Rose Belle

There were systems in place to reduce the risk of infection from COVID 19. There were protocols in place for visitors which included temperature testing and sanitising before entering the service.

The service was visibly clean. The provider had increased cleaning in the service including high touch areas such as door handles and light switches. Some areas of the service needed repair which made cleaning more difficult. We were assured that there were plans in place to undertake these repairs as soon as this could be undertaken in a safe way.

People living in the service were monitored for the symptoms of COVID 19. Checks on temperature were undertaken daily to enable staff to quickly identify any changes in people’s health.

The service was following government guidance on whole home testing for people and staff. This included rapid testing, weekly testing and monthly testing for people who used the service.

Suitable arrangements had been put in place during the outbreak of COVID19 to separate the environment for people who had tested positive and those who were not, to minimise the risk of transmission.

Regular audits were undertaken on the effectiveness of cleaning and infection control measures.

We signposted the provider to resources to develop their approach regarding the laundry and waste management and they subsequently confirmed that they had amended their processes in line with the government guidance.

Rose Belle is a residential care home providing personal care for up to seven people living with a learning disability. At the time of inspection there were five people living in the home.

People living in the home have their own bedroom and access to a large communal lounge and open plan dining room. There is a quieter space close to the staff office on the ground floor.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Incidents were captured and used to inform care planning to ensure risks were managed effectively, but they were not analysed at service level to identify any themes and trends. Fire evacuation was not practised in line with the procedure and we had some concerns with how the provider managed medicines. However, people were receiving their medicines safely and as prescribed. People were supported by enough suitably trained staff who knew how to keep people safe. The home was clean, and procedures were in place to reduce the risk and control the spread of any infections.

Audits used to measure the safety and quality of services provided were minimal and in general were not frequent enough to drive improvement in a timely way. Formal feedback was gathered from people using the service, staff and external professionals. The feedback was all positive and consistently praised the staff and management for the service they delivered. A clear values base was evident promoting people’s autonomy and independence wherever possible

People were supported effectively by well trained staff who worked with all relevant professionals to meet people’s individual needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff showed people respect, giving them choices around how they spent their days. People had their own space and could interact with others or not dependant on their preference at that time. Meetings were held to gather people’s feedback and steps were taken to make any changes people wanted in how the home was run. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Comprehensive care plans allowed staff good information on people’s needs and preferences in how they wanted to be supported. Information was available on people’s life histories and any interests they had. Staff supported them with these and considered the care and support people would need at the end of their life. There had been no complaints in the last 12 months, but the registered manager had taken the initiative to investigate a safeguarding concern under their complaints policy to ensure if they needed to make any changes in practice they were able to do so.

We have made two recommendations. One in relation to medicine management and one in relation to continuous improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (12 June 2017)

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosebelle provides accommodation for up to six people who may have a learning disability or mental health support needs. At the time of our inspection there were five people using the service.

At the last inspection we asked the registered manager to improve the quality assurance and auditing system and the way they reviewed accidents and incidents. We asked them to look at how they could improve staff values, and levels of staff training. We recommended that the registered manager should implement infection control policies and procedures, and make sure that people had their nutritional requirements assessed. We asked the registered manager to involve people more and make improvements to the décor of the premises. At this inspection we found that these improvements had been made.

The registered manager looked at ways they could improve people’s safety by analysing themes and trends when accidents or incidents had occurred. They looked at different ways they could reduce risks to people.

The registered manager had implemented a quality assurance system and audits had been introduced and were being completed on a regular basis.

Medicine audits were carried out and staff with the responsibility for administering medicines had their practice observed to ensure that they could do this safely.

Since our last inspection, the registered manager had introduced a core set of values and staff told us these were dignity, self-determination, fulfilment, privacy and choice.

People’s information included guidance for staff so that they could follow a structured approach to recognising and managing certain health conditions. People were given nutritious meals and were involved with developing the menus.

The registered manager had improved their approach to managing the control and prevention of infection. Staff followed policies and procedures that met current and relevant national guidance.

Staff were given regular training in a wide range of topics and had a clear understanding of the requirements of the Mental Capacity Act 2005.

Some improvement's to modernise the décor of the communal areas had been completed since the last inspection. Other areas such as the bathroom and the garden area still needed some work which would be completed in the next six months.

The registered manager was present during 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 2008 and associated regulations about how the service is run.

The registered manager was present during 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 2008 and associated regulations about how the service is run.

At this inspection we found the service to be in breach of regulations 18 and 14 of the Health and Social care Act 2008 (Regulated activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

The service did not always focus on how they could improve their safety records and did not analyse themes and trends when accident or incidents had occurred.

The provider did not have a core set of values that staff were required to work towards. Quality assurance systems were in place, but were inconsistently applied

Medicine audits were not carried out consistently and staff with the responsibility for administering medicines had not had their practice observed to ensure that they could do this safely.

The service did not manage the control and prevention of infection well and staff did not follow policies and procedures that meet current and relevant national guidance.

People could access food and drink as they wished, but care plans lacked nutritional assessments, which meant that staff could not follow a structured approach to recognising and managing certain conditions. People were given meal options that were nutritious, but were not involved with developing the menus.

Staff was given a thorough induction that gave them the skills and confidence to carry out their role. Staff training however was not kept up to date.

Staff did not have a good understanding of the requirements of the Mental Capacity Act 2005 and required training in this area. Records were effective in demonstrating people’s level of mental capacity and applications to apply for Deprivation of Liberty Safeguards (DoLS) to protect the rights of people had been submitted to the local supervisory body for authorisation. Improvements to modernise the décor of the communal areas and some of the bathrooms was required and plans had been put in place.

People and their relatives were involved in care planning and risks had been assessed. People’s privacy and dignity was maintained whilst encouraging them to remain as independent as possible, and activities were provided to meet the interests of individual people.

A complaints policy was in place along with an easy read version. All of the people we spoke with were happy to make a complaint should the need arise. People told us they felt safe and staff understood their responsibilities to protect people from harm and abuse.

We saw that people received care and support according to their assessed needs. Where people did not have capacity to consent to their care and support and where they required treatment the provider acted in accordance with the legal requirements and principles of Mental Capacity Act (MCA) 2005.

We found that there were enough qualified, skilled and experienced staff to meet people's needs. We spoke with two staff who told us that they received training and support to do their jobs. They both spoke knowledgably about the people they provided care and support to. They told us that they felt there was enough staff on duty.

We found that people were protected from the risk of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We observed that the staff were attentive to people's needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff sought people's agreement before providing any support or assistance.

We saw that people were protected by the service's safeguarding policy and that staff were supported in their work by being offered appropriate training and supervision.

People were encouraged and supported to make complaints. Staff on duty told us that they tried to ensure that complaints were dealt with informally and we saw that complaints that had been received were dealt with in line with the provider's complaints procedure.