This inspection took place on 11 and 12 July 2018. Rose Farm House is a residential care home for up to five adults with a learning disability. There were five people living at the service at the time of inspection. The accommodation is spread over one main building which contains two bedrooms and one flat and two annex’s each of which contained a one person flat. Rose Farm House is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good. At this inspection we found that the service had improved and the service is now rated Good.

At the previous inspection of the service on 15 June 2017, there was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider had failed to assess and mitigate the risks to the health and safety of people of receiving support. At this inspection the provider had taken the appropriate action. The registered manager had assessed risks and there was a plan to minimise these risks in place. There was clear, detailed and appropriate guidance for staff.

At the previous inspection of the service on 15 June 2017, there was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider had failed to protect people from improper treatment. The provider had provided care that intended to control and restrain people that was not assessed, agreed, reviewed and was not always the least restrictive option. At this inspection the service had made the improvements required. There were systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. The use of restraint had been reviewed and some people were no longer subject to restrictive practices or restraint. Where restraint continued to be used, this had been properly assessed and appropriately agreed in advance. Plans had been updated to ensure that staff always used the least restrictive option and restraint was regularly re-assessed and reviewed. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

At the previous inspection of the service on 15 June 2017, there were two breaches of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider had failed to maintain an accurate and complete record about people's support needs and. had failed to carry out effective audits to identify the shortfalls found at that inspection. At this inspection people’s support records were complete and up to date and the registered manager regularly audited the service to identify where improvements were needed. These checks were effective and actions identified had been undertaken.

When we completed our previous inspection on 15 June 2017 there were concerns relating to the services pre-admission assessment procedure and made a recommendation about this. At that time, this topic was included under the key question of responsive. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic is included under the key question of effective. Therefore, for this inspection, we have inspected this key question and also the previous key question of responsive to make sure all areas are inspected to validate the ratings. At this inspection the provider had reviewed the pre-admission procedure

This inspection took place on 15 June 2017. We contacted the registered manager the day before the inspection so staff could prepare people for our visit.

Rose Farm House is a detached property located in a rural setting close to Ramsgate and Margate. Staff provide 24/7 care and support for up to five people with learning disabilities and / or Autistic Spectrum conditions. There are three bedrooms in the main house and two one bedroom self-contained flats attached to the main house. On the day of our inspection there were five people living at the service.

High Quality Lifestyles Limited is part of the Priory Group. There was 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 worked hard to increase people’s independence and opportunities. People who were previously restricted or who had reduced opportunities due to their behaviours were now leading more fulfilled lives and were part of the community. However, the need for very clear and recorded assessment and agreement, by people, their loved ones and others, for the physical restraint being used for some people had been overlooked. People were being restrained by two or three staff with no assessment or thought given to the risks to people and with no recorded agreement and review of each incident.

Staff were committed to providing individual care to people and the aim of the service was to do things with people rather than for them. The registered manager was qualified and experienced. However, the governance and oversight had failed to recognise that restrictions had been imposed, including the use of restrictive physical intervention, without agreement, assessment and regular review. The governance, or oversight, of incidents of when restraint was used was lacking. The provider took action to address this after our inspection.

People’s needs should be assessed before they moved in but this had not happened for everyone. Each person had a support plan, a behaviour support plan and health action plan detailing their needs. People and their loved ones had been involved in writing their support plans. Not all support plans were up to date so staff may not have up to date guidance about people’s support needs. Support plans were not readily available for staff to refer to as they were stored in a separate building away from the main house.

People were given choices in a way they could understand and staff knew about the Mental Capacity Act (MCA). Staff had not always worked in line with the principles of the MCA. People and their loved ones had opportunities to air their views and make complaints and these were mostly acted on although some issues remained unresolved.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

Staff knew about different types of abuse and who to report any concerns to. Most risks to people were managed although some risks had not been assessed. There were enough trained staff to meet people’ needs and staff were checked before they worked with people. People had a say in recruiting the staff who might support them. Medicines were managed safely and people were supported to eat a healthy diet, to take part in cooking meals and to remain healthy. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people receiv

One inspector visited the service. We spoke with some of the people who used the service, their relatives, the management and care staff. We spent time with people and observed the interactions between people and staff during the day.

We set out to answer our five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe. Before the inspection concerns were raised about infection control and the environment.

The flooring in the bathroom upstairs was not sealed and water was leaking through the ceiling. The carpets were not suitable for everyone’s needs and could not be cleaned thoroughly.

