Roseland Care Limited

Roseland Care Limited is a care home providing personal and nursing care to up to 36 people. The service provides support to people of all ages with a range of health needs, physical disabilities and people with cognitive impairment. At the time of our inspection there were 34 people using the service.

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

There was no registered manager in post at the time of this inspection, as they had left immediately following the last inspection. A new manager had been in post for the past six weeks and was in the process of registering with the CQC.

There had been improvements in the oversight and governance of the service since the last inspection. The provider was visiting very regularly and supporting the new manager. The senior regional manager was present at the time of this inspection.

There was an accurate record of all staff supervision and appraisals. Staff told us they that their support had improved since the new manager arrived. However, many care staff had not had recorded supervision in the last year, which was not in line with the providers policy. The manager had a plan to provide supervision to all staff in the coming months.

The recording of monitoring records, by staff, had improved since the last inspection. For example, when people were having their food and drink intake recorded. These records were regularly totalled; however, they was no evidence of them being reviewed by senior staff to ensure people always had sufficient quantities of food and drink to meet their needs.

The service was facing challenges in receiving a timely supply of some prescribed medicines. This had led to two people not always having their medicines as prescribed. The service was being proactive and was regularly chasing up these medicines, but the delay was beyond their control. We have made a recommendation about this in the safe section of this report.

We found some named confidential information was being displayed in the manager’s office on noticeboards. This office was not always occupied, and the door was always open. This was removed immediately.

Staff training was recorded and monitored. There was a programme of updates scheduled to take place to ensure staff had the knowledge and skills needed for their role.

The new manager was knowledgeable about the people living at the service and the staff. There was a programme of audits in place and these were regularly reviewed by the provider. All the audits were up to date and there was evidence of actions taken when improvements had been required. All accidents and incidents were recorded, audited and reviewed by the provider.

Daily ‘flash’ meetings were taking place each weekday at 11am. All heads of department met with care staff, nurses and management to share information and encourage effective communication. Staff told us, “Everything is so much better recently. It feels more organised. Morale is better and communication is good now.”

There were sufficient staff on duty to meet people's needs. Recruitment processes were robust. Files were organised and contained all of the required checks to ensure people were safe to work with vulnerable people. The service was in the process of recruiting new staff. The numbers of agency staff being used had reduced since the last inspection. Agency staff on shift were consistent and knew the people living at the service.

There was a handover record used for each shift change. It contained information about each person’s needs. However, some of the information was not always up to date. This was addressed immediately.

There was a system in place to monitor the Personal Identification Numbers (PIN) of all employed nurses. The PIN is compulsory for working as a nurse in the UK.

Deprivation of Liberty Safeguards (DOLS) records were accurate and tallied with the local authority records. 2 authorisations were in place at the time of this inspection.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (Published 3 September 2022)

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Roseland Care is a residential care home providing personal care to up to 55 people. The service provides residential care to older people who may have a physical disability. At the time of our inspection there were 31 people using the service.

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

The registered manager was not present at the service at the time of this inspection. The deputy manager was acting up to the manager role and the nurses were supporting them.

Auditing and monitoring processes were not robust at the time of this inspection. Whilst the planned audits had been completed regularly up to and including June 2022, the audits planned for July 2022 had not taken place. We were told this was due to staff shortages. This meant opportunities to improve the service had been missed.

The regular review of records such as daily care notes and monitoring charts was not taking place as planned. We found some planned care had not always been recorded.

Daily ‘flash meetings’, which involved representatives of each department to share information, were taking place until recently. Staffing challenges had meant these communication and information sharing daily meetings had not taken place recently.

Some records containing confidential personal information were not always stored securely. Accident and incidents that had taken place, and reported by staff since January 2022 were all held together in a file on a shelf in the manager's office which was often open and unattended.

Some recruitment records did not hold all the relevant information required. Confirmation was sought from the provider to be assured safe recruitment processes were in place.

People were supported by staff who had been appropriately trained and were skilled in their role. Staff told us they felt well supported by the deputy manager and nurses. Staff told us they were able to access the management team whenever they needed any assistance or guidance. However, staff had not received recent supervision. We requested, but were not provided with, information about the last time staff were provided with appraisals therefore we could not make a judgement on this. Staff told us they could not recall the last time they received formal one to one support meetings.

Mental capacity assessments had been carried out where it was indicated. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. Two authorisations, for restrictive care plans, were in place at the time of this inspection. However, the records held by the service relating to the applications made for people to have a restricted care plan, agreed by a DoLS authorisation, did not match with the information held by the local authority. We have been assured that this has now been addressed.

There were sufficient staff on shift to support people at the time of this inspection. However, the service was not fully staffed and was struggling to recruit new staff to vacant posts. Several staff and the administrator had left the service in recent weeks. The service was using agency staff, but the rotas showed not all shifts had been covered by the planned number of staff.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet. Some people were having their food and drink intake recorded and were regularly weighed.

Care plans were completed for each person and contained details of the person's needs and preferences. Care plans had been regularly reviewed and updated. Risks were identified, assessed, recorded and reviewed regularly.

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.

People told us they felt safe with staff. There were systems to help protect people from abuse. Staff had received training on how to recognise abuse.

Staff understood the importance of respecting people's diverse needs and promoting independence. We observed many caring and supportive interactions between staff and people. One relative told us, “I would recommend it to anyone, what a wonderful place it is. It was our wedding anniversary of 58 years in March, and one staff took a photograph of us and put it in a frame. They even took flowers from a bouquet I bought (Person’s name) and pressed them into a card. I am so fortunate to have found this place for (Person’s name).”

People told us they liked living at Roseland Care and that the staff were caring and responded when they called. Comments included, “I am ok here, I can spend time where I like” and “The staff come when I call.”

People were asked for their views by the provider through a survey, responses had been audited and acted upon. A residents meeting was seen to have been held in May 2022 which asked people for ideas for activities and events.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

This is the first inspection for this service since changing provider. The last rating for this service, under the previous provider, was good (published 2 October 2020)

Why we inspected

This inspection was prompted by a review of the information we held about this service. This service was registered by a new provider 4 August 2021.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.