Archived: Roseview Care Homes - New Southgate

Roseview Care Homes –New Southgate is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Roseview Care Homes –New Southgate provides care and support for up to 14 older people some of whom live with dementia and/or mental health needs. At the time of our inspection 14 people were using the service. People have access to safe outdoor space and the home is located close to shops and public transport.

The service has a registered manager. A registered manager is a person who has registered with the CQC 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.

At our previous inspection on the 9 and 11 June 2015 we rated the service as Good. The provider had met legal requirements. During this inspection we found there were two breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, and we rated the service overall as Requires Improvement.

People received their prescribed medicines at the right time but we found some shortfalls in the management and administration of people’s medicines.

There were some systems in place for monitoring the quality and safety of the service provided to people, but these were not always sufficiently robust in identifying deficiencies and demonstrating that improvements had been made when needed.

All the people using the service told us that they were satisfied with the service including the care and support that they received from staff. People using the service told us that staff were kind and they felt safe. Staff engaged with people in a respectful manner. They knew the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights.

Staff knew people well. Staff received a range of training relevant to their roles and responsibilities and received the support that they needed.

Arrangements were in place to protect people from abuse. Risks to people were identified and measures were in place to lessen the risk of people being harmed.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). 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.

People's care plans were personalised. They included details about people’s individual needs and preferences and guidance for staff to follow so people received personalised care and support.

People had the opportunity to choose, plan and take part in activities that met their preferences and needs. People’s independence was supported.

Appropriate staff recruitment procedures were in place so that only suitable staff were employed. Staffing levels and skill mix provided people with the assistance and care that they needed.

People knew how to make a complaint and there was a system for recording and responding to complaints.

People were supported to access the healthcare services they needed. Staff liaised closely with healthcare professionals to ensure that people’s health and medical needs were identified and met.

People told us that they enjoyed the meals. Their dietary needs and preferences were accommodated by the service.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of this inspection there were twelve people living in the home. Some people who used the service had dementia while others had mental health needs.

We observed the care provided and the interaction between staff and people who used the service. We spoke with seven people who used the service and two relatives. We also spoke with the registered provider, the area manager, the registered manager, the activities organiser, domestic and care staff.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People indicated to us that they felt safe with staff. This was also reiterated by relatives we spoke with. The premises were clean and regular health & safety checks had been carried out. Fire safety arrangements were in place and the fire alarm had been tested weekly. Infection control arrangements were satisfactory. The staffing levels were adequate and people stated that staff were attentive and able to meet their needs. Staff informed us that they were well supported and able to attend to the needs of people.

Is the service effective?

Feedback from relatives and people who used the service indicated that the service was effective in ensuring that people were well cared for. One person stated, 'I am satisfied with the care. People get the respect and care they need. I had a one to one session with staff recently.' Another person said, 'They consult with me about my care. I am satisfied with everything.'

People's care needs had been assessed before they arrived at the home and care plans were in place to ensure that their needs were met. People and their representatives had been consulted regarding their personal preferences, dietary needs and activities they liked to engage in. The service had a varied programme of social and therapeutic activities and people could participate in activities if they chose to.

Is the service caring?

A relative said, 'They have been very good to my relative. They keep me informed of progress and the care has been reviewed.' A person who used the service said, 'They treat me well. They help me to walk and they provide food that suits me.' A relative wrote, 'Thank you so much for your care and kindness to X. It's lovely he has someone like you.'

We observed that staff spent time with people and staff asked how they were. The care records indicated that the care of people had been carefully monitored and appointments had been made for them to see healthcare professionals such as the physiotherapy, GP and dietician when needed. Residents' meetings and one to one sessions had been provided to ensure that people could express their views and be listened to.

Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. The activities organiser informed us that he had consulted with people regarding their likes and dislikes and appropriate activities had been organised for them.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The manager and some staff had received training and had an understanding of the need to make an application for deprivation of people's liberty to be authorised by the local authority if this was needed for people's own safety.

Is the service responsive?

People who used the service informed us that staff were responsive to their needs. One person stated, 'I have a special diet and they provide this for me.' Another person stated, 'When I made a complaint, staff responded to it. When I press the buzzer, they respond to it. I am satisfied with the care.'

We observed that staff were pleasant and spoke in a gentle and friendly manner towards people. We noted that when the call buzzers were activated, staff responded promptly.

We noted that suggestions made by people in residents meetings had been followed up. This included organising an outing to the seaside and having cooked breakfast.

