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Inspection report

Date of Inspection: 29 May 2014
Date of Publication: 8 July 2014
Inspection Report published 08 July 2014 PDF | 95.16 KB

Overview

Inspection carried out on 29 May 2014

During an inspection in response to concerns

We undertook this inspection following receipt of some information of concern. We spent a whole day in the service to look at the concerns raised and also inspected other outcomes.

During this visit we were shown all areas of Rosecroft and Heron�s view. We spoke with the deputy manager, two care staff and the provider. We met and spoke to the people that lived in Rosecroft, and we found that they had varied communication difficulties which made it difficult for them to fully express their views. We therefore used a number of different methods to help us understand their experiences of using the service.

We were unable to conduct a Short Observational Framework for Inspection (SOFI) which is an observational tool used to help us collect evidence about the experience of people who use services, who may not be able to fully describe this themselves because of cognitive or other problems. This was because our presence was upsetting to one of the people who was new to the home and we did not wish to increase their concerns. We therefore undertook brief observations of people and their interactions with each other and with staff throughout the day and listened to staff interactions with people in the home. We also spoke to four relatives of people that lived at Rosecroft and Heron�s View.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that staff demonstrated a good understanding of the use of different positive strategies when supporting people with behaviour that could sometimes be challenging. However this was not always well documented. There were safe recruitment practices in place to protect people from the risks of unsuitable staff. The home was clean but shortfalls in infection control processes could place people and staff at risk from cross infection. People were unable to manage their own medicine, and shortfalls in the training of staff in this area could place people at risk of harm.

Is the service effective?

Care plans demonstrated that people�s preferences were taken account of but their involvement in their care planning was less evident. Records showed that people were supported to access healthcare as and when required. We observed staff offering support and prompting around personal care issues in a discreet manner, encouraging people to return to their room where support was needed. Staff told us that they received one to one support from their registered manager to discuss work related issues and training needs and we saw records of this.

We saw that people ate well and staff explained that menus were based on staff�s understanding of people�s individual preferences around the food they enjoyed. Where someone had a special requirement relating to how their food was presented staff understood this and ensured this was adhered to.

Is the service caring?

Staff spoken with demonstrated a full and in-depth knowledge and understanding of people�s individual needs. Their knowledge and understanding was echoed by relatives we spoke with after the inspection who said they had, �Never seen their relative happier,� �They (the providers) really put themselves out for the clients and for their relatives�, �He has a better social life than I do,� �How do I know he is happy? When he is at home he can�t wait to get back there�.

Is the service responsive?

The home was a small service, and staff and people in the home spent time in each other�s company throughout the day. Staff understood people�s methods of communication and were confident that if people were distressed or expressed any issues of concern they would be aware of it. However, individual time staff spent with people was not well documented. Records viewed showed that people�s needs were reviewed annually or sooner if a change occurred and relatives and social care professionals were involved in this.

People were supported to maintain relationships with their families and actively supported to have visits to their homes. Relatives we spoke with said that they felt comfortable about raising concerns if they needed to and found the providers approachable and open to discussion, however there was an absence of records to support this. In discussion with staff we were concerned about the moving and handling arrangements for one person, when we discussed this with the provider they agreed to refer the person for a re-assessment by the physiotherapist.

Is the service well-led?

In discussion the provider was able to give examples of where the home had implemented personalised care for individuals, for example, continence management. In discussion staff said they felt comfortable raising issues and found the providers and senior staff approachable. There was evidence of learning from incidents. The provider ensured that an adequate level of staffing was provided by using a dependency assessment tool to help calculate the correct staffing hours required. There was good stable leadership and staff demonstrated caring and respectful attitudes. Risks were understood and measures were implemented to mitigate these without being overly restrictive. However, there was often an absence of recording to show how staff had made decisions, and how the provider was monitoring service quality.