RoseLea House

RoseLea House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. RoseLea House is registered to accommodate nine people living with learning disability. At the time of our inspection there were nine people living in the home.

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.

At our last inspection on 23 March 2016 we rated the service good overall. We rated the key question Effective `requires improvement'. This was because information in people's assessments of their mental capacity was not always consistent with information about their capacity in parts of their care plans. At this inspection we found that improvements had been.

At this inspection we found that evidence continued to support a rating of `Good' for the key question Safe and that the service had improved to being 'Outstanding' in key questions Effective, Caring and Responsive. The overall rating was therefore 'Outstanding'.

Feedback from people who used the service, health and social care professionals and staff was consistently and unanimously positive. People spoke enthusiastically about how much they enjoyed living at RoseLea House. A healthcare professional attributed the success they had achieved with the treatment of a person to the service. They wrote, "I am sure that the success of this situation is down to the staff at RoseLea.' The register manager and staff are proud to work at the service and equally proud that people had achieved 'golden aspirations' and greater levels of independence. People's diversity is celebrated through innovative and creative activities.

The service has built an outstanding model of care and support. The registered manager was invited to speak about the outstanding success of activities at a forum organised by a local authority. All the staff continually looked to find ways to improve the service. They are driven by their passion for caring for people. Staff supported people to develop skills, confidence and self-esteem beyond what they thought possible.

The registered manager and staff had an excellent understanding of people's needs. Staff found ways to improve people's lives by introducing creative activities that opened new possibilities for people. Innovative ways were found to support a person with access to healthcare that was essential to them but which they at times were reluctant to do.

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.

The service had staff who were designated 'champions' for dignity, the Mental Capacity Act (MCA) 2005, end- of-life care and infection control. These champions continue to play an essential role in developing best practice, sharing learning and acting as role models for other staff. Staff had training from healthcare professionals to understand about health conditions that people lived with. This meant there was an exceptionally strong team of staff who worked at the service.

Staff have a good safeguarding matters and excellent understanding of behaviours that are challenging to others. Staff viewed people's behaviours that were challenging as behaviours that require 'positive support'. This meant that people were always treated with dignity and their behaviours understood. We saw people receiving excellent support with their medicines. Staff explained to people what their medicines were for and how they should be taken. People knew when they should have their medicines.

There was a stable exceptionally well skilled workforce to ensure people's wellbeing, safety and continuous development was embedded in the service. A robust recruitment and selection process is in place. People participated in the recruitment of staff and their opinions were considered before a decision was made whether to employ someone. This ensures prospective new staff have the right skills and are suitable to work with people living in the home. People chose who they wanted to be their key worker.

Staff are compassionate, kind and caring. Of the 22 staff who worked at the service, eight had worked there for over 10 years and most had worked there for over five years. This enabled staff to develop caring relationships with people. We saw that people were comfortable in the presence of staff and the manager. A professional advocate had told the registered manager, `Staff interact well and it is obvious [person] was comfortable and relaxed in their surroundings.'

People were taught life skills that they were supported to develop further. This supported people in their aspiration of becoming as independent as possible. A person was supported to learn new skills which they turned into a hobby they were passionate about. People told us that the thing they enjoyed most were the activities they were supported to participate in.

Staff understand the importance of supporting people to live life to the full whilst they are fit and able to do so. They supported people to cope with bereavement of loved ones. Where people wanted, they had end of life care plans which included people's thoughts, feelings and wishes to ensure their passing is comfortable, pain free and as peaceful as possible and their funeral arrangements respected.

Staff spoke consistently about the service being an exceptional place to work and one that was exceptionally well led. The registered manager works in partnership with other organisations and had taken part in several good practice initiatives designed to further develop the service. The registered manager involved staff and people in the development of a continuous improvement plan for the service. Staff were highly motivated. A staff member told us. "The sky is the limit here."

The five questions we ask about services and what we found