Keychange Charity Rosemary Mount Care Home

We found the following examples of good practice.

The home had prepared for the possibility of an outbreak of COVID-19 and had implemented robust systems and practices to prevent the risk of the spread of infection. COVID-19 risk assessments and care plans ensured that people’s support needs were met. The home was open to new admissions. Pre-admission assessments were completed and each person had to complete a 14-day isolation period, as well as being tested for COVID-19.

Information and guidance for visitors to the home was on display on the entrance door and reception area. Any visitors had to undertake a Lateral Flow Device (LFD) test and receive a negative result before being allowed into the home. Personal Protective Equipment (PPE) such as masks, aprons and gloves, were provided to visitors.

As much as possible, social distancing rules were followed. Staff took their breaks separately. Some furniture had been rearranged within the home to promote social distancing.

We observed staff wearing PPE around the home. Infection prevention and control (IPC) systems were appropriate and effective, and staff had completed training on this. For example, the infection control lead would assess staff competencies in donning and doffing of PPE and hand hygiene.

People and staff were regularly tested for COVID-19. People undertook a Polymerase Chain Reaction (PCR) test every 28 days, and staff completed twice weekly LFD tests. Each person had a COVID-19 care plan and within this people’s daily observations were recorded. The observations, such as temperature checks and oximeter readings, could help detect any early symptoms of COVID-19.

We observed areas around the home were very clean, and equipment, such as mobile hoists, were cleaned between use. Furniture that had been recently cleaned displayed ‘I am clean’ stickers. Cleaning schedules in bathrooms showed when the room had last been cleaned and were signed by a member of the housekeeping staff. When cleaning tasks had been completed, these were logged onto the home’s system and this was shown to us.

At our last inspection we rated the service as ‘Good’ overall. We rated the key question of ‘Safe’ as ‘Requires Improvement’ because of concerns relating to the administration of medicines. At this inspection, we found that improvements had been made and this key question has improved to ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained ‘Good’.

People told us they felt safe living at the home. Staff had been trained to recognise the signs of potential abuse and know what action to take if they suspected abuse had occurred. People’s risks were identified, assessed and managed safely. Staffing levels were assessed based on people’s care and support needs. New staff were recruited safely. Medicines were managed safely. If things went wrong, lessons were learned and improvements made. The home was clean, tidy and smelled fresh.

People received effective care from staff who had completed relevant training and received regular supervisions and annual appraisals. People had a choice of what they wanted to eat and drinks were freely available. A range of healthcare professionals and services were available to support people with their health needs. 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.

Positive, caring relationships had been developed between people and staff. People were positive about the care and complimentary about the staff who supported them. People were encouraged to be involved in decisions relating to their care. They were treated with dignity and respect.

Care was planned in a personalised way to meet people’s support needs, likes and dislikes. Activities were organised based on people’s interests and what they would like to do. Outings were organised which people enjoyed, in addition to activities provided in-house. People knew how to make a complaint and who to speak with. No complaints had been recorded in the last year. If they wished, and if their care needs could be met, people could live out their lives at the home.

The home was well led and staff felt supported by the management team. People and a relative were asked for their feedback about the service and any improvements identified were acted upon. A system of audits had been implemented which was robust and drove continual improvement.

Further information is in the detailed findings below.

Keychange Charity Rosemary Mount Care Home is a large, detached house situated to the east of Worthing town centre, with access to local shops, public transport and the train station. A large, bright, airy reception area with seating and a baby grand piano leads into a large sitting room and adjacent dining room. There is another smaller sitting room available for prayer and reflection and this room can also be used by families and visitors who require privacy. Bedrooms are of single occupancy and housed over three floors, accessible from a lift. Gardens surround three sides of the property. The home is registered for up to 29 people with a variety of health and mental care needs. At the time of our inspection, the home was at maximum capacity.

A registered manager was in post. 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.

Generally, medicines were managed safely. We observed a senior member of staff administering medicines to people at lunchtime. The trolley was not always locked when left unattended and blister packs of medicines were left on top of the trolley. People were left to take their medicines in their own time and were not closely supervised by staff.

People told us they felt safe from abuse and harm. Staff had been trained to recognise the signs of potential abuse and knew what action to take. People’s risks and environmental risks had been identified and assessed and were managed appropriately. Communication between staff regarding one person’s care had not been effective, but this was promptly investigated and resolved. Accidents and incidents were reported by staff and appropriate action taken, with risk assessments updated as needed. There were sufficient numbers of staff on duty to keep people safe. Robust recruitment practices ensured that staff were vetted before they commenced employment.

Staff had been trained in all essential areas and were encouraged by management to take additional qualifications. New staff completed the Care Certificate, a universally recognised qualification. Staff had regular supervisions and an annual appraisal with their line managers. Staff had a good understanding of the requirements of the Mental Capacity Act 2005 and associated legislation and put this into practice. People had sufficient to eat and drink and menu choices were varied over a three weekly cycle. People were supported to maintain good health and had access to a range of healthcare professionals. The premises were well adapted for people with limited mobility and people could personalise their rooms in line with their preferences.

