Keychange Charity Rosemary Mount Care Home

The way some medicines were managed was an area for improvement. A medicine which required secure storage in line with legislation and which should have been entered on a register had not been recorded, although it had been entered on the provider’s internal medicines management system. This had no impact on people but placed the medicines at potential risk of misappropriation. The provider requested new medicines to be prescribed for people over a 28-day cycle. However, instead of reviewing stocks of medicines every month, any surplus medicines were disposed of when the same medicine was requested the following month. This meant that medicines were being disposed of unnecessarily and is not good practice. Other aspects of medicines management were safe, and people received their medicines as prescribed.

People felt safe living at the home. One person said, “It’s a good care home. I don’t think it’s a safe world, but it’s safe here.” The provider was proactive when incidents or accidents occurred. Events were recorded on the provider’s system and shared with managers of the provider’s other homes, to enable learning and prevent similar incidents from occurring. People’s risk of unsafe care and support were managed well, with clear guidance set out in care plans that staff followed in practice. The home provided a safe environment with access to the garden, accessible bathrooms and a lift between floors. Staffing levels were sufficient to ensure people’s care and support needs were met promptly; staff were recruited safely.

People’s care and support needs were assessed before they came to live at the home. Their preferences and wishes were catered for. Relatives provided information about their loved ones too. One relative said, “We looked at a few homes. She was in another home for a while, but there was lots of trouble. Mum liked this home, so we picked it. [Registered manager and deputy manager] went to the previous home to do an assessment. Then Mum came to a fun day in the garden here, had lunch, she could meet people, and she liked it, so she moved in.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the provider was working within the principles of the MCA and how they managed DoLS within the home. We found that staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions; they had choice, control and freedom over their lives. One person told us, “Oh yes, I like it here. I don’t mix very well, but I can shut my bedroom door anytime. I would rather stay in my room.” Some people used wheelchairs to aid their mobility. A staff member told us, “Some people don’t consent to having lap belts, so we don’t always use them; that’s people’s choice. They are aware of the risks.”

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed autistic people and people with a learning disability respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.The service was supporting some people with a learning disability and ensured they had good access to the community and local activities. Staff completed a range of training to undertake their role and responsibilities effectively with regard to everyone living at the home. This included Oliver McGowan training which is the recommended training. The Health and Care Act 2022 introduced a statutory requirement that CQC registered providers must ensure their staff receive learning disability and autism training appropriate to their role. Staff completed this training and knew how to care and support people appropriately in line with what they had learned.

People were treated with dignity, kindness and respect. We observed staff knew people well and interactions were caring; staff were considerate and patient with every aspect of their care. At lunchtime, staff encouraged people to eat independently. For example, a staff member placed food on a person’s fork which the person then lifted to their mouth. Although it took a while for this person to eat their lunch, their independence had been promoted. One person said, “I was very poorly when I came in. Staff made me feel relaxed. They leave me alone to be me.”

People received personalised care and were involved in reviewing their care if they wished, as were their relatives. One relative told us, “I don’t review her care plan, staff deal with that, but I can talk to staff about it.” People were encouraged to make decisions about their care and support, and residents’ meetings provided a forum for suggestions which were listened to. For example, a food survey enabled people to feedback on what they enjoyed to eat and drink. At lunchtime, some enjoyed a small glass of cream liquor and others a glass of wine; others preferred water or a soft drink. People had access to healthcare support from external professionals. A healthcare professional told us, “All staff are welcoming and friendly, which helps to make my input much more effective. I feel they listen to me and action what I suggest. I feel we have a really good relationship where they can all ask for my advice and support and in return I get lots of really relevant and helpful information.”

The home was well managed by the registered manager and deputy manager, who were supported by the provider’s operations team. Operations managers organised interactive workshops, so staff understood the model of care and the behaviours expected of them. Staff meetings were organised and an open culture was evident where staff felt they could make suggestions and feel listened to. A healthcare professional told us, “The team are always asking for my support if they are unsure about anything. The Manager and Deputy are fantastic and always strive to do the best for each resident and always ask if there's anything they could be doing. Any new initiatives etc and are always keen to have new info given to them.” Governance systems were effective in monitoring safety and quality across the home and were used to drive improvements.