The inspection took place on 9 and 10 October 2017 and was unannounced. The home was previously inspected in January 2017. We found the provider did not have suitable arrangements in place for obtaining, and acting in accordance with the consent of people who used the service in relation to care and treatment provided to them in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We found people were not protected from the risks of unsafe medication administration. The provider did not have suitable arrangements in place for assessing, monitoring and improving the quality and safety of the service. We concluded these were breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider sent us an action plan outlining how they would meet these breaches. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Rosedene is a residential care home providing accommodation and personal care and support for up to three people who have a learning disability. People using the service are supported to maintain their independence and live a lifestyle of their choice.

The service had a registered manager in post 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.

Medicines were managed appropriately. However, we recommended that medicine receipt records should be signed by two members of staff to confirm the accuracy of the medication received into the home. We recommended, in relation to the handwritten MAR, that two members of staff sign the MAR to confirm the information has been transcribed correctly. This should also include allergy details. In addition where a person uses a patch to administer medicines, staff should sign the MAR twice to confirm removal and application.

There was an appropriate recruitment process was in place, which was overseen by the provider’s Human Resource department. There were enough staff to meet people’s needs. The Learning and Development Manager had responsibility for ensuring staff training and supervisions were kept up to date. When staff training and supervisions were due this was planned for on the staff rota.

Care records and risk assessments were in place for areas such as; travelling in vehicles and accessing the community. These were regularly reviewed and provided guidance to staff on how a person’s needs should be met. The care records evidenced people had accessed to other healthcare professionals when needed.

We saw evidence to show that equipment and appliances were maintained. The provider was fitting window restrictors to all first floor windows and temperature valves on the taps to prevent injury to people who lived at Rosedene. The provider had a redecoration schedule in place to ensure the home was updated over the next year. We found the home was clean and odour free.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were knowledgeable about the MCA. They clearly explained how they supported people to make decisions about their care. Throughout the inspection we observed staff respecting people’s choices including, when to get up and have their breakfast.

Staff respected people’s privacy and dignity. We observed people's independence was promoted, and staff encouraged people to do as much for themselves as they were able. The provider had introduced a ‘bite sized bulletin’ to communicate with people. This was an easy read newsletter which would be published four times

The inspection took place on 18 January, 2017 and was unannounced. The home was previously inspected in March 2015 when breaches of legal requirement were identified. The provider sent us an action plan outlining how they would meet these breaches. You can read the report from our last inspection, by selecting the 'all reports' link for ‘Rosedene’ on our website at www.cqc.org.uk.

Rosedene is a residential care home providing accommodation and personal care and support for up to three people who have a learning disability. People using the service are supported to maintain their independence and life a lifestyle of their choice.

The service had a registered manager in post 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.

During this inspection we looked to see if improvements had been embedded in to practice from our last inspection. We found insufficient progress had been made in some areas. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at the procedures in place for managing medicines within the home and found some concerns. The medication policy in place did not give sufficient information to direct staff in how to store and administer medicines safely.

People were supported by sufficient numbers of staff to meet their needs. The provider had a safe recruitment system in place which involved pre-employment checks being made prior to the person commencing employment.

The staff we spoke with were very knowledgeable on safeguarding and knew how to recognise and report abuse if they needed to.

We looked at support plans belonging to three people and found there were no mental capacity assessments. Staff we spoke with told us that people they supported had capacity to make decisions about day to day life but would require further support with more complex decisions. This was not documents in support plans.

People were supported to have a healthy and nutritious diet which supported their needs. People were encouraged to take part in shopping for food items and meal preparation.

People had access to healthcare professionals when required and routine check-ups with doctors, dentists and opticians were also arranged.

Staff completed training relevant to their role and found the training valuable. Staff we spoke with felt supported by their managers and told us they had regular reflective meetings. These were one to one meetings with their line manager to discuss their work and training requirements.

We spoke with people who used the service and they told us they liked the staff team and felt they supported them well. Throughout the inspection we observed staff supporting people who used the service with consideration and respect. Staff knew people well and respected their likes and dislikes. We spoke with staff about maintaining privacy and dignity.

