This unannounced comprehensive inspection took place on 5 March 2018. Rosecroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service was not registered to provide nursing care. The service provides accommodation for up to five people who have learning disabilities and needed a range of support with their care and health needs.
Accommodation was provided in a detached chalet bungalow in a quiet residential area, close to public transport links and local and shops. Accommodation was arranged over two floors and each person had their own bedroom. The service benefitted from an enclosed back garden and a separate activities building set within the grounds.
At our last inspection on 16 December 2016, the service was rated ‘Good’ in the Effective, Caring and Responsive domains and ‘Requires improvement’ in the Safe and Well Led domains. The overall judgement rating for the service was ‘Requires Improvement’ and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 17 HSCA RA Regulations 2014 Good Governance and Regulation 19 HSCA RA Regulations 2014 Fit and proper persons employed. This was because we found that the provider had not ensured systems or processes to assess, monitor and improve the quality and safety of services were fully effective and the provider had not fully applied established recruitment systems to ensure all processes were embedded into practice.
At this inspection, we found that improvements have been made.
There were now effective staff recruitment and selection processes in place. A member of staff had been employed since our last inspection and the recruitment process had been robust and all the appropriate checks were completed before staff were employed.
We found there was clear and detailed guidance in place for staff to follow for people who had specific health conditions, for example, epilepsy. The guidance included individual symptoms or indicators which may precede a seizure and the support the person would need.
Systems were now in place to enable the provider to assess, monitor and improve the quality and safety of the service and these were being followed.
This service had a registered manager in post. A registered manager is a person who is 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 was also responsible for looking after other services owned by the same provider.
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.
Staffing arrangements were flexible in order to meet people's individual needs. Rotas and our observations noted sufficient numbers of skilled staff were deployed to ensure people's needs were met safely.
Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication between staff at the service.
Staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised.
Measures to manage risk were as least restrictive as possible to protect people's freedom. Risk management considered people's physical and mental health needs.
Medicines were safely managed on people's behalf as people were not able to manage their own medicines because of their complex needs. There were systems in place to ensure people received their medicines as prescribed.
Staff ensured infection control procedures were in place. People's individual needs were met by the adaptation, design and decoration of the premises. Bedrooms were personalised and people’s preferences were respected.
Care files were personalised to reflect people's personal preferences. Care plans were pictorial, individual and depicted people's social, physical, emotional needs. Information was accessible and in format that people could understand.
Risks to people were assessed and appropriate steps were in place to mitigate any identified risk. Similarly incidents and accidents were monitored to ensure staff learnt from them.
Staff understood their responsibility to help protect people from discrimination and ensure people's rights were protected.
People were treated with dignity and respect. Staff were kind, caring and people enjoyed a friendly atmosphere.
People were supported and encouraged to maintain their independence and do as much for themselves as possible.
People were able to engage in activities and had many options available to them. These included art, crafts, music, swimming, walking, and eating out. There was strong support of relationships with friends and family.
People were supported to maintain a balanced diet, which they enjoyed. People's health care needs were met through working with external health care professionals and staff's detailed knowledge of the people using the service.
There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.
Audits and checks were carried out in-house and through the provider, so any problem could be identified and rectified. The premises were maintained through a programme of maintenance and servicing.
The registered manager showed strong leadership and a passion for the people in their care.
The registered manager was aware of when notifications had to be sent to CQC. This showed they understood their legal responsibilities.
Further information is in the detailed findings below.