Keychange Charity Rose Lawn Care Home

Keychange Charity Rose Lawn Care Home is a residential care home providing accommodation and personal care for up to 29 people. At the time of the inspection 26 people were living at the home, some living with dementia or physical frailty.

The home is a large well maintained detached house close to the town centre of Sidmouth. All bedrooms are for single occupancy, although some are large enough for couples or friends/family if requested. The website states, “The care provision is based on a strong Christian ethos, while carers are trained to take a holistic approach and in achieving best practice.”

People's experience of using this service and what we found

People told us staff were, "Amazing and treated people very well" and were, "Very kind, caring and funny." People said, “‘They can’t do enough for you. Everybody just takes care of you”, “It’s like being on holiday, a lovely club. The atmosphere is rather nice” and “They are very helpful, you get to know them as real friends”. One relative said, “They are checking on [person’s name] constantly, they’re very kind’. The provider had been recommended on the national care home review website as one of the top 20 care home groups, with many positive comments.

Staff interacted with people at their pace, unrushed, and joked and laughed with each other. Staff in all roles were empowered to sit and chat to people and developed relationships that helped people feel confident to speak up. Relatives told us the service was, "Fantastic." and "The best home ever." People and their relatives were supported in a variety of ways to speak up and have a say in how the service was run. Many people, relatives and staff used the word 'family' when describing the service.

People told us of many examples of where staff had altered activities and care approaches to support individual preferences, including bucket lists, finding people’s passions to help them engage and using detailed ‘Who am I?’ folders. Staff were creative in how they engaged people and prevented people feeling isolated.

People and their relatives were supported with end of life care in a sensitive and individual way. There was a strong spiritual element and a home group to enable people to talk about their wishes, as well as be supported through bereavements and celebrating people’s lives.

People who wanted to be, were supported to have roles in the care home which they were very proud of and boosted their sense of self-worth.

People and their relatives experienced a positive and inclusive approach to care and conducted audits to give their feedback to help improve the service. The staff worked with outside professionals and communities to improve people's health and social wellbeing, including local churches and businesses.

The registered manager and staff team all had an excellent understanding of their roles and were empowered to make suggestions to keep improving the care, including sharing their knowledge through various ‘champion’ roles. These were meaningful with learning always shared and put into practice.

People told us they felt safe and secure and well cared for. People were safe because the service had excellent systems for monitoring risk whilst promoting independence and positive risk taking. Staff had excellent understanding of people's needs and how to keep them safe with a team approach.

People were able to live full lives supported by sufficient staff on duty to meet their needs and they did not need to wait when they called for support.

People were supported to take their medicines safely whilst being cared for in a way that enabled them to take minimal medication.

People told us the food was lovely and they had plenty of choice. In particular, staff ensured that people not only received food they enjoyed with opportunities to try new things but that their meal experience and environment was suitable for them using individualised ‘Dining with Dignity’ and ‘Early Bird’ schemes. The chef had been empowered to use their knowledge of catering and care combined, and was passionate in providing creative, highly person centred nutrition for people as the home’s nutrition and hydration champion.

People and their relatives were involved in planning their care and assessing their needs. People could choose the décor and personalise their rooms. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff focus was on people’s wellbeing and maintaining people’s independence or providing discreet support in a respectful way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last

The last rating for this service was Outstanding. (15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

The home provides accommodation and personal care for up to 29 older adults. At the time of inspection there were 28 people living at the home. The service provides care for older people, some of whom are living with dementia or physical frailty.

The home is a large well maintained detached house on the outskirts of Sidmouth. All bedrooms are for single occupancy, although some are large enough to accommodate couples if requested.

The home was well run by a registered manager who was supported by an experienced deputy and other senior staff. 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 and staff were proactive in looking for ways to improve the home and the services provided. They did this in consultation with people living in the home and their families. Minutes of resident meetings showed how they had made suggestions about mealtimes which had led to the time of lunch being altered.

The registered manager described how the emphasis was on all staff taking responsibility for leadership. As part of this, the registered manager and her deputy had introduced a ‘traffic light’ card system to ensure that people’s needs were dealt with in a timely manner by team leaders and care staff. This system was monitored regularly to ensure its effectiveness.

The registered manager took quality assurance very seriously. This involved getting feedback from people, relatives and staff. Staff were encouraged to be involved in quality improvements. Trustees and senior staff from the provider organisation visited the home on a regular basis and also monitored the quality and safety of the home. Regular audits were undertaken to ensure the quality of the home and the care provided was reviewed. Where shortfalls were identified, actions were taken to address the issues.

Meals were served so that people could select from a choice of dishes and accompaniments. People praised the standard of the food and were encouraged to discuss menus and preferences. People were supported to eat and drink in a relaxed and supportive manner by staff who worked to promote a pleasant meal time experience.

The atmosphere of the home was one of constant stimulation whether on a one to one basis or through group activities. People were encouraged to continue their own interests as well as join in a programme of activities which ran throughout the day and evening. These included regular sessions of exercise, discussion groups, singing, musical entertainment and art classes. Additionally there were special events run which included a ‘pub quiz’ and a fashion show which people had taken part in. People were also supported to go out either individually or as a group. Trips had been organised including a visit to a local zoo. People described how much they enjoyed the wide range of activities. Staff were well-organised, working as a team while maintaining a relaxed and unrushed manner.

