected people’s independence. One person said “I do my own thing.” Another person told us “It’s alright here. I can do what I like.”

Snacks and drinks were available to people throughout the day. Meals were provided to people who wished to eat at the home. People’s nutritional well-being was assessed and diets were provided in accordance with people’s needs.

People felt safe at the home and staff knew how to recognise and report abuse. People said staff always had time to talk with them and they said they would be comfortable to make a complaint.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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 the summary of what we found:

On the day of our inspection at Rosewood Lodge and Brook House there were 18 people living in the two houses that had recently been joined by a connecting door. We spoke to 10 people living in both houses and we spoke to six staff.

Is the service safe?

We observed that people were cared for in an environment that was safe, clean and hygienic. Five people were able to tell us they "felt safe" living at Rosewood Lodge and Brook House and knew they could "trust" the staff to care for them and support them. We noted that appropriate safeguarding arrangements were in place in the form of safeguarding and whistleblowing policies. All staff had attended training in the Mental Health Act 2005 and Deprivation of Liberties and we saw evidence of this in staff files and training records.

CQC monitors the operation of Deprivation of Liberties which applies to care homes. We noted that no applications had needed to be submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. We observed that all of the people living at Rosewood Lodge and Brook House had capacity and the registered manager's told us that good practice indicates that all reasonable steps are taken to avoid a Deprivation of Liberties from occurring. This helped protect people's human rights.

We observed there were sufficient staff on duty to meet the needs of the people living at Rosewood Lodge and Brook House and the registered manager's for each house were on call in case of emergencies. We noted that staff records were accurate and complete. We saw evidence that staff had the skills and experience needed to support people in their care at Rosewood Lodge and Brook House. We observed that emergency procedures were in place in the event of a fire and noted that fire evacuation training was up to date and documented in staff files.

Is the service effective?

We found the service was effective in meeting people's needs. We observed that people at Rosewood Lodge and Brook House interacted well with staff and it was evident that staff were well known to them. One person said "I am very happy here and my key worker is wonderful and helps me whenever I need them to ". Another person told us "I know that the care I have received at Rosewood Lodge has helped me to become much more independent and the managers are helping me to find a home that will be my own". We noted this person had completed a skills for life programme and was now able to care for themselves independently. We saw that each of the five care plans we reviewed contained risk assessments and crisis intervention information. We saw the care plans contained triggers and behaviours which would indicate to staff a person was becoming unwell. We noted the assessments contained clear guidance on how to prevent any relapse becoming a crisis.

Is the service caring?

People we spoke to told us they were "well cared for" and said "I am always asked what I want to do and what I would like to eat each day". Another person said "My relative is so happy here and is always cared for by kind and supportive staff". We observed throughout the visit that staff interacted with people at Rosewood Lodge and Brook House in a kind and sensitive manner and there was good humour demonstrated between staff and the people living at the home. We reviewed five care plans and noted that each care plan contained a comprehensive assessment of each person's care and support needs.

Is the service responsive?

We spoke to staff who told us it was essential to the care and well being of people at the home to be responsive to their care and support needs which were constantly changing. Staff told us "We plan each person's day around their specific care needs as each person's physical and emotional state is constantly changing. We plan activities with each person on the day to ensure that the activity is appropriate to the person's needs at that time". The registered manager's told us that assessments for new people planning to come to the home could take a number of weeks and were centred around the needs of each person. We saw evidence of where assessment visits had been undertaken and short stays had been arranged. This ensured that either Rosewood Lodge or Brook House were able to meet the person's care and support needs.

Is the service well-led?

We observed that staff had a good understanding of the ethos of the home. They demonstrated throughout the visit how people were cared for and supported to live independent and full lives in line with their medical condition. We reviewed the feedback from quality assurance surveys that had been completed by people living at the home, relatives and visiting professionals. We noted that care and support was rated as 'excellent to good' by everyone receiving a service from the provider. One person said "The management of Rosewood Lodge and Brook House is "excellent" and the atmosphere is always kind and supportive.

