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 o

This inspection took place on 16 December 2016 and was unannounced. The previous inspection took place on 26 September 2014 and found there were no breaches in the legal requirements at that time.

Rosecroft provides accommodation and personal care for up to five people who have learning disabilities. Accommodation is provided in a detached chalet bungalow in a quiet residential area, close to public transport links and local and shops. Accommodation is arranged over two floors and each person has their own bedroom. The service benefitted from a large enclosed back garden and a separate activities building set within the grounds.

There were five people using the service at the time of our inspection who had learning disabilities and needed a range of support with their care and health needs. Some people presented complex behaviours that could challenge staff and others. People communicated verbally, some with the support of Makaton, the use of signs and symbols to help understanding and communication. We met and spoke with each person. People were able to tell us they liked living at the service, they appeared happy, settled and contented. People engaged readily with staff and enjoyed this interaction.

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. Although always in contact with staff, when the registered manager was not present at Rosecroft, a team leader oversaw the running of the service.

People’s needs were supported and the service offered a safe and comfortable living environment, however, there were some areas that meant the service required improvement.

A system to recruit new staff was in place, however, a specific requirement about references for staff had not been met and although provider checks were in place, this had not been noticed.

The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way. However, information held about individual symptoms or indicators which may precede people’s epileptic seizures could be enhanced. We have identified this as an area that requires improvement.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regula

During our visit of 29 May 2014 we found that people were not always protected from the risk of infection because appropriate guidance or equipment was not in place. Also people were not protected against the risks associated with medicines because the provider had not ensured that appropriate arrangements were in place for the training of staff. The home sent us information on 26 June 2014, which set out the plan of action that they would take to improve the service.

At our visit to the home on 26 September 2014 we found that an infection control lead had been appointed to oversee the practices in the home and to ensure that appropriate equipment and guidance was in place for staff. All staff had received training in how to administer medicines safely. Audits had been developed but had not yet commenced to ensure that practices in relation to infection control and medicines administration were maintained to a satisfactory standard.

We undertook this inspection following receipt of some information of concern. We spent a whole day in the service to look at the concerns raised and also inspected other outcomes.

During this visit we were shown all areas of Rosecroft and Heron’s view. We spoke with the deputy manager, two care staff and the provider. We met and spoke to the people that lived in Rosecroft, and we found that they had varied communication difficulties which made it difficult for them to fully express their views. We therefore used a number of different methods to help us understand their experiences of using the service.

We were unable to conduct a Short Observational Framework for Inspection (SOFI) which is an observational tool used to help us collect evidence about the experience of people who use services, who may not be able to fully describe this themselves because of cognitive or other problems. This was because our presence was upsetting to one of the people who was new to the home and we did not wish to increase their concerns. We therefore undertook brief observations of people and their interactions with each other and with staff throughout the day and listened to staff interactions with people in the home. We also spoke to four relatives of people that lived at Rosecroft and Heron’s View.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that staff demonstrated a good understanding of the use of different positive strategies when supporting people with behaviour that could sometimes be challenging. However this was not always well documented. There were safe recruitment practices in place to protect people from the risks of unsuitable staff. The home was clean but shortfalls in infection control processes could place people and staff at risk from cross infection. People were unable to manage their own medicine, and shortfalls in the training of staff in this area could place people at risk of harm.

Is the service effective?

Care plans demonstrated that people’s preferences were taken account of but their involvement in their care planning was less evident. Records showed that people were supported to access healthcare as and when required. We observed staff offering support and prompting around personal care issues in a discreet manner, encouraging people to return to their room where support was needed. Staff told us that they received one to one support from their registered manager to discuss work related issues and training needs and we saw records of this.

We saw that people ate well and staff explained that menus were based on staff’s understanding of people’s individual preferences around the food they enjoyed. Where someone had a special requirement relating to how their food was presented staff understood this and ensured this was adhered to.

Is the service caring?

Staff spoken with demonstrated a full and in-depth knowledge and understanding of people’s individual needs. Their knowledge and understanding was echoed by relatives we spoke with after the inspection who said they had, “Never seen their relative happier,” “They (the providers) really put themselves out for the clients and for their relatives”, “He has a better social life than I do,” “How do I know he is happy? When he is at home he can’t wait to get back there”.

Is the service responsive?

The home was a small service, and staff and people in the home spent time in each other’s company throughout the day. Staff understood people’s methods of communication and were confident that if people were distressed or expressed any issues of concern they would be aware of it. However, individual time staff spent with people was not well documented. Records viewed showed that people’s needs were reviewed annually or sooner if a change occurred and relatives and social care professionals were involved in this.

People were supported to maintain relationships with their families and actively supported to have visits to their homes. Relatives we spoke with said that they felt comfortable about raising concerns if they needed to and found the providers approachable and open to discussion, however there was an absence of records to support this. In discussion with staff we were concerned about the moving and handling arrangements for one person, when we discussed this with the provider they agreed to refer the person for a re-assessment by the physiotherapist.

Is the service well-led?

In discussion the provider was able to give examples of where the home had implemented personalised care for individuals, for example, continence management. In discussion staff said they felt comfortable raising issues and found the providers and senior staff approachable. There was evidence of learning from incidents. The provider ensured that an adequate level of staffing was provided by using a dependency assessment tool to help calculate the correct staffing hours required. There was good stable leadership and staff demonstrated caring and respectful attitudes. Risks were understood and measures were implemented to mitigate these without being overly restrictive. However, there was often an absence of recording to show how staff had made decisions, and how the provider was monitoring service quality.

We carried out this inspection to check that the provider had made the required improvements following our last inspection. Our inspection of 4 March 2013 found that people did not have care plans that reflected their current needs and records were not always accurate. Staff had not received the training they needed to effectively carry out their roles, in particular to safely carry out a physical restraint hold that was being used in response to a person’s challenging behaviour. We found that staff were unclear about reporting allegations of abuse.

The provider wrote to us and told us that by 30 June 2013 they would review and update people’s care plans and provide a programme of training courses for staff. They told us the service had stopped using the physical restraint hold and that staff were being made aware of the reviewed adult protection policy for the service.

At this inspection we found that people using the service had an updated care plan that detailed the support they needed. Staff had clear guidance to support people with managing their behaviours without the use of physical restraint holds and accurate records were being maintained. Staff had received the training they needed to effectively and safely care for people and they knew how to report any concerns about people’s welfare.

At this inspection we also checked the management systems and found the service was being managed effectively to ensure that people received safe care and support.

At the time of our inspection there were four people living in Rosecroft and one in Heron View. People lived in a comfortable and safe environment. People were supported to make decisions about their everyday lives and to maintain their independence and staff respected their privacy. People were supported to go out in the community for a range of social activities. A person told us “I have been out for a walk today”. Staff knew people well and responded to their needs quickly. A person that used the service told us “I am happy here”.

People’s care plans had not always been updated when their needs had changed and plans were not always written to help people achieve their goals. Where restrictions and physical restraint were used it was not clear that the appropriate healthcare professionals had been involved in making the decision about their use or that the restriction or restraint had been properly reviewed. Staff had not been properly trained in the use of physical restraint techniques.

Staff had not received all the training they needed to safely support people. Some of their training was out of date. Staff had received an induction to their role, but this did not meet the recommended standards set by the government for social care.

People were given the information and support they needed to be able to make a complaint. They had regular opportunities to talk with staff about their care. People told us that they felt safe in the service.