We carried out an unannounced comprehensive inspection of Rosewood House on 23 October 2018. The previous inspection took place on 8 March 2016, we had no concerns and the service was rated as Good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Rosewood House is a nursing home providing accommodation, nursing and care for up to 16 people with mental health needs, learning disabilities or physical disabilities. At the time of the inspection 15 people were living at the service, about half of those people required some nursing care. Rosewood House is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in six residential homes on the same site and in the nearby village of Polyphant.

Rosewood House has a registered manager who was responsible for all the services on the complex. 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. In addition to the registered manager, the service had a deputy manager and team leaders who oversaw the day to day running of the service.

The care service was established before the development of the CQC policy, 'Registering the Right Support' and other current best practice guidance. This guidance includes the promotion of values including choice, independence and inclusion. The service was working with people with learning disabilities that used the service to support them to live as ordinary a life as any citizen. For example, people’s bedrooms offered space and privacy. There was access to activities both on site and outside of the organisation. Changes to way meals were organised were planned which would allow people to become more involved in this aspect of their life.

People and their relatives spoke highly of the care and support provided at the service. Comments included “We have no concerns at all, staff know [Person’s name] very well.” Most people were unable to verbally express their views of the service. We observed people were at ease with staff and comfortable in their environment.

People are 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. Where restrictions were in place in order to keep people safe the best interest process had been followed to check the restrictions were necessary, proportionate and the least restrictive practice.

People’s records were comprehensive and relevant to their specific needs. Photographs were used to support written information so staff had a clear understanding of how to support people in specific circumstances. Any identified risks were recorded and guidance given on how to minimise the risk. All records were reviewed regularly and staff were alerted to any changes in people’s needs.

There were sufficient staff to meet people’s needs and support their choices and preferences. The atmosphere was vibrant and staff were able to support each other and work as a team to help ensure people’s needs were met.

People’s medicines were stored, administered and disposed of safely. People were supported to maintain good health through regular access to healthcare professionals such as GPs, speech and language therapists and consultants.

Staff knew people well and had a good understanding of both their health and social needs. Bedrooms were personalised and reflected their tastes and interests. People took part in a range of activities both within the service and wider community.

There were effective quality assurance systems in place. The de

This inspection took place on 8 March 2016 and was unannounced.

Rosewood House is a residential service providing accommodation, nursing and care for up to 16 people with mental health needs, learning disabilities or physical disabilities . At the time of the inspection 14 people were living at the service. Rosewood House is one of four houses which are part of the larger complex, Bowden Derra Park.

Rosewood House has a registered manager who was responsible for all the services on the complex. 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. In addition to the registered manager, the service had a deputy manager and a team leader who oversaw the day to day running of the service.

People and their relatives spoke highly of the care and support provided at the service. Comments included “I love it here”, “There is nothing they could do better. People come here and stay here. They love it” and “I can share my concerns with staff and I now have peace of mind when I leave my relative, It’s amazing”.

People’s records were comprehensive and personalised. This meant staff had the information they required to support people in the way they needed and preferred.

There were sufficient staff to meet people’s needs and support their choices and preferences. Staff said they were happy in their work and this was evident in the calm and relaxed atmosphere at Rosewood House. Positive working relationships had developed between people and staff and people were made to feel valued and well cared for.

People’s medicines were stored, administered and disposed of safely. People were supported to maintain good health through regular access to healthcare professionals such as GPs, speech and language therapists and consultants.

Staff were knowledgeable about the people they cared for and their right to privacy and dignity was upheld. People’s bedrooms were personalised and they had been involved in decorating them. People took part in a range of activities both within the service and wider community. People were supported to remain as independent as possible.

There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance processes with involvement from people, staff, relatives and professionals and was committed to continually improving the service. Staff described the management as approachable and supportive.

We found that people using the service were supported in a way which respected their individuality and the care provided was tailored to the individual person. Support workers knew how to communicate with people and recognised their needs and responded to them. Care and support was planned and delivered according to the plans of care. People's health was monitored and there was a lot of input from expert health care professionals, such as occupational therapists and dieticians so as to promote health and well-being. Arrangements were in place should any emergency occur, such as hospital admission.

People received a healthy and varied diet, which was monitored so that any concerns could be followed up in a timely manner.

The home environment was suitable for the needs of the people living there and it was well maintained, clean, warm and light. However, safety could be further promoted through more effective policy and procedure.

There were sufficient support workers to meet people's needs and those support workers received regular and ongoing training. Support workers knew people who used the service well and said they felt well trained and that there were enough staff to support people.

Record keeping at Rosewood House was improved in that all records were found to be kept confidentially and records were more detailed and provided better information to inform support workers about people's needs.

We spoke to two people who used the service and looked at their records. We observed the support provided to five others; most of the people were out for the day when we visited. We spoke to one person's family, five staff and looked at records.

People received support in a respectful way and staff were able to describe their needs and how they were met. There was a relaxed atmosphere and staff engaged with people at the person's own pace. However, there had been times when staffing numbers had affected the number of activities available and staff were not always receiving ongoing training to provide the support and care needed.

People's personal care and health needs were fully understood, monitored and met. People were supported to make decisions and be involved in their care. Vulnerable people had their rights upheld and appropriate people were involved in best interest decisions on their behalf.

One person told us that he liked his room. The home was warm, clean, fresh and safe. Another person said they she liked crayoning and we saw that she did this often. There were a lot of activities for people to choose from, both on site and off site, some therapeutic, some just fun.

Some records were detailed, current and fit for purpose. Some were not. This had already been identified as needing attention. The provider had arrangements in place to monitor and improve the service for people.