The annex was poorly maintained. Doors were damaged; plaster was missing from parts of the walls. Paintwork was patchy and uneven. One wall was damp and parts of the ceiling were stained. Flooring was damaged in areas. Some of the furniture was broken including storage units and fittings.

Risk assessments were reviewed regularly and care plans updated. People were referred to healthcare professionals appropriately. Managers and staff learned from accidents and incidents by looking for patterns and trends to prevent further incidents.

Staff had knowledge of safeguarding people from abuse and how and where to report any concerns. Staff knew where the policies and procedures were and said they could refer to them should it be needed.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and that their care needs were met. One person said, "I am happy here. Staff treat me well. I have no worries". Another said, "Staff talk to me when I am worried. I like it here".

Is the service caring?

The service was caring. People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

Is the service responsive?

The service was responsive. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care plans of two people who used the service. Care plans had guidelines about the support needed to meet the people's needs. Staff had an awareness of the detail in the care plans and of people’s needs.

People were supported to attend health appointments, such as, doctors or dentists.

Is the service well-led?

The service was well led. Staff told us that they felt well supported and were given the information they needed to support the people who used the service.

Staff meetings were held where changes or issues with people’s care were discussed. Surveys were sent to people who used the service and their relatives to gain their views about the service.

The manager carried out audits but actions from the audits were not always addressed.

One of the people who used the service was unable to communicate with us and tell us what they thought of the quality of the care due to their communication difficulties. We were able to speak with some of the other people who used the service. Those spoken with were happy with the care and support given and had no concerns with regard to the quality of care. One said "I enjoy living here. Staff treat me well and help me. If I am unhappy I talk to the manager". Another person said "Staff help me to go to my job and talk to me when I am worried". Through observation during the inspection, we were able to observe staff supporting people who used the service in a respectful way and observed staff taking time to explain, where possible, the options available whilst involving people in making choices.

Through direct observation, discussions with staff and records we viewed, we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills.

During the inspection we were able to observe people who used the service being supported with their hobbies and interests. People also took part in many every day activities. These included going for a walk and shopping. People were also supported to carry out household chores such as vacuuming and laundry.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed.

People told us they received care from a small team of staff and were happy with the care received and had no concerns relating to the home.

One person spoke of his part time job and how staff supported him. Another said he enjoyed his computer and liked going out with staff and cooking. All spoken with expressed a great deal of satisfaction from living within the service and did not raise any concerns about the quality of care. All said if they were not happy they would speak to staff or the manager.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed.

People told us they received care from a small team of staff and were happy with the care received and had no concerns relating to the home.

Rose Farm House is a detached property located in a rural setting close to Ramsgate and Margate. Staff provide 24/7 care and support for up to four people with learning disabilities and / or Autistic Spectrum conditions. There are four bedrooms in the service and a self-contained flat with one bedroom. On the day of our inspection there were four people living at the service.

The registered manager is no longer employed by the provider and a new manager has been recruited. The service is run by the new manager, who has worked in the service for many years, and although they had applied to be registered with the Care Quality Commission (CQC), they had not yet gone through the process. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. Having a registered manager is a condition of the registration of the service.

The manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made where this was in their best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Three people living at the service had an authorised DoLS in place.

Risks to people’s safety were identified and managed appropriately. Staff knew how to protect people from the risk of abuse. Recruitment processes were in place to check that staff were of good character to work with people living at the service. People were supported by sufficient numbers of staff with the right mix of skills, knowledge and experience to meet their needs. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles.

People were happy with the standard of care at the service and were relaxed in each other’s company and in the presence of staff. People were involved with the planning of their care. People’s needs were assessed and care and support was planned and delivered in line with their individual needs. Care plans were regularly reviewed so they were up to date.

Staff were kind, caring and compassionate and knew people well. The range of activities at the service, to reduce the risk of social isolation, was directly linked to people’s choices. There was a complaints system and people knew how to complain. People’s views were taken into account and acted on.

People were provided with a choice of healthy food and drinks which ensured that their nutritional needs were met. People’s physical health was monitored and people were supported to see healthcare professionals, such as, dentists and GPs. People were supported to take their medicines safely.

The previous inspection of this service was carried out in September 2014. We found that maintenance and renewal programmes were not carried out in a timely manner. This had an impact on the state of the building which had resulted in a poor environment for people. At this inspection there were no signs of damp and ceilings had been repaired and redecorated. The design and layout of the building met people’s needs and was safe. The building and grounds were adequately maintained. The atmosphere was calm, happy and relaxed.

Staff told us that there was an open culture and that they felt supported by the manager.

The provider had systems in place to monitor the quality of the service. The manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.