Prior to people receiving support from the service, an assessment was carried out to ensure the service could meet people’s needs. This information was then used to write support plans. We looked at support plans and found they gave enough detail about people to be able to support them well.

People were supported to maintain an active life and people were involved in a range of social activities of their choice.

The service had a complaints procedure and people who used the service told us they would speak with staff if they had any concerns. They were confident that their worries would be acted on and resolved.

We found some systems were in place to monitor the quality of service provision. However, these were not effective and did not always identify concerns.

We looked at policie

This was an announced inspection carried out on the 4 March 2015. At the last inspection in October 2013 we found the provider met the regulations we looked at.

Rosedene provides accommodation, personal care and support for up to three people who have a learning disability. The home is close to local shops, amenities and a ski village.

At the time of our inspection the service had a registered manager. However, they were no longer in day to day control of the service. The service had another manager who was in the process of registering with the Care Quality Commission. 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 training provided did not equip staff with the knowledge and skills to support people safely. There was no evidence staff knowledge and competency was checked following completion of specific training courses. Opportunities were not always available for staff to attend regular supervision meetings.

The manager had not made applications to the local authority for assessments under the Deprivation of Liberty Safeguards procedures appropriately. There were no decision specific mental capacity assessments in people’s support plans.

There were no effective systems in place to manage, monitor and improve the quality of the service provided.

People were supported by sufficient numbers of staff to meet their needs and to maximise their independence. However, on occasion last minute staff sick leave was not always covered. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The support plans included risk assessments.

People’s medicines were stored safely and they received them as prescribed and people had access to health care professionals to meet their specific needs.

People were supported to have enough suitable food and drink when and how they wanted it and staff understood people’s nutritional needs.

We observed interactions between staff and people living in the home and staff were respectful to people when they were supporting them. Staff knew how to respect people’s privacy and dignity.

Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed. People could express their views about the home and their care. A range of activities were provided both in-house and in the community. People were able to choose where they spent their time.

The management team investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

We found the home was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. Each person using the service had their own bedroom which was furnished and decorated as they requested.

Staff had a good understanding of the needs of people living in the home. They were able to describe different people and what care they required.

People’s needs were assessed and care and treatment was planned in line with their individual care plan. We looked at three care records and saw that records recorded information on people’s daily routine. They described how people liked to spend their days. One person liked to go out and see the Christmas lights and on the day of the visit was being taken out to see the lights and to have lunch.

All of the staff we spoke to during our visit were familiar with safeguarding procedures. When asked what constituted abuse one member of staff said “It can be anything, physical or mental”. The staff member said that she had never experienced any abusive behaviour towards people whilst she had been working in the home.

We saw that training records had information on staff attending training in areas such as safeguarding, fire safety, first aid, food safety, infection control, medication and challenging behaviour.

We asked how the provider monitored the quality of the care they delivered. We were told that the provider carried out an annual review with service users. We were shown information on the results of the questionnaire.

The manager said that one of the team leaders carried out unannounced visits to the home to audit staffs interaction with people and to monitor the environment.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people. We observed that staff and people who lived at the service had positive relationships. People appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff supported people to make choices about their daily living.

We spoke to people who use the service and they told us that they had been included in decisions about what care and support they received and when this would be available. They told us that “I like living here, it’s really good” and “the staff are lovely, we all decide what meals we have”.

We spoke with two members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Rosedene. They told us that they were well supported by managers of the home and there were good opportunities for training.

One person said they like living in the home but they also like going out. Another said they like working in the day centre café and like making cups of tea and coffee. Another said they like following the horse racing and could name all of the racetracks. They said they do not bet but they like to try and pick the winners. People said they like their support workers as they take them out and help them do things.

People living in the home said they feel safe. People said they like the people supporting them as they listen to what they say and take them out.

People say they like the people caring for them. People were observed communicating freely with those supporting them and people were observed being treated with dignity and respect at all times.

One person said they like living in the home and the people looking after them. Another said they like the driver who picks them up and takes them to work. They also said they like going to the day centre and working in the café. The people there are nice and they like making cups of tea and coffee for them.