Is the service well-led?

Staff meetings had been held and the minutes of these meetings indicated that staff had been updated regarding the management of the home and the care of people. Staff we spoke with said they had been provided with appropriate support to enable them to take good care of people. Essential training had been provided and staff were knowledgeable regarding the specific care needs of people.

There were arrangements for monitoring the quality of care. Regular audits and checks had been carried out in areas such as the medication arrangements, cleanliness and the maintenance of the premises. Records were well maintained and up to date.

We spoke with four people who told us they were generally happy with the service. One person said, 'it's OK,' and another that it was, 'quite nice.' However, it was not possible for us to speak with everyone as many of the people had dementia or a mental health diagnosis and were not able to fully communicate verbally. Instead, we observed within the main lounge at the start of the inspection and at the lunch period in the dining room.

People told us they were offered choice and there were systems, such as the use of food photographs, to help give people a means to choose. People told us they could choose what to do each day. One person told us, 'I'm more or less free to come and go.' There were detailed care plans for people which were well presented and easy to follow. However, we identified some shortfalls. There was a lack of clarity about the use of the hoist for one person and there was a need to update two care plans after a change of care arrangements.

People were provided with sufficient amounts to eat and drink and staff helped people to eat where needed. However, there was confusion amongst staff about the number of staff on duty at the start of the inspection, we saw that people in the lounge had been left without a staff presence for 30 minutes and there was reliance on trainee staff. This meant that the available staff may not have been suitably skilled and experienced to safeguard people's health, safety and welfare.

Although action had been taken to address infection control risks, such as providing training for most staff, there were potential risks to people, staff and visitors of acquiring health care infections. These included the cleaning arrangements and clinical waste procedure which had not been assessed and controlled.

The people we spoke with told us they were happy with the service. One person said, 'it's alright,' and another that it was, 'good.' However, it was not possible for us to speak with everyone as many of the people had dementia or a mental health diagnosis and were not able to fully communicate verbally.

We observed staff interacting with people using the service. We saw staff working patiently with people. For example, spending time reassuring people. We also saw staff working calmly with one person who had become anxious.

Staff were aware of people's nutritional needs and special diets and we saw that staff were active in helping people to eat at lunch time. People were provided with a range of meals which took into consideration people's ethnicity and culture.

We checked the equipment in use and saw that there was a range of equipment for people's needs such as a hoist, profiling beds, pressure relieving equipment and wheelchairs. Staff told us they used the equipment and they had received relevant manual handling training.

The physical standards of the premises were poor. Although attention had been paid to making sure that the home was fire safe and that the passenger lift and electrical installations were regularly checked there were a number of outstanding repair matters. The bathrooms were uninviting with very old and wrinkled flooring, some of the hallway and stair carpets were old and stained and we found a leaking pipe and a broken shower surround door in a ground floor bathroom. The chairs in the lounge were old and worn. We have asked the provider to take action to improve the premises.

The provider told us work was about to start to redecorate and improve the premises. After our visit the provider sent us a copy of their timetabled premises development plan.

We saw that staff were calm and respectful when working with people using the service. We saw them give regular positive interactions to people who were not able to communicate verbally. We spoke with two healthcare professionals who had visited the service regularly. They both told us that staff worked well with people and especially people who had high level needs. They said that the manager and staff were well organised and had been able to meet people's needs.

We saw that care plans were clear, regularly reviewed and that risks had been assessed and updated when needed. Staff told us that they felt supported and we saw that relevant training had been provided. We saw that the matters we had said must be put right had been. These related to staff recruitment and to the need to report to us important events that affect the welfare, health and safety of people using the service.

People using the service told us that they were satisfied with how the home accessed the doctor and other healthcare professionals such as district nurses and chiropodists. One person told us that the district nurse visited the home most days and they could ask for healthcare advice if they needed to. Records indicated that people had good access to healthcare professionals and these visits were being recorded appropriately in people's care plans.

People told us that the cleanliness of the home was, 'pretty good' and that the staff were, 'good at cleaning.'

People who use the service were positive about the staff who supported them. They told us there were enough staff on duty to meet their needs. One person commented, 'I think they have enough (staff).'

However, the service had not always followed recruitment procedures appropriately to ensure the provider was assured that the worker was suitable for their role.

The provider was not notifying the Care Quality Commission of important events that affected people's welfare, health and safety at the home so that, where needed, action could be taken by the Commission.