This inspection took place on 13 June 2017. The service was last inspected on 14 July 2015, the service was rated Good. At this inspection we found the service remained Good.

Rosewood is a care home which provides care and support for adults with learning disabilities, some of whom also have associated physical disabilities. The home is registered to provide accommodation for up to eight people. The home is a detached bungalow set in its own grounds, and parking is available.

People were kept safe and free from harm. Risk assessments identified individual risks to people's health and safety and there was information in each person's support plan showing how they should be supported to manage these risks. Risks to people arising from the premises were assessed, and plans were in place to minimise them.

There were systems in place to ensure that people received their medication as prescribed.

There was enough staff to meet people's needs. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role and received additional training to ensure they could support people’s needs. Staff were given effective supervision and a yearly appraisal.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. We observed people had a choice of what to eat and when to eat.

The service worked with external professionals to support and maintain people’s health.

Staff protected people's privacy and dignity. All interactions between staff and people were caring and respectful, with staff being consistently patient, kind and compassionate as well as being fun. We observed lots of laughter and singing throughout the day. Staff demonstrated affection and warmth in their contact with people, which was clearly reciprocated.

Support plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People and their family members were consulted and involved in assessments and reviews.

People had access to a wide range of activities, which they enjoyed. Staff were clearly passionate about providing meaningful activities and spent a lot of time on a one to one basis with people.

The service had a clear complaints policy that was applied when issues arose.

The registered manager was a visible presence at the service, and was actively involved in monitoring standards and promoting good practice. The service had quality assurance systems in place which were used to drive continuous improvements.

Further information is in the detailed findings below:

We carried out a comprehensive inspection of this service on 10 February 2015. At this inspection a breach of legal requirements was found. The registered provider did not have suitable arrangements in place for obtaining consent and acting in accordance with the consent of people who used the service in relation to their care and treatment provided for them. Capacity assessments had not been undertaken where needed and best interest decisions were not recorded. The registered provider wrote to us telling us what action they would be taking in relation to the breach. As a result we undertook a focussed inspection on 14 July 2015 to follow up on whether action had been taken in relation to the breach.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosewood on our website at www.cqc.org.uk’

Rosewood provides care and accommodation for up to eight adults who have a learning disability, some of whom also have associated physical disabilities. The service is a detached bungalow set in its own grounds, and parking is available.

The home had a registered manager. 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 registered manager started working at the service in October 2014.

At this focussed inspection on 14 July 2015 we found that the registered provider had followed their plan and legal requirements had been met.

After the comprehensive inspection all staff had attended training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguarding (DoLS). MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health, care, welfare or finances. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Staff we spoke with had an understanding MCA of DoLS. The registered manager had ensured that appropriate Deprivation of Liberty Safeguarding (DoLS) applications had been made to the local authority for three people who used the service. The service was awaiting the outcome and decisions in respect of this.

The registered manager had carried assessments of people’s capacity where needed, however some work was still required to ensure that all best interest decisions were recorded in care records.

We inspected Rosewood on 10 February 2015. This was an announced inspection. We informed the provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day and we needed to be sure that someone would be in.

Rosewood provides care and accommodation for up to eight adults who have a learning disability, some of whom also have associated physical disabilities. The service is a detached bungalow set in its own grounds, and parking is available.

The home had a registered manager. 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 registered manager started working at the service in October 2014.

There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were individual risk assessments in place. These were supported by plans which detailed how to manage the risk. This enabled staff to have the guidance they needed to help people to remain safe.

Staff told us that the registered manager was supportive and that they had received supervision. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. The registered manager had planned appraisals with staff.

Staff had received training in safeguarding vulnerable adults, infection control, food hygiene, nutrition, people movement, fire, emergency aid, and medicines administration. They also had received training which was specific to individual people’s needs such as in diabetes and epilepsy.

The registered manager and staff we spoke with had a basic understanding of the principles and responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. However further work was needed in this area. The registered manager told us that staff had not been on training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. We saw that some people who used the service were unable to make some decisions particularly in relation to their health. Staff had not undertaken capacity assessments as part of this process and best interest decisions were not recorded on the care notes looked at during the visit.

There were enough staff on duty to provide support and ensure that peoples needs were met.

The service had a stable work force and as such had not needed to recruit any new staff in the last five years (other than the registered manager).

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. People had health passports, however these contained limited information about the person and how they wanted to be supported. A health passport is a booklet which people can carry with them when they are attending medical appointments.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However records needed further detail to ensure care and support was delivered in a way that they wanted it to be.

People’s independence was encouraged and they were encouraged to take part in activities and outings.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations have been replaced with the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Rosewood was a large bungalow and was home for people with learning disabilities and complex needs. The home had been specially adapted for people who were wheelchair users and who required assistance with complex needs. The staff were highly trained and appropriate checks were undertaken before staff began work.

The provider had made reasonable provision for service users to have as full and diverse a life as possible given people's care requirements.

The home was comfortable with large rooms and a large outside area. Staff and service users engaged positively with each other and we observed warm and caring interactions.

One service user told us;

"It's marvellous, the staff look after us"

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider responded appropriately to any allegation of abuse.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People were protected from the risks of inadequate nutrition and dehydration.

We were unable to communicate verbally with the majority of the people at the home, however we were able to speak with one person who lived at the home, who told us they liked living there and they liked the staff. We also spoke to two relatives of people who use the service, who said “my relative always looks happy and contented”; “I’m happy with the service” and “the staff are more like family really.” People told us they had not had to make a complaint, but would feel comfortable doing so if the need arose. The home had a complaints procedure in place.

We observed that staff interacted with people living at the home in a relaxed, friendly manner, and had the time to engage people in hobbies and activities. People looked well cared for.

We looked at the care plans for three people who live at the home. Records for each person showed that the home had carried out sufficient assessment of the needs of each person, to enable appropriate care and support to be given.

Staff told us they enjoyed working at the home, and had been given sufficient training to enable them to be confident in their roles. Staff said there were sufficient numbers of staff always on duty and they had time to carry out care tasks and interact with people living at the home.

We looked at medication administration records and checked some people’s medication to make sure that the records were correct, The home had sufficient procedures in place to ensure medication was managed safely.

During our inspection visit we were able to speak with one person who used the service. They told us they felt they were able to make choices about how they spent their time and the care they received. The told us that they do voluntary work in the community and had been having computer lessons in the home. At the time of our inspection, three people who used the service were on day placement. The majority of the people who were at the home during our visit were unable to verbally communicate. We observed care provision. People appeared settled and content.