Visitors to the home, including relatives and health professionals, praised the care of the staff. Everyone we spoke with said the registered manager and her deputy were always available to discuss care and were open to suggestions about how the home could be improved. People felt safe and well cared for. Staff were attentive to people's needs and supported them quickly and effectively. Staff consistently demonstrated affection and warmth in their relationships with people. People commented how staff were “lovely” and “really wonderful.” There was evidence that all staff were constantly looking at ways to enhance the home itself and the care provided. Staff had been trained to support people with specific needs and were being encouraged to undertake on specific areas of interest such as dementia and end of life care. Staff morale was very good with staff commenting that it was a nice home to work in. Staff were polite and friendly to visitors and were consistently smiling and positive.

People and visitors to the home were very complimentary about the home. One said “I would be happy to move in here.” Other comments also described how clean and well maintained the home was. The registered manager clearly demonstrated their commitment to provide an innovative environment that enabled people to be as independent and engaged as possible. They had sought to involve people in choosing décor and furniture for communal areas as well as their own bedrooms. They had also recognised people’s interest in having new and interesting experiences, such as going on safari and swimming in the ocean. They had organised a virtual reality system which allowed people to experience these from the comfort of the home. People were also encouraged to use their skills and experience with activities in the home. This had led to a fashion show and an art exhibition being staged.

There was sufficient staff to meet the needs of people using the service. Staff were very attentive and had time to talk to people about things that interested them. The registered manager paid particular attention to recruitment of new staff to ensure they were suitable and had the right skills and ethos for the role. Staff completed an induction when they first joined the home and also underwent training to refresh their knowledge and skills. Staff were supported to complete training to support care of people with specific needs, for example diabetes care and dementia care. Staff had completed training in how to recognise and take action if they had concerns about abuse.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. We discussed DoLS with the registered manager and looked at records. We found the provider was following legal requirements. At the time of the inspection, no DoLS applications had been made, although the home assessed the situation on a regular basis.

People and relatives said they were confident that if they had a concern or complaint, they would be listened to and that the issue would be addressed quickly and to their satisfaction.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

This inspection was undertaken to follow up that required improvements had been made in relation to care and welfare, infection control and medicines management following our previous inspection in October 2013. Following the inspection the provider sent an action plan to us detailing the improvements being made

On the day of our inspection there were 27 people living at Roselawn with one person currently away from the home.

We spoke with nine people using the service, the deputy manager and nine staff supporting them. In addition we spoke to a registered manager from one of the provider's other homes, the provider's operations manager and an agency care worker working at the home.

We also spoke to a visitor and three district nurses who visits the home to support people living there.

Is the service safe?

The deputy manager ensured there were staff on duty with the appropriate qualifications, skills and experience required to ensure people's needs were met.

The deputy manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLs). The deputy manager told us that there had been no reason to restrict or deprive people using the service of their liberty, in line with Deprivation of Liberty Safeguards legislation.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated.

The home was clean and had processes in place to maintain a clean environment. A person living at the home and a visitor told us 'they keep it nice and clean here' and 'it is lovely here they keep it beautifully clean'.

Is the service effective?

People's health and care needs were assessed and their care plans and assessments were reviewed monthly. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking to people and staff that they had a good understanding of people's care and support needs and that they knew them well.

Visiting district nurses told us that they had seen improvements at the home. They told us they were working with the home and felt staff would benefit from additional training in catheter care and tissue viability.

Is the service caring?

People were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave reassurance and encouragement when supporting people.

People at the home told us they were happy at the home. Comments included, 'I am very comfortable here' and 'We are very well cared for'.

Is the service responsive?

The home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the deputy manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they knew how to make a complaint if they were unhappy. A complaint received since our last inspection had been acted upon promptly and in line with the homes complaints policy and procedure. People can therefore be assured that the home acts upon complaints, they are investigated and action is taken as necessary.

Is the service well-led?

The home do not currently have a registered manager in post. The provider Keychange Charity had put in place support for the homes deputy manager in the absence of a registered manager. The provider's operation manager and registered manager from one of the provider's other homes visited a minimum of weekly. This meant that the provider had ensured the home was managed by a person supported by competent managers in the absence of a registered manager at the home.

Staff were confident in the deputy manager, they told us since she had taken charge there was a positive atmosphere amongst the staff. Comments included 'X has done really well' and 'X has done a great job, we are now working as a team'.

The provider's representative undertook a monthly compliance visit. This showed that they worked with the deputy manager and the staff to ensure the standards that people expected at the home were maintained.

There had been communication difficulties between the local district nurse team and the home. Systems were being put into place to remedy this to make sure people received their care in a joined up way.

We were told of a serious incident that had occurred a few weeks before our visit. Our attention was also drawn to concerns regarding communication that could have consequences about the quality of care provided by Rose Lawn. The interim regional manager told us that the organisation was aware of concerns at Rose Lawn and that the organisation was taking steps to rectify matters.

We also met people who lived at Rose Lawn who spoke positively about the support they received and who told us "We have nothing to compare it with, but I think it's good. I can't think of anything to improve it. Staff are very good, I would say so."

Care and support was delivered in a kind and respectful way. People told us that they were able to do what they wanted to do. Staff offered drinks to service users and relatives throughout the day were attentive to people's needs. There had been restructuring of staff roles and documentation which meant that staff had time to assist people in an unhurried way and ensure that they knew how to meet people's needs. We saw that people were involved in making decisions about their care.

Everyone we spoke with made positive comments about the running of the home and opportunities made available to them. The home regularly monitored the quality of the service. People's comments included 'The staff are so kind and prompt to help; they are always so good and supportive' and from a visitor 'I'm so impressed, every time we visit it is so wonderful.'