Rose Belle, a seven-bed learning disability residential home, declined from Good to Requires Improvement overall, driven by weaknesses in medicines record-keeping and an insufficiently frequent and effective audit programme that failed to identify known issues. Care delivery, staffing, and the person-centred culture remained strong, with effective MCP/DoLS practice and consistently positive feedback from people, families and professionals.
Concerns (5)
moderateMedication management: “when they were handwritten they were not always signed and rarely by two people... Some bottles and creams had not been dated when opened.”
moderateGovernance: “only one of the audits received was identified on the annual planner as for completion in November 2019... audits did not identify any concerns.”
moderateGovernance: “audit of care plans which were audited twice in the year... Regular care plan audits were required to ensure all the information was available for staff.”
minorIncident learning: “Accidents and incidents were recorded, and action was taken to address any concerns. These were not analysed at service level.”
minorRecord keeping: “records were not always updated to include the action taken... There were not any records for fire drills which showed the home's procedure had been followed.”
Strengths
· People were supported by enough suitably trained and recruited staff who knew how to keep people safe.
· Comprehensive, person-centred care plans reflecting individual needs, preferences, life histories and interests.
· Strong application of the Mental Capacity Act and Deprivation of Liberty Safeguards across all relevant decisions.
· Holistic multi-professional working with GPs, psychiatrists, community teams and health professionals.
· Highly positive culture promoting autonomy, independence and inclusion in line with Registering the Right Support.
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving care; quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive, person-centred, open and inclusive cultureGood
well-led: Engaging and involving people, the public and staff; working in partnershipGood
This targeted COVID-19 IPC inspection of Rose Belle found the provider broadly meeting infection prevention requirements, with robust testing, PPE use, and cleaning regimes in place. Minor gaps were identified around hand sanitiser availability at the entrance, lidless waste bins, and absence of red bags for soiled laundry segregation.
Concerns (2)
minorInfection control: “there was no hand sanitiser at the entrance and not all procedures were being followed.”
minorInfection control: “waste bins did not all have lids. Red bags were not available to ensure adequate separation of soiled laundry.”
Strengths
· Systems in place to reduce the risk of infection from COVID-19 including visitor protocols with temperature testing and sanitising.
· Service was visibly clean with increased cleaning of high touch areas such as door handles and light switches.
· Daily temperature monitoring of residents to quickly identify changes in health.
· Following government guidance on whole home testing including rapid, weekly and monthly testing.
· Suitable arrangements in place to separate environment for COVID-19 positive individuals to minimise transmission.
Quality-Statement breakdown (1)
safe: How well are people protected by the prevention and control of infection?Insufficient evidence to rate
Rose Belle, a six-bed supported living service for people with learning disabilities or mental health needs, was rated Good across all five key questions at this May 2017 inspection. The provider had successfully remediated all breaches identified at the previous April 2016 inspection, including improvements to governance, staff training, infection control, nutritional assessment and quality auditing.
Concerns (4)
moderateGovernance: “At our last inspection we found that the way the registered manager monitored the quality of the service people received needed to improve. This was a breach of Regulation 17”
moderateStaff training: “the provider had breached Regulation 12...in relation to the lack of staff training and meeting people's nutritional needs”
moderateCare planning: “people's care records lacked nutritional assessments for people who were diabetic and there was not a structured approach to show that staff could recognise and manage the condition”
minorInfection control: “We recommended that the registered manager should implement infection control policies and procedures”
Strengths
· Staff knew how to recognise and report abuse and had received appropriate safeguarding training
· Medicines were stored, administered and audited safely with regular competency observations of staff
· All staff fully trained following previous breaches, including MCA 2005 and DoLS
· Person-centred care plans available in pictorial and easy-read formats reflecting individual needs and preferences
· Robust quality assurance system introduced with monthly audits covering medicines, finances, accidents and incidents
Rose Belle, a six-bed supported living service for people with learning disabilities or mental health needs, was rated Requires Improvement overall following an unannounced inspection in April 2016, with two regulatory breaches identified relating to staffing/training and nutritional care planning. While the service was caring, responsive, and safe, significant governance weaknesses included inconsistent auditing, absent infection control oversight, lack of organisational values, and widespread gaps in mandatory staff training including MCA/DoLS.
Concerns (8)
criticalStaff training: “large numbers of staff who had not completed training around the MCA and DoLS, managing challenging behaviour, fire safety, manual handling, infection control and hand hygiene”
criticalCare planning: “care records lacked nutritional assessments for people who were diabetic and there was not a structured approach to show that staff could recognise and manage the condition”
moderateGovernance: “medicines had not always been audited and accidents and incidents were not reviewed to see where areas of risk could be reduced”
moderateInfection control: “infection control audits were not in place and that no one was responsible for taking a lead on infection prevention”
moderateIncident learning: “accidents and incidents were recorded, but audits were not carried out to look at ways in which risks could be reduced”
moderateLeadership: “staff were unable to explain to us what the provider's vision and values were... the service did not have clear vision or a core set of values”
moderateConsent / capacity: “large numbers of staff who had not completed training around the MCA and DoLS”
minorPerson-centred care: “residents did not contribute to the development of the menus... people had not been consulted about the changes that would be made”
Strengths
· Staff understood safeguarding responsibilities and people told us they felt safe
· Medicines were stored, disposed of, and administered safely with appropriate MAR records and protocols
· Individual risk assessments were in place with clear guidance for staff
· Staff interacted with people in a kind, caring and respectful manner maintaining privacy and dignity
· Care plans were personalised and reviewed monthly or as needs changed
Quality-Statement breakdown (15)
safe: SafeguardingGood
safe: Medicines managementGood
safe: Risk assessment and managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training and developmentRequires improvement
effective: Nutritional and hydration needsRequires improvement
effective: Mental Capacity Act and DoLSRequires improvement
effective: Staff supervisionGood
effective: Mental Capacity Act and Deprivation of Liberty Safeguards
Good
effective: Access to healthcareGood
caring: Dignity and respectGood
caring: Person-centred support and communicationGood
caring: Privacy and involvement in careGood
responsive: Care planning and individual needsGood
responsive: Activities and community accessGood
responsive: Complaints handlingGood
well-led: Quality assurance and governanceGood
well-led: Leadership and staff cultureGood
well-led: Continuous improvement and staff engagementGood