We noted that staff received regular supervision, appraisal and in service training. This was recorded in staff files and on the electronic training records for the home. This demonstrated that staff were supported to give quality care to people at Rosewood Lodge and Brook House.

We carried out this inspection as part of our routine schedule of inspections. We spoke with eight people who lived in the home and three staff members. The home had two registered managers one for each house both were available for the inspection.

People spoken with told us they were happy with the care they received. One person told us, "This is my home and it feels like that, I wouldn’t want to be anywhere else”. Another person told us, “It’s good living here, the staff are really good, I got a key worker you can talk to them about how I like it here”.

We observed staff had a close and friendly rapport with people, one person told us, “I get on all right with all of them really”. We saw people were encouraged to make their own decisions about what they wanted to do during their day.

We saw care planning was person centred and written with the individual. We found that people consented to their care and treatment, both in writing and verbally on a daily one to one basis.

We saw people lived in a home that had a friendly homely atmosphere and was suitable to their needs.

Staff spoken with confirmed they were given the opportunity to build on their skills and received appropriate support from both the managers.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

People who lived in the home told us that staff provided the care and support they needed. People were able to do things for themselves although some occasionally declined or preferred staff members to do things for them. Staff made efforts to ensure that people did the things they could do for themselves. One person said “I do my own washing now and I make my own lunch. I try to keep my room tidy and I go out with staff”.

During our visit we observed staff interacting with people who lived in the home and noted how people chose to spend their time. We saw people made their own lunch, laundered their clothes and helped clean communal areas of the home. One person did a reading activity with their key worker. One person had gone to the cinema. Other people watched television, spent time in the gardens or in their own rooms. Some people chose to have their hair done by the hairdresser who was visiting the home.

Most people were free to come and go as they pleased into the town. For others there were guidelines in their care plan regarding the need to be accompanied. People chose activities outside of the home which suited them. One person told us they went to the theatre to see a show. They went on the train with staff and said “I enjoyed it, it was good fun”. People told us staff helped them organise holidays if they wished to go.

People who lived in the home told us they were well cared for and that staff were available when they needed them. People told us they attended their review meetings and they saw their care co-ordinators regularly. One person said “this is the best home I’ve lived in. They look after me. I would give this home five stars”. Another person said “if I wanted something I could ask my social worker. I see them a lot and I have reviews”.

People told us they were happy living at the home. One person told us “I’ve lived here for five years. I feel safe here. No one has been aggressive to me since I have lived here. They have in other places I have lived in”. Another person said “I would rather stay here than go to live in another care home. This is my home and I feel safe here”.

People told us they had the support they needed from staff and that they liked the staff who worked in the home. One person told us “the staff are really nice and respectful”. Another person said “most of the staff are alright. They have their job to do”. Throughout our visit we saw staff interact and communicate with people who lived at the home. Staff communicated with people in a kind and professional way.

People who live in the home were able to explain to us that staff provided much of the care and support they needed. People were able to do many things for themselves but often declined or preferred staff members to do things for them. One person said “I do my own laundry, clean my room and make a sandwich at lunchtime. That’s all I do really and I know other people don’t even do that”. Another person said “staff do most things here, they do all the cooking, cleaning and laundry”.

People spoken with told us that they were able to make decisions about their lives, but they were not always clear on the risks and benefits. One person said “we have house meetings and I have my own reviews with my social worker and my mum comes. They have read me my care plan”. Another person said “it’s alright being here. I try my best to look after myself, they say that is what you have to do now. I go to the house meetings, they are alright but I can’t remember what we talk about though. I know I have a care plan, I wouldn’t like to see it though”.

