Rosekeys

About the service

Rosekeys is a residential care home providing accommodation and personal care to people with learning disabilities and autism. The service can support up to 13 people. There were 9 people using the service at the time of the inspection.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The provider failed to ensure people were not subject to the least restrictive practice. Physical restrictions did not always follow care planning guidance.

Staffing levels did not support people to receive their assessed support. Staff did not always have the right training and knowledge to support people effectively and achieve good outcomes.

Governance processes failed to identify risk and improve the quality of the service.

Right Care:

Care was not person-centred and did not promote people's dignity, privacy and human rights. The service environment did not facilitate good care or promote people’s dignity and privacy. Positive person-centred outcomes were limited, and this was not a focus at the service.

People were not supported to follow professional advice, sometimes putting them at serious risk of harm.

Staff and the management team did not understand how to mitigate risks and protect people from the risk of abuse.

Care plans and risk assessments failed to consistently outline people’s needs and the staff team did not always understand the level of care people required.

People and most relatives we spoke with felt the care provided was safe.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. People’s rights were not always respected and people were not free from unwanted restrictions.

Ineffective governance systems and a lack of effective partnership working meant there were closed culture concerns at this service. The provider did not have effective oversight of the actions of the management of the service and were not aware of widespread risks.

The manager was not always available for relatives and some staff told us were not always confident in the manager’s approach.

People’s rooms were personalised and areas of the service had decorations people could interact with.

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 (published 29 November 2021).

Why we inspected

We received concerns in relation to incident reporting, safeguarding, governance and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We inspected and found there was a concern with deprivation of liberty (DoLS), so we widened the scope of the inspection to include the key questions of effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosekeys on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s health and safety, safeguarding, staffing, dignity and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rosekeys is a residential care home providing accommodation and personal care to people with learning disabilities and autism. The service is a large home, bigger than most domestic style properties. Six people were using the service at the time of the inspection. The service can support up to 13 people.

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

We last inspected the service in June 2021 and at that time we had concerns regarding staff training and governance of the service and Rosekeys was rated requires improvement overall. At this inspection we found that improvements had been made and the home was no longer in breach of regulation, however further improvements were still needed to ensure they can be sustained by the new management team.

People told us that they felt safe with staff. Staff knew how to recognise a safeguarding concern and how to report this. Medicines were managed safely by staff who had now received appropriate training. There were enough staff to meet people's needs, although we were told by staff at times there had been some shortages. The provider was actively recruiting new staff.

People's care plans were comprehensive and gave staff all the information they needed about people. The management and staff had worked closely with outside health professionals to help people maintain their health and stay well. 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.

The provider had quality assurance tools in place to monitor the quality of care and support provided. The management team was open and responsive.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions Safe, Effective and Well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

¿ Staff supported people in their independence and learning new life skills

Right care:

¿ People were supported to make decisions about their daily care and staff understood people's personal preferences and support needs

Right culture:

¿ The culture of the service was positive, person centred and promoted good outcomes for people

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 July 2021) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosekeys on our website at www.cqc.org.uk.

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.

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

Rosekeys is a residential care home providing accommodation and personal care to people with learning disabilities and autism. The service is a large home, bigger than most domestic style properties. Six people were using the service at the time of the inspection. This is larger than current best practice guidance. The service can support up to 13 people.

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

The provider's quality assurance systems were not always in place to assure good quality. Policies and procedures were in place to help ensure the quality and safety of services however, these had not always been followed. Audits had not always identified shortfalls and had not led to improvements in the quality and safety of services.

Some staff’s mandatory refresher training was out of date. Peoples had person centred, accurate and up to date care plans. People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. People were provided with sufficient food and drink to meet their dietary needs.

People were not always protected from catching and spreading infections because the risks were not always appropriately managed. Safeguarding systems and processes were in place. People had received their medicines as prescribed for them. People were supported by a sufficient number of staff to meet their needs. Staff were recruited safely.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 and 10 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, premises and equipment and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosekeys on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staff training and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles. However, shortfalls were identified as training had not been refreshed for all staff in in this area.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Seven people were using the service. This is larger than current best practice guidance. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

Some areas of the home were clean, however we found some areas were poorly maintained. We also identified poor infection control practices which hadn’t been identified by the providers audits.

The property was large and spacious but needed redecoration and the gardens needed attention.

Staff were trained and knowledgeable in safeguarding people. We identified a shortfall in the safeguarding of one person’s finances.

There were shortfalls in the audits which the provider needed to strengthen and embed into practice.

Risks to individuals and the environment were assessed and monitored. Fire equipment was serviced and regularly tested however, not all staff had taken part in a fire evacuation.

Refresher training had expired for a number of staff meaning they may not have been able to effectively carry out their role in supporting people with behaviours which challenge others. Staff told us they received regular supervision and support.

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.

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.

There were enough staff on duty to meet people's needs and we saw staff were effectively deployed. There was a recruitment system in place that helped the employer make safe recruitment decisions when employing new staff.

Safe systems were in place for medicines and we saw people were receiving them on time and as they were prescribed. Staff received appropriate training and competency assessments in administration of medicines. Peoples physical, social and mental health care needs were met.

Staff were kind and caring and respected people’s privacy and dignity. People were supported to follow their interests and take part in activities that were important to them.

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

The last rating for this service was good (published 7 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report. The provider acted to mitigate the risks we identified as part of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosekeys on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

The service had 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

Staff had a good understanding of their role and responsibilities in protecting people from harm or abuse and followed correct procedures in relation to raising concerns. The registered manager shared information with the Care Quality Commission and the local authority when needed. Risks to people’s safety were clearly identified and assessed, and measures were in place to ensure people were safe. People received their medicines as prescribed and the management of medicines was safe.

The staffing levels were sufficient to support people’s needs and, although the service did use agency staff at times, the staff were well supported and underwent appropriate employment checks. Staff received regular and appropriate training and supervision to assist them in their roles.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People’s health needs were managed with referrals made to health care professionals when required. People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care, and were treated in a caring and respectful manner by relaxed and considerate staff.

People’s care plans contained up to date, relevant information and they received care from staff who understood their care needs. People who used the service or their representatives felt they could report any concerns to the management team and felt they would be taken seriously.

The registered manager ensured there were systems in place to continually monitor the quality of service provision.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us, 'If we are capable of doing it they watch over us, they are like a safety net, they reassure us.' Another person said, 'I don't like the risk assessments, but they are there to keep me safe.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A person who used the service told us, 'They manage my medication. I read the information pack.'

We found the staff team were supported through training and the provider had an effective complaints procedure. A person who used the service told us, 'I feel they listen to me, I am not afraid to say anything. They act on it straight away.'

One person confirmed they liked living at the home and they liked the staff. They told us they enjoyed being outside and liked to keep the garden nice. Another person confirmed they made their own decisions about how they spent their day and what activities they did.

We saw people being supported in their activities of daily living and staff encouraged people to make their own decisions about how they spent their time and how they structured their day.

People who spoke with us said they were happy and had lots of things to do. A person said "I love painting and baking. I do what I want to do when I want."

A person's relative visited and when we spoke with them they said, "This is the best thing that could have happened for my relative. They go out to play golf, snooker, shopping and for meals. They have been happy here all the time. I visit every week and feel very welcome. I know they are well looked after and I have no worries or concerns at all."