People were looked after by kind and caring staff. People and their relatives spoke highly of the staff and were encouraged to express their views and to be involved in making decisions about their care. People were treated with dignity and respect. Where appropriate, documents relating to people’s end of life care needs had been completed. People and their relatives were consulted about end of life wishes.

Care plans provided comprehensive, detailed information to staff about people’s care and support needs and how they should be cared for. People were encouraged to be as independent as possible and relatives told us of the improvements their family members had made since they were admitted to the home. Handover meetings were organised between shifts so staff could update each other about people’s care, their moods and health needs. A programme of activities was organised by an activities co-ordinator. People enjoyed the activities on offer and some people had 1:1 support with activities. Complaints were managed appropriately in line with the provider’s policy.

The home was well managed and demonstrated good leadership at all levels. People and their relatives were asked for the views about the service provided and the quality of care, with positive results overall. Staff felt well supported by management and were asked for their feedback on the home. A system of robust quality assurance systems measured the quality of care delivered. A representative of the provider undertook quarterly monitoring visits which were used to drive continuous improvement.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Rosemary Mount is registered to provide accommodation and nursing care for up to 29 people, some of whom may have dementia. On the day of our inspection 26 people were living at the home. We carried out our inspection over two days. On the first day we looked at documentation such as care plans, policies and procedures, training records, staff records, surveys and quality and audits. We spoke with eight people using the service, the deputy manager and five members of staff.

On the second day we undertook telephone conversations with two relatives of people who use the service. This is a summary of what we found.

Is the service safe?

The service was safe. The provider had detailed and accurate care and support plans which were intended to ensure peoples welfare and safety. People were receiving medication appropriately. Medicines were stored securely and arrangements were in place for the safe disposal of medicines.

There were systems in place to make sure the premises provided a safe environment and we saw certificates to evidence that the electrical wiring, boilers and water system had been inspected within the required time frame.

People's personal records including medical records were accurate and fit for purpose. Records were organised, tidy and they contained up to date information about the person.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The service was effective. We saw that people were weighed regularly to reduce the risk of malnutrition. Staff respected people's privacy and dignity and sought their agreement before providing any support or assistance.

Staff showed a good understanding of people's needs and demonstrated that they had built up good relationships with the people they supported.

Is the service caring?

The service was caring. People told us: 'I couldn't ask for better care. Staff are lovely caring people. The staff are kind and friendly. The food is very nice' One relative we spoke with told us: 'Staff are respectful, caring and loving and that extends to family as well'.

Activities were planned throughout the day and were tailored to meet each person's individual needs. Care plans were reviewed monthly, or as needs changed to ensure that information was current.

Is the service responsive?

The service was responsive because the provider took steps to identify risk and put systems in place to minimise the risk of harm to people. For example, two people who use the service had been identified as at risk of falls during the night. Pressure mats had been placed by the side of their beds. These were linked to the electronic call system operated within the home and triggered an audible alarm when stepped on. This alerted staff who would respond to offer support and to ensure that the person had not fallen.

Is the service well led?

The service was well led. The registered manager or her deputy reviewed care plans monthly or as needs changed to ensure that information was current and relevant. People who use the service and staff members we spoke to told us that the manager of the service was very approachable, and that if they had any worries, complaints or concerns they felt confident that matters brought to the managers attention would be addressed and dealt with.

There was evidence of a pro-active approach toward training and supporting staff working at the service including ancillary staff, for example, catering and domestic staff. Staff we interviewed confirmed that they were well trained and supported, with regular supervision and staff meetings being provided and led by management.

We found that people felt well cared for with one person saying 'I couldn't be happier and I couldn't wish for anything else.' We saw that staff treated people with respect and dignity. There were care plans with information regarding the care and treatment required. There was a lack of recognition and documentation of potential risks to some people who lived there and a lack of recorded actions to reduce these risks.

Staff had received training in the management of medications. We found there were discrepancies in the records relating to the administration of medication. There were no checks in place to ensure people received their medication as prescribed.

We found new staff had the necessary checks carried out, prior to them starting employment, to ensure they were fit to carry out their work. Staff told us they were well supported by the manager and could discuss any issues they had at any time.

There were mechanisms in place for consulting people who lived there and monitoring the quality of some aspects of the service.

People told us they felt safe. Staff members were aware of what constituted abuse and the safeguarding procedures and were trained in safeguarding. The manager was aware of her responsibilities in respect of safeguarding service users.

We looked at staff files and other documents that showed how staff were supported, supervised and trained. Staff told us they were well supported and received regular varied training and professional development.

We sampled areas of the services quality assurance systems. We found a manager who was aware of what the service did well and of what needs to be developed with the service user group and other stakeholders. People told us they were consulted regularly about the services provided, and that they were asked their views about their care and support and they were acted on.