Rose Farm

Rose Farm is a residential care home providing personal and nursing care to 49 people, aged 18 and over at the time of the inspection, some of whom were living with dementia.

The service can support up to 54 people over 3 adapted units. One of which is in a separate building providing care to people living more independently.

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

People were safely supported and cared for whilst living at Rose Farm. They felt safe and staff understood the importance of maintaining their safety. People’s risks were monitored and managed by staff who had been recruited appropriately.

People’s needs were being appropriately assessed and were being met by staff who were appropriately trained. People spoke very positively about their meals and their needs relating to nutrition and hydration were being met. People were supported to access healthcare as required.

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.

People spoke highly of the staff who supported them. Staff treated people with care, kindness and dignity. People were encouraged to express their wishes and their independence was promoted.

People’s care plans were personalised and included information about their choices. Information from families was sought and families felt involved in their loved one’s care. People had a choice of activities to participate in. The service had not received any complaints and people felt confident to raise any concerns.

Rose Farm had a good management structure in place who monitored the quality of care delivered and took action to improve care where necessary.

Rating at last inspection

The last rating for this service was good (published 11 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection on 24 November 2016 concerns were identified relating to risk assessments and safety plans, which did not always contain sufficient information and had not been updated to accurately reflect changes. Risks to people were not always sufficiently monitored. Checks on pressure relieving equipment were not documented and some areas of the home and equipment were not clean. We were also concerned that internal quality monitoring systems had failed to identify these shortfalls. However we did not consider these shortfalls constituted a breach of regulations. We asked the provider to take action to address these issues and ensure people were cared for in a way that protected them from risk of harm. At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day of the 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.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The service was clean, well maintained and readily accessible throughout. There were improved quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

The home had a registered manager at the time 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 2008 and associated Regulations about how the service is run.

At our inspection on 12 November 2015, we asked the provider to take action to ensure that people were cared for in a way that protected them from risk of harm but did not restrict their freedom and independence. Action had been taken by the provider to seek legal authorisation for restrictions placed on people.

Risks to people had been identified. However, risk assessments and safety plans did not always contain sufficient information and had not been updated to reflect changes.

Risks to people were not always sufficiently monitored. Checks on pressure relieving equipment were not documented and some areas of the home and equipment were not clean.

People were protected from the risk of abuse as management and staff understood their role in keeping people safe from harm. People were also supported by sufficient numbers of staff.

People received their medicines from trained staff and the storage and administration of medicines was safe.

People were supported by staff who had received training and were supported by the management team to ensure they could perform their roles and responsibilities effectively.

People were encouraged to make choices and decisions. If there was doubt as to whether people had the capacity to make decisions, a capacity assessment had been carried out and a best interest decision made. The registered manager had applied for authorisations to deprive people of their liberty if required.

People told us they found the food satisfactory and that people’s dietary requirements were known and catered for. People received support to maintain their hydration, nutrition and healthcare.

People were treated with dignity and respect. We saw staff were kind and caring when supporting people and people were given information and choices.

We found that staff were knowledgeable about people’s needs and preferences but that this information was not always recorded. People benefitted from a range of activities which they were supported to engage with as they wished.

People and their relatives felt able to approach the management team with any concerns they had although were not always aware of different feedback mechanisms within the home.

At our inspection on 12 November 2015, we asked the provider to take action to ensure they were monitoring service provision to identify where improvements were required. We found that management systems were in place and when issues were identified these had been addressed. However, systems were not always effective in identifying issues such as lack of information in care plans and cleanliness.

People told us that the management of the home were visible and approachable and staff felt supported and motivated. We observed that the staff worked well as a team.

We found people were not fully involved in planning or reviewing their care. We asked four people if they had discussed their care plans with staff and they all said they had not. One person told us, 'Nobody asked me to sign anything.'

We found people received care and support that met their needs. A person who used the service told us, 'I have had good care so far, my clothes are washed every day and the food is good.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A relative told us, 'They look after the medication and make sure she (their relation) takes it.'

We found there was an effective system for identifying and responding to any complaints or comments made. A person who used the service told us, 'The staff sort things out the best they can, they are all very helpful.'