Rossall

Rossall is a nursing home providing personal care to 46 people with complex needs at the time of our inspection. The service can support up to 46 people within three units spread over one floor. There are multiple lounges, rest spaces, dining areas and themed rooms for people’s comfort and relaxation.

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

The provider continued to have exceptionally high staffing levels and skill mixes to maximise people’s safety and welfare. A relative commented, “The home is a well organised team, each member fully supporting each other. I cannot speak highly enough of the team.” People and relatives told us this meant they were empowered to lead significantly more purposeful lives. The provider excelled in protecting people from harm, including extensive training provision. They were also highly innovative and effective in using evidence-based tools and procedures to retain people’s safety. A relative stated, “Absolutely, [my relative] is not at all unsafe. I can’t praise this place enough.” The registered manager continued to maintain very good standards in the safe management of people’s medicines. The focus was centred on administering medication only where it maximised a purposeful life.

The provider was highly effective at ensuring people were vigorously assessed and monitored through extensive, multi-disciplinary and proactive treatment programmes. A visiting professional said, “Having worked for quite some time with this home, I find it is without doubt excellent. It is the most enthusiastic and compliant of all the services we work with.” The provider continued to maintain an outstanding model to meet people’s nutritional care. A relative told us, “[My family member] absolutely does not go hungry, she has everything she needs.” The provider had an extensive training programme that led to extremely effective and skilled staff. A relative confirmed, “Yes, absolutely the staff are well trained.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A visiting professional stated, “The care records show an exemplary standard in the application of the Mental Capacity Act (2005).” Staff demonstrated outstanding skills in deploying different methods to help people fully participate in their care. The provider excelled at maintaining and enriching a highly adapted environment to support distressed individuals, including sensory areas to stimulate them and provide activities.

The management team and staff embraced people’s diversity and excelled in sensitive care delivery centred on optimising people’s human rights. A visiting professional described staff as exceedingly calm, professional and kind when assisting each person. People and relatives unanimously described staff as exceptionally caring. A relative commented, “What really sets them apart is their kindness and compassion. Often going the extra mile to make not just my [relative], but myself and my family feel very safe and secure.”

The registered manager provided an outstanding range of activities to improve people’s social skills and mental welfare. A staff member told us, “The activities are amazing and we keep this as our main focus.” The management team created a highly proactive care model to ensure staff were responsive to people’s needs. They delivered outstanding end of life care by optimising people’s comfort, wishes and symptom management and instilled this in their workforce.

The provider worked with other organisations to enhance its excellent service delivery. The management team analysed survey results with a strong desire to continuously improve. Extensive service auditing was clearly directed at reviewing any lessons learnt to maximise people’s safety and quality of life. Rossall had very strong leadership with an excellent caring approach to its workforce. A relative said, “[The registered manager] is very hands on. You can see her any time.” A staff member added, “I really like it here. I feel well supported and the opportunity for promotion contributes to a very positive culture within the home.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was outstanding (published 07 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rossall currently provides nursing care and support for a maximum of 33 people who live with dementia, physical disability, alcohol/drug dependency or mental health conditions. As part of the planned, staged expansion by the provider, an additional 13 bedrooms were registered following our inspection. At the time of our inspection there were 32 people living at the home. Rossall is situated next to the promenade in Fleetwood. Accommodation is provided on the ground floor within separate units. There are multiple lounges, rest spaces, dining areas and themed rooms, including a cinema. Every bedroom is for single occupancy, spacious and contains a wet room, toilet and sink.

Rossall was newly registered on 18 March 2016. Consequently, this was their first inspection.

During this inspection, we found the provider had thoughtfully redesigned the building and deployed cohesive staff teams in an exceptional manner. A member of the commissioning team told us the systems in place were ‘amazing’ and care was ‘exceptional’. A relative said, “I know you give a rating on homes now. We are incredibly happy.”

We corroborated this when we toured the building and talked with people and relatives. Outstanding features included automatic bedroom lights to illuminate the path to the ensuite toilet and discreet bed safety strips to reduce the risk of falls. The provider had funded a member of staff to commence a degree in physiotherapy as an advanced way of supporting people’s mobility. We saw the management team completed an in-depth risk assessment matrix to monitor the efficiency of risk evaluation and related processes. We saw this had consequently reduced falls and serious injuries resulting in reduced hospitalisation.

Staff worked within a highly trained team and had ample time to support individuals in a meaningful way. This was because very high staff numbers and skills mixes were deployed to provide a holistic approach to care and people’s safety. We found excellent, consistent recordkeeping, systems related to the recruitment of suitable staff. A newly recruited staff member told us, “It’s in my best interest because I’m new in care and want to learn as much as possible.”

We found care records contained detailed, personalised and specific medicines management care plans. We observed staff followed these in their exceptionally safe and caring approach to people’s related support. The provider was the only service in the region to train their nurses to deliver intravenous fluids and antibiotics. These safe systems meant staff maintained people’s related care to a very high degree.

Staff recorded best interest meetings and transparently documented mental capacity assessments and decision-making practices. We saw this followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We observed staff treated people as equals, offering them options whenever they engaged with them. Local commissioners said they found staff were very knowledgeable about the MCA and tried everything to help people make their own decisions.

Food standards were enhanced by a very high level of organisation of the kitchen. The provider utilised inventive processes to support people with their nutritional requirements. When we discussed the quality of meals with people and their relatives, they said food was of a very high quality.

People and their representatives said staff worked collaboratively with them to ensure they received high standards of care. One relative said other services had never involved them in their family member’s care planning. They added, “They involved me right from the start and focused on what my [relative] was like. What did he use to do? What was family life like? His food likes and dislikes. To me, that’s where Rossall goes above and beyond.”

We found Rossall had a particularly tranquil, warm and welcoming atmosphere throughout. We saw people were relaxed and staff had an exceptionally caring attitude. A relative commented, “Each person matters and they have a meaningful and high quality of life.”

Relatives told us they felt extremely well supported and encouraged to maintain their important relationships with those who lived at Rossall. They said the management team was extremely good at keeping them informed about people’s care. One relative said, “As soon as we arrive, they give us an update. In between times they contact us just to reassure us [our family member] is fine. It’s fantastic.”

We saw staff were responsive to each person’s changing needs and adopted revised care planning to improve upon assistance. One relative said, “As a result of the staff’s care, [our relative] has improved beyond believe. We can talk with her now, she washes herself and dresses smartly, just like the way she used to be many years ago.” We found care planning enabled staff to work in a highly personalised and holistic approach. A member of the commissioning team said they found Rossall was a wonderful home and would rate it as outstanding in all areas.

The management team provided excellent opportunities to optimise people’s social and stimulation requirements. A relative told us, “I go home not feeling anxious because I know the quality of care is exceptional and [my relative] is fully occupied and never bored.”

We found staff, people and relatives were at the heart of Rossall’s quality assurance programme. The management team had a wide range of systems to gain their feedback. This included multiple meetings and a variety of satisfaction questionnaires. Staff, people, their relatives and visiting professionals told us the home was highly organised and exceptionally well-led.

The provider and registered manager regularly completed multiple auditing systems and acted swiftly to address any identified issues. They had remarkable oversight of care provision, service quality and everyone’s safety.