People do go out, but the activities people choose are limited and some people told us that activities they previously enjoyed and took part in regularly have now stopped. One person said “I can go out when I please. I’m quite happy with everything but I would like to go out to watch football. A member of staff used to take me but they left and they haven’t got the time here now. (The provider told us following our visit that a member of staff has been allocated to take this individual to the matches when they wish to attend). I would also love to see the cricket in Taunton but I can’t get there”. The provider told us following our visit that this individual 'has never shown an interest in cricket and has never requested that staff take him to watch cricket'. Another person said “I would like to go out more but there are not so many staff now”.

People who live in the home told us they generally felt well cared for and that staff were usually available when they need them. People told us they usually attend their review meeting and some people told us they had their care plan explained to them.

One person said “I’m quite happy with everything and I have made some friends here”. Another person told us “it’s alright here I suppose. I keep my own cigarettes and I’m going for a walk into town later. I always have a shower in the morning. I try my best to look after myself”.

Not everyone said they were entirely happy living at the home. One person told us one staff member “shouts at me if I don’t do something I’m suppose to and I don’t like it”. We discussed this issue the manager who said this had happened before and this had been addressed with this staff member. Another person told us “I’m very unhappy here and I’d like to get moved. I don’t have many friends here. Most of the staff I can get on with, but not all of them”.

We asked people about how they choose to spend their money. One person told us “I look after my money, it goes straight into the bank”. Another person told us “staff look after my money for me. I get my money on a Thursday. Staff took me out to buy new bedding and things for my room and I paid for it myself. Staff cancel [one activity they enjoy] though if I don’t clean my room”. We were told by the provider following our visit that this is not a practice that occurs now.

Some people choose to smoke and spend much of their money on this. “I keep my cigarettes in the day but I have to hand in my cigarettes and lighter to staff at night. I should get my own cigarettes but a member of staff usually gets them for me”. Another person said “I have one cigarette an hour and I have to ask staff for them”. During our visit we observed one person having to knock and wait outside the office for their cigarettes.

People told us they met with their care coordinators when they had review meetings. They also said they saw their GP if they were unwell. We saw in people’s records that they had access to opticians, dentist, district nurses, mental health professionals and a chiropodist.

People who live at the home do not always get along with each other. There was a recent incident where one person who lives in the home assaulted another person they share the home with. This resulted in one person receiving a small cut to the head and they were taken to hospital for for treatment.

We were told that there are some restrictions placed upon people. If people do not wish to bathe or shower they are asked not to use some communal areas. One person told us “staff cancel [one activity they enjoy] though if I don’t clean my room”. We were told by the provider following our visit that this is not a practice that occurs now. Most staff had not been trained in the Mental Capacity Act or the Deprivation of Liberty Safeguards and it is therefore not clear if staff consider these when imposing restrictions upon people.

People made different comments about their home. In general people said they were happy with their home and felt it was generally kept clean and tidy. Some people told us they kept their own room clean, but others told us that staff did this for them. One person said “staff do most things here, they do all the cleaning”.

Many people we spoke with were happy to show us their rooms. Some were very clean and tidy but others were not. Some people told us they had chosen the colour scheme for their room and had bought some of the furnishings. One person said “staff took me out to buy new bedding and things for my room” and another person told us “I have everything I think I need. I’ve got a TV, lots of books and I keep my room clean”.

Accommodation is arranged over four floors and this may not always suit some of the people who live in the home as there is no lift. One person told us “my bedroom is on the second floor, up two flights of stairs. I find it difficult to use the stairs sometimes and I have to use my walking stick to come down”. The provider told us following our visit that how this person chooses to present himself in relation to his mobility varies each day. One of the laundry areas is not accessible to people who live in the home, due to its location and is kept locked. This means that only staff are able to use this facility.

Most people told us they liked the staff who supported them, but some people said they did not get on with all the staff who work in the home. One person said “most of the staff I can get on with. I do like [three members of staff who they named] but I can’t get on with [two named members of staff]”. Another person spoke about one staff member and said “she was nice”.