Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

This unannounced comprehensive inspection took place on 20 February 2018. We last inspected Rosehill House in May 2017, we had no concerns at that time. However, due to concerns identified at a previous inspection in January 2017 the service was rated Requires Improvement. At this inspection we found the service was Good.

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 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.

The service requires a registered manager and there was one 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.

The premises had been organised to enable people to have their own private spaces as well as opportunities to spend time together when they wished. The service was split into three separate living spaces; a self-contained annexe, the main house and a separate one bedroom apartment. Each had its own front door, kitchen and living area. Appropriate safety checks were completed to help ensure the building and utilities were safe. The environment was clean and well-decorated.

We spent some time with people and staff. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. When staff spoke with people they spent time to check people were engaged with them. Relatives were positive about the staff team and the management of the service. One commented; "We're very happy and [person's name] is the happiest there she has been."

Care plans identified how people preferred to be supported and how much support they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Technology was used to help improve the delivery of effective care. Spectrum had introduced an electronic system for the recording of daily notes, appointments and incidents and accidents. This meant information could be more effectively and accurately captured and was accessible to senior management as well as staff at the service.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. There were enough staff to support people safely and allow them to take part in individual activities. The staff team were willing and able to shift their working hours in order to ensure people could take part in events outside of normal shift hours.

The registered manager had a positive approach to risk management. They worked with the staff team to identify the least restrictive way of supporting people and enabling them to access the community.

The staff team felt valued and morale was good. One commented; “We’re a team, we help each other.” They told us the registered manager was approachable and available for advice

We carried out an unannounced comprehensive inspection at Rosehill House on 4 January 2017 when we identified breaches of the legal requirements. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to staffing levels, ensuring people received care which met their individual needs and preferences and the systems for recording the care and treatment people were receiving.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosehill House on our website at www.cqc.org.uk.

Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

Although there was a registered manager in post they were no longer working at the service. 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. The service was being overseen by a manager who told us they were applying to be the registered manager for Rosehill House. We will monitor the situation to check the registered manager requirement is met in a timely manner.

New staff had been recruited to the service which was fully staffed at the time of this inspection. There were sufficient staff to help ensure people’s health and social needs were met according to their preferences. People were supported to take part in a range of activities which were in line with their interests and preferences. Staff were pro-active in encouraging people to try new experiences and visit different places to widen their experiences. Staff helped people take part in day to day tasks such as household chores and baking. This meant people were active both in and outside of the service.

Risk assessments were in place and new ones were developed as people tried new activities. Learning logs were kept to record what worked well for people and where improvements could be made.

Staff were confident about reporting any safeguarding concerns both inside and outside of the organisation. We found there was an open culture amongst the staff team which enabled them to raise any concerns and question working practices if they wished to. Staff told us they were well supported by the manager and could ask for guidance at any time. There was a system of regular supervisions and staff meetings in place to help facilitate open discussion.

Training was updated regularly. The manager had completed a recent audit of staff training needs and was arranging for any identified gaps in training to be addressed. Most staff were booked to receive training for people's specific health needs the following month.

People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental capacity Act 2005 (MCA). The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). One person was subject to a DoLS authorisation. There were conditions attached to the authorisation regarding the recording of activities the person had taken part in. These conditions were now being met.

Care plans were informative and regularly reviewed. They were very focused on people's individual needs, describing their likes and dislikes, communication preferences and st

We carried out a comprehensive inspection at Rosehill House on 4 January 2017, the inspection was unannounced. Rosehill House is a newly registered service and this was their first inspection.

Rosehill House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. The people living at Rosehill House had previously lived at another Spectrum service which has now closed. They had moved into Rosehill together in November 2016. Staff and relatives told us the move had been well managed and people had settled in well.

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.

People's social needs and preferences were not being met. There were four staff vacancies at the time of the inspection. The registered manager told us this was being addressed and two new members of staff, plus a new deputy manager, were due to start working at Rosehill House in the next few weeks. However, the rotas for December showed there had been several occasions when staffing levels had dropped below the minimum identified as necessary to meet people's needs when they were at home. Additional staff were required to support people to access the community and take part in individual pastimes. People's daily records showed they were seldom going out to take part in activities which had been identified as meaningful and important to them. The records showed three of the four people frequently went on drives as a group but staff told us people usually stayed on the bus as there were not enough staff to support people safely in the community.

Records of the care and treatment people received were kept. Some of these records were incomplete. For example, we found gaps in daily records and records of when one person had received prescribed topical medicines. This meant we were not consistently able to establish the care people had received. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental capacity Act 2005 (MCA). The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). One person was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation. There were conditions attached to the authorisation regarding the recording of activities the person had taken part in. These conditions were not being met.

Care plans were informative and regularly reviewed. They were very focused on people's individual needs, describing their likes and dislikes, communication preferences and styles and personal histories.

Staff knew people well and understood their communication styles and how they preferred to be supported. We saw examples of positive interactions during the inspection when staff supported people in line with their care plan. People were encouraged to do things for themselves and staff showed compassion and patience in their approach.

Regular audits were carried out to monitor the quality of the service provided. However, these had not highlighted the problems identified at this inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.