Archived: Keychange Charity Rosset Holt Care Home

This inspection was carried out on 18 January 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

At our inspection on 5 January 2016 we found breaches of regulation relating to personalised care, medicines, managing risks and governance. At this inspection we found that improvements had been made and sustained and the regulations were being met.

People told us they were very happy using the service and felt safe and well cared for. The registered manager had ensured the culture of the service was person centred and flexible to meet people’s needs and wishes. People’s spiritual and cultural needs were met. The values of the service were based on Christian beliefs, but people were supported to practice their own beliefs.

People were protected by staff that understood how to recognise and respond to signs of abuse. Risks to people’s wellbeing were assessed and staff knew what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. The premises were safe, clean and hygienic. People had individual evacuation plans outlining the support and equipment they would need to safely evacuate the building. Staff understood how to reduce the risk of infection spreading in the service and they followed safe practice.

There was a sufficient number of staff on duty at all times to meet people’s needs in a safe way. We saw that staff had time to chat with people and support them with social activities in addition to meeting their health and care needs. The registered provider had systems in place to check the suitability of staff before they began working in the service. People and their relatives could be assured that staff were of good character and fit to carry out their duties. Staff had completed training and qualifications relevant to their role. The registered manager monitored staff training needs to ensure that staff were skilled and competent to meet people’s needs.

Staff identified and met people’s health needs. Where people’s needs changed they sought advice from healthcare professionals and reviewed their care plan. Records relating to the care of people using the service were accurate and complete to allow the registered manager to monitor their needs. People had enough to eat and drink and were supported to make choices about their meals. Staff knew about and provided for people’s dietary preferences and restrictions. Medicines were stored, administered, recorded and disposed of safely and correctly.

Staff communicated effectively with people and treated them with kindness and respect. They knew people well and understood what was important to them. People’s right to privacy was maintained. Staff promoted people’s independence and encouraged people to do as much as possible for themselves. Personalised care and support was provided at an appropriate pace for each person so that they did not feel rushed. Staff were responsive to people’s needs and requests.

Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. Meetings were held, when needed, to make decisions in people’s best interest, following the requirements of the Mental Capacity Act 2005. The requirements of the Mental Capacity Act 2005 had been followed in respect of depriving people of their liberty. However, the registered manager had not informed us when authorisations had been granted and not all staff were clear when these were in place. We have made a recommendation about this.

People were involved in making decisions about their care and treatment. Clear information about the service and how to complain was provided to people and visitors. The registered provider sought feedback from people and used the information to improve the service provided. People were involved in developing and improving the service through residents meetings, quality surveys and being involved in the recruitment of new staff. It was evident that people’s opinions were valued.

There was a system for monitoring the quality and safety of the service to identify any improvements that needed to be made. Staff felt supported in their roles.

This inspection was carried out on 5 January 2016 by three inspectors. It was an unannounced inspection. There were 16 people using the service at the time of the inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 was taking retirement at the end of the week of the inspection. The deputy manager, who had worked in the service for 12 months, had been appointed as the new manager of the service. They had not yet made their application for registration with the Commission.

Risks to individuals’ safety and wellbeing were identified, but they were not always managed effectively to ensure the risk was reduced. Staff were not provided with written guidance about how to reduce risks for individuals, for example the risk of an infection or poor hydration. There was a lack of clear guidance for staff about how to safely evacuate people in the event of an emergency. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not managed in a safe way. Staff did not always follow safe practices when administering and storing people’s prescribed medicines. You can see what action we told the provider to take at the back of the full version of the report.

People did not have personalised care plans in place that ensured their individual needs and preferences were met. Whilst people’s needs had been assessed the information had not been used effectively to plan personalised care that met these needs, such as their social needs. Staff were not provided with clear written guidance about how to meet people’s needs and preferences, such as how to reduce anxiety. You can see what action we told the provider to take at the back of the full version of the report.

An effective system for identifying shortfalls in the quality and safety of the service and making improvements was not in place. The registered manager had not identified the shortfalls we had found in the management of risk, medicines and in the provision of personalised care. Action plans for making improvements to the service to meet the needs of people living with dementia had not been implemented in a timely way. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager had not ensured that accurate and complete records about the care provided to people were maintained. This meant that the registered manager was not able to monitor whether people were receiving the care they needed and whether there were any changes to their wellbeing. You can see what action we told the provider to take at the back of the full version of the report.

Thorough recruitment procedures were followed to ensure staff were suitable to work with people. The registered manager did not have in place an effective system for establishing how many staff were required to work in the service to meet people’s needs. This meant that they could not monitor the provision of staffing numbers to ensure it was adequate. However, we found that at the time of the inspection sufficient staff were provided in the service. We have made a recommendation about this.

Staff had completed the training they needed to provide safe and effective care. Staff were supported to gain qualifications relevant to their role. Staff told us they felt supported in their roles, but not all staff received an annual appraisal of their performance to ensure they continued to effectively meet people’s needs. We have made a recommendation about this.

The premises had been adapted to meet the needs of people with limited mobility, but had not been designed to meet the needs of people living with dementia. A plan was in place to improve the environment to help people who were living with dementia, but this had not yet been implemented. We have made a recommendation about this.

People did not have effective care plans in place that recognised their existing skills and encouraged and supported them to be independent. We have made a recommendation about this.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

The premises were maintained to ensure it was safe for people to use and people benefitted from a clean environment that minimised the risk of the spread of infection.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. This ensured people’s rights to make their own decisions were respected and promoted when applicable.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People had their health needs assessed and care plans put in place to meet their needs.

People and their relatives were very positive about the caring attitude of the staff. One person told us, “It doesn’t matter who you are you never feel out of place here.” A person’s relative commented “The staff are wonderful.” Staff knew people well and had developed positive relationships with them. Staff were caring and kind when they supported people. People’s privacy was respected and people were assisted in a way that respected their dignity. People and their relatives praised the commitment of the service to meeting people’s spiritual needs.

People’s views were sought and listened to. People knew how to make a complaint if they needed to and felt confident they would be listened to. Complaints were recorded and responded to appropriately. We saw that the registered manager had dealt with complaints in an honest and transparent way.

People said the home was comfortable and kept clean and tidy. People liked their rooms, they said 'I am as happy here as I could be anywhere, I think I have one of the best rooms, my room is lovely' and 'I like my room it is comfortable and I like to spend time in it, but I go down for lunch and supper'.

People said they had enough to do and they spent time in their rooms, or with others when they wanted to. People made choices about their daily lives. Such as, when to get up and go to bed and what to eat. They said staff respected their choices.

People said they knew who to go to if they had any concerns or complaints. The provider had systems in place to monitor the quality of the service. People were asked for their views about it and changes were made in response when necessary.

People said they appreciated that staff respected the choices they made and that they liked to be as independent as possible.

People said there were enough staff on duty to meet their needs and staff were kind, polite and respectful. People said, 'They do whatever I ask them to', 'They would do more if I needed them to' and 'They look after me very well'. They said that mostly staff responded quickly if they used their call bells.

People said staff knew how they liked to be supported. However, people's individual care records did not always fully reflect their current needs, or record when staff needed to be aware of how to reduce an identified risk to a person.

People said the service was homely and comfortable and that they liked their rooms. They said, 'I don't have any grumbles' and 'It is very comfortable here'.

People said they were offered plenty of choice of meals, that staff knew their likes and dislikes and catered for them accordingly. One person said 'The food is beautiful' and that there was plenty of choice.

People said that they felt able to speak to staff if they were not happy about anything and that they were listened to and concerns were addressed.