Archived: Roseville Care Centre

We last inspected the home in November 2015 and found people had limited access to activities; evidence that people had consented to their care was not always available; the dining experience required improvement; there were gaps in staff training and supervision; there were insufficient staff; the management of cleaning products needed to be improved; medication administration arrangements needed to be enhanced; and the performance management and audit systems needed to be improved. We found that the home was breaching regulation 12 (Safe care and treatment), regulation 17 (Good Governance) and regulation 18 (Staffing). We rated Roseville Care Centre as requires improvement in four domains.

Roseville Care Centre is a large residential and nursing home situated in Ingleby Barwick. It has a three storey building and two storey annexe which are currently divided in to five units. All floors are accessible by lift. There are lounges, dining rooms and bathrooms on all floors and bedrooms are en suite. The service provides care and support for people with nursing care needs, dementia and those who require residential support. It is registered to provide care and support for 103 people. At the time of the inspection 93 people used the service.

The home has had a registered manager since October 2010. A registered manager is a person who has registered with the Care Quality Commission 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.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found the action the registered provider and registered manager had taken had made significant improvements to the way the service was run. The registered provider had increased the support provided to the registered manager by creating more deputy manager roles and reviewing the clinical lead role. The team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

The registered manager with the support of the registered provider had introduced a full and comprehensive assessment and monitoring system. They were in the process of delegating some of the tasks within this system across the new management team. We found that the system had improved the care being provided to people, staff training and staffing levels as well as the management of cleaning products and fire risk assessments.

We found that although some improvements had been made to the management of medication, further work was needed to ensure all medication was administered in line with people's prescriptions.

People told us they were happy with the service and felt the staff did a good job. We heard how people felt the service was well-run and that the registered manager was extremely effective.

We found that since the last inspection and feedback from relatives meetings the registered manager had sought to improve the range of activities that were available. Additional activity coordinators had been employed so people could be engaged in meaningful occupation seven days a week. People told us that in recent months stimulating and engaging activities were being provided at the home. We saw that there were enough staff to support people to undertake activities in the service and community. We saw there was a full programme of activity provided through the week at the service. During the visit we enjoyed joining people for a coffee morning and quiz.

The registered manager told us that on the nursing unit this was an area they continued to work on as people were often unable to join group activities so they had asked the activity co-ordinator to look at the one-to-one activities that could be provided. We saw the activities coordinator was already starting to work on increasing the available activities on the nursing unit and while we were there we saw people enjoying aromatic massages.

People’s care plans were tailored for them as individuals and created with them and their family involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful. We saw that they were aware of how to respect people’s privacy and dignity.

Staff were supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff were all clear that they worked as a team and for the benefit of the people who lived at the service.

The registered manager understood the complaints process and detailed how they would investigate any concerns. The registered manager took on board the issues raised in complaints so for example had improved the care records by introducing a one-page summary sheet, as a family member pointed out this could readily assist staff to understand people’s needs.

The operations manager discussed with us how they were supporting the team to fully incorporate a reflective learning culture in the service. This type of reflection allows staff to critically review even the smallest of incident in order to determine what lessons could be learnt so improvements to staff practice can be made.

The registered manager and staff had a clear understanding of safeguarding. The registered manager had ensured staff training and supervision were up to date.

We found that there were enough staff on duty to meet people’s needs. The registered manager had closely considered people’s needs and ensured there were sufficient numbers of staff.

Where people had difficulty making decisions we saw that staff worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. The cook provided home cooked meals, including dietary specific such as vegan and vegetarian meals. They also provided a range of fortified and adapted meals for people who needed extra calories to ensure they maintained their weight. People were supported to maintain good health.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We looked at a range of records, spoke with the manager, administrator, activity coordinator, 12 members of staff, 16 people who used the service and eight relatives. We also observed the interactions between staff and people living at Roseville Care Centre.

Below is a summary of what we found.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at Roseville Care Centre. Staff we spoke with understood the procedures which they needed to follow that ensured people were safe. People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Although medicines were not recorded appropriately they were kept safely, we discussed recording with the manager and they have recognised recording problems through their own audits and were addressing this. People told us that they had no concerns about their medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had eight DoLS authorisations in place. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. Staff were also taking responsive action in submitting applications for those people who were affected by the recent case law judgement passed by the Supreme Court in March 2014.

People were aware of the complaints procedure and there were systems in place for

monitoring complaints.

Is it effective?

People who used the service had their needs assessed and had individual care records which set out their care needs. People told us that they received the care and support they needed. One relative we spoke with confirmed they had been asked for their input and opinions on their loved ones care plans. We saw evidence of how the information from people's care records were transferred into practice. Examples included the use of certain equipment, such as moving and handling equipment and how someone was cared for throughout the day.

It was clear from our observations and from speaking with staff that they had a good

understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people's care records.

Arrangements were in place to administer medicines at the right time in relation to meals, or to meet the needs of people who required their medicines at specific times of the day.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records were quite complicated, with a lot of information to look at visibly and a duplication of information with some information not being consistent, for example one person's care file stated they were a non-smoker and then in the oral assessment it stated they were a smoker.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to. When asked about the complaints process, the relatives we spoke with all said they would go to the manager with any problem which had not been resolved with care staff.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and to also give feedback about the service via an annual survey.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

We saw that a system for regular quality assurance and monitoring of medicines management was in place.

What people told us.

People who used the service we spoke with said 'X is top dog, lovely.' And 'X is a good old soul, they are lovely.' And 'I would like more entertainment and exercise.' Other people said 'Yes I feel safe here, they are all lovely.'

Relatives we spoke with said 'I was pleasantly surprised by the 'personal 'touch of staff.' Whilst they expected staff to know the first name of their relative who had just moved into Roseville, they said 'It was a surprise and lovely when they also knew mine. They'd clearly also read and digested the notes on my relative too. Whenever staff chatted to them they dropped in little snippets about what they did and did not like. I thought that was nice'. Another relative said 'Every time I visit, my X is always clean, tidy and comfortable.' Another relative said 'I have no complaints about staff, I think they chase their tails sometimes.'

At this inspection, people told us that they were addressed by their preferred name; that they were given choices about their daily lives; and that staff respected them and treated them with dignity.

When carried out observations around the service and found that people's dignity was preserved and that they were spoken with respectfully by staff.

We previously identified concerns about the standard of records kept by the service. We found that records were not regularly reviewed and updated; that they contained contradictory information; and that there was no consistency in some risk assessments.

At this inspection we found that the record keeping by the service had improved and that new style care records were being introduced. Assessments were carried out regularly and there was consistency in the methods used. Information was up to date and sufficient to ensure that people received care and treatment that met their needs.

People were given choices about their daily lives and staff had a good awareness of the needs of people they supported. When people needed to, staff arranged for them to be seen by health professionals and supported them to attend appointments.

Most people were happy with the food and drinks they received but some people thought the food could be improved. We found that there was a varied menu and that people were given choices of drinks and meals.

People told us they thought there were enough staff on duty to meet their needs. Staffing was calculated using a dependency system and staff numbers were flexible to meet needs. Staff felt that there were enough staff to meet people's needs.

Record keeping needed to improve. Some risk assessments had not been carried out and some risk assessments, care plans and dependency ratings had not been reviewed regularly. Some information in care plans was contradictory and difficult to find. This meant people were at risk of inappropriate care because staff could not find information easily.

In this report the name of a registered manager appears who was not managing the location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.