Archived: Rosegarth Residential Home

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of 'is the service safe' and 'is the service well led' to at least good. We found this had been achieved at this inspection.

Rosegarth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation and personal care to a maximum of 18 older people and people living with dementia in one adapted building. There were 17 people living at the service on the day of our inspection.

The service is owned and managed by an individual and therefore is not required to have a registered manager.

People felt safe and happy living at Rosegarth. Staff had been trained to recognise and report signs of abuse. Safeguarding concerns had been reported and dealt with appropriately. People were comfortable in the presence of staff and told us staff were kind and compassionate.

Accidents and incidents were reported, investigated and analysed for themes and trends. Actions were taken to mitigate risks, such as providing specialist equipment for people where required.

Medicines were managed safely and people received their medicines as prescribed.

The home was clean, well maintained and tidy. Safety checks were up to date. Staff wore aprons and gloves when carrying out personal care. People looked clean and well groomed. We saw staff had respect for people's privacy, dignity and the choices they made.

Sufficient staff were deployed to keep people safe and provide care and support to people living at the home. Staff spent time engaging people in meaningful activities which people clearly enjoyed. Staff were recruited safely and had received training, supervision and appraisal to equip them to carry out their roles effectively. Staff meetings were held and staff opinions of the service quality were sought through an annual survey.

People's nutritional needs were supported and special diets were catered for. The service worked with health care professionals to support people's health care needs and to maintain people's independence wherever possible. People's consent was sought and the service was working within the legal requirements of the Mental Capacity Act 2005.

People's needs were assessed, plans of care formulated and reviewed regularly. People and/or their relatives were involved with these, which reflected the personalised care we observed during our inspection. People and their relatives were asked their opinion of the service quality through surveys and meetings. Actions were seen to have been taken as a result of responses received.

Complaints were effectively dealt with. Health care professionals, people staff and relatives praised the management team and commented on the good level of communication from the service.

Staff told us they were supported and morale was good. Staff worked well as a team to achieve positive outcomes for people living at the service.

A range of effective quality checks were in place to ensure the service worked well at all times. These were used as a means to monitor and drive improvements within the service.

The last inspection was carried out in November 2014. At that time we found the provider was in breach of one regulation because they did not have proper systems in place to ensure they were meeting the requirements of the Mental Capacity Act 2005. Following the inspection the provider told us they had taken action to address this concern.

Rosegarth is a care home without nursing. It provides accommodation and personal care to a maximum of 18 older people and people living with dementia. It is a converted property located in a residential area and within a short distance of the town centre and local amenities. The service is owned and managed by an individual and therefore is not required to have a registered manager.

Everyone we spoke with told us they felt the service was safe. Staff had received training on safeguarding and knew how to report concerns about people’s safety and welfare. All the required checks were done before new staff started work and this helped to protect people from the risks of being care for by staff unsuitable to work in a care setting.

During the day we saw staff were available to support people as needed. People told us there were enough staff and said staff responded quickly when they needed help. Overnight there was on member of staff on duty and a sleep over to provide additional support as needed. Everyone spoke highly of the staff describing them as caring, friendly and welcoming. Staff received training and were supported through one to one supervisions, appraisals and staff meetings.

People told us they received their medicines which were administered by staff. The home had made improvements to the way medicines were stored but we found further improvements were needed. Following the visit the provider confirmed these matters had been addressed.

We also found some improvements were needed to the way medicines were recorded and accounted for. The manager told us they were implementing a new system for checking medicines which they were confident would address this.

We found risks arising from people’s individual needs in areas such as falls and pressure sores were identified and action was taken to manage the risk. However, we found some shortfalls in the way environmental risks were managed. In particular we were concerned the provider did not have effective measures in place to manage the risks associated with the hot surface temperatures of radiators.

We found the home was clean and well maintained and people told us it was always clean and fresh.

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. During the day we observed staff offered people choices and respected their wishes.

People told us the food was good and said they enjoyed the home made meals and cakes. People’s individual needs and preferences were catered for and people. We saw people were offered a choice of drinks including water, fruit juice and wine with their meals. Drinks and snacks were available throughout the day and when people were at risk of poor nutrition they were supported to increase their calorie intake. For example by being encouraged to have fortified milky drinks.

People who used the service, relatives and health care professionals told us they were satisfied people were supported to meet their health care needs.

Everyone we spoke with told us the staff were kind, caring and treated them with respect. We observed lots of positive interactions and people laughing and joking with staff. Visitors were welcomed at any time and people were able to see their visitors in private.

Staff knew people well and understood how they liked their care and support to be delivered. There were meetings where people were able to share their views and make suggestions about how their support was provided. People were supported to take part in a range of social activities which took account of their interests and individual needs.

People’s needs were assessed and this information was used to develop care plans. We found the care plans were up to date but did not always have enough details about people’s care and support needs. Although the relatives we spoke with told us they were kept informed and involved in people’s care we found this was not always reflected in the records.

People told us they did not have any complaints or concerns and would not hesitate to speak to one of the management team if they were unhappy about anything. There was a complaints procedure in place; however, we found this had not been followed in the case of a complaint where the person had not been satisfied with the provider’s response.

People told us they thought the home was well led and everyone we spoke with during the inspection said they would recommend the service.

We found there were systems in place to monitor and assess the quality and safety of the services provided and it was clear the management team were committed to providing a good quality service. However, we found the processes for managing risks and monitoring quality were not always as effective as they should be.

We found there was a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found people's care needs were assessed and care was planned and delivered to meet their needs.

We found people's nutritional needs were assessed and people were offered a choice of suitable and nutritious food and drink. We observed the meal service at lunch time and found more could be done to enhance people's dining experience.

We found the provider had suitable arrangements in place to protect people from abuse and the risk of abuse.

We found the environment was clean and hygienic and people were supported to personalise their rooms by having some of their personal belongings around them.

We found there were enough staff available to meet people's needs and the management team were available to provide out of hours support. However, we found the skill mix could be improved.

We found the provider had suitable systems in place to make sure records were managed properly and this helped to make sure people were protected from the risk of receiving inappropriate or unsafe care.

Two people who were able to tell us about their experiences told us they were 'well looked after'. We spoke with one relative and they told us they were satisfied with the service. They said the staff were kind and caring and they felt people who used the service were safe. They said they were kept fully informed about any changes to their relatives needs. They told us the food was 'excellent' and said they were always offered refreshments when they visited.

We found there had been a number of changes to the senior staff team. The provider said they were confident they had suitable arrangements in place to make sure people continued to receive appropriate care and support during the transition period. A relative told us they felt confident the provider would make sure standards were maintained.

We found people were supported to take their prescribed medication. However, the storage arrangements for some medicines were not satisfactory. Following the inspection the provider told us they had taken action to address this.

We found that people's care records did not always provide an accurate record of their care and treatment. We have asked the provider to take action to deal with this.