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Roseacre Requires improvement


Inspection carried out on 4 June 2019

During a routine inspection

About the service: Roseacre provides accommodation with personal care for up to 22 people. There were 17 older people using the service at the time of our inspection.

People’s experience of using the service:

Some people were not able to tell us verbally about their experience of living at Roseacre. Therefore, we observed the interactions between people and the staff supporting them.

Staff were kind and spent time chatting with people as they moved around the service. However, we did identify some records made by staff which did not always demonstrate a caring or empathetic approach.

There were some concerns with the environment. Damaged walls, a damaged sink surround, stained and marked furniture, and a bolted fire door were identified during this inspection. The fire service have been contacted and will visit the service to provide advice.

Some people’s sinks did not have plugs, some soap dispensers were empty and there was no provision for a towel or paper towels to use in a communally used toilet.

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

There were some activities provided for people. However, the activities did not always relate to the detailed information gathered by staff which identified people’s specific interests and preferences.

Not everyone living at the service had a care plan. Risk assessments did not always provide staff with sufficient guidance and direction to provide person-centred care and support. Some staff were being inappropriately touched by people living at the service. Pre-assessment information showed this was a known risk but this had not been recorded and addressed in care plans. There was no guidance on how staff could protect themselves.

Many quality monitoring systems were in place. However, the audit process had not always enabled the provider to identify the concerns found at this inspection. Staff did not always have enough information about people who had not been living at Roseacre for very long. This meant they may not have been able to support them according to their needs and preferences.

A recent survey sent out to people and their families had positive responses. We had received information from an anonymous source that their complaints had not been addressed to their satisfaction. Complaints were recorded and responses were seen. The registered manager told us there were no on-going complaints at the time of this inspection.

Rating at last inspection: At the last inspection the service was rated as Good (report published 2 September 2017)

Due to breaches of the regulations identified at this inspection the service rating has changed. The rating for Roseacre is now Requires Improvement.

Why we inspected: This inspection was bought forward following several anonymous concerns being received by CQC. Concerns had been raised about the quality of the support provided to some people, the approach of the management, concerns about the premises, infection control concerns and a lack of staff in the lounge areas at times and at weekends. One person told us they felt their complaint had not been resolved.

We specifically reviewed these areas during this comprehensive inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this report.. Not all the concerns raised to us were upheld.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return t

Inspection carried out on 14 August 2017

During a routine inspection

The inspection took place on the 14 and 17 August 2017 and was unannounced on both days. Roseacre provides care and accommodation for up to 22 older people some of whom are living with dementia. At the time of the inspection there were 18 people living in the service.

We received information about concerns in relation to the service. The concerns were in respect of how the home was run down. These included dangerous ripped carpets, no running hot water in some bathrooms, no cleaning products, continence equipment shared and not being cleaned. Information included that people were bored with no activities and not given proper personal care, concerns about staff conduct on the night shift and concerns that often only two members of staff were on duty at weekends for 20 residents.

We also received concerns that the service had poor hygiene. Staff didn’t use gloves and aprons and people’s rooms were filthy and bells were unplugged. MAR (medicines administration record) were tampered with and filled in later. During this inspection we found all of these concerns to be unsubstantiated.

We visited at 7am and met and observed the night staff and spoke to people who used the service, staff, visitors and a healthcare professional.

There was a registered manager 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.

At the last inspection, the service was rated Good overall.

At this inspection we found the service remained Good in all areas.

Why the service is rated good.

One person said; “I’m happy with all of them (staff).” Another person said; “I’m very happy here.” A visitor said; “People we visit always have their needs met.” A relative said; “I find this a well presented, clean and tidy home.” Another said; “We are so glad mum came here. She seems so happy and that makes us happy.”

People remained safe at Roseacre because they received their medicines safely and from staff that had received medicines training. People, relatives, visitors and staff told us there were sufficient staff to meet people’s needs. Risk assessments had been completed to help people to retain as much independence as possible and receive care with minimum risk to themselves or others.

People continued to receive care from a staff team that had the skills and knowledge required to effectively support them. Staff received regular training and updates and were competent. People were supported to have as much choice and control of their lives as possible. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to healthcare professionals according to their individual needs.

People said the staff were kind and very caring. One relative said; “She always looks well cared for and settled.” A visitor said; “Everyone seems very comfortable.” There was mainly a calm atmosphere in the service with staff supporting people with their care needs discreetly. When people started to become anxious staff intervened and people soon settled. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs. Care and support was personalised to each individual which helped ensure people were able to make choices about their day to day lives. Complaints were fully investigated and responded to. One person said; “I’ve never had any complaints to make here. But […] (naming the registered manager, provider and other senior staff) would help me sort it.”

People were assisted to take par

Inspection carried out on 21 July 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 17 November 2015. After that inspection we received information of concern in relation to the service.

As a result we undertook a focused inspection at 7am on 22 July 2016, to look into the concerns. The concerns related to staff training and induction, unsafe moving and handling practices and equipment, staffing levels and length of staff shifts; not meeting people’s dietary needs safely and staff not respecting people’s right to choose when they wanted to get up and restricting their ability to move about freely. There were also concerns raised about the safety of two people living at Roseacre.

This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseacre on our website at

Roseacre is a residential care home which predominately supports older people with dementia. The home can accommodate up to 22 people. On the day of the inspection 19 people were living at the service and two people were staying on short term respite.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us they felt safe living at Roseacre. One person commented, “It’s quite the nicest place I’ve ever been.” People told us they felt safe telling staff when they wanted to get up and go to bed and were not told when to do this. People told us they felt safe whilst staff supported them to mobilise and staff confirmed they had received training on how to move people safely and felt confident asking for advice if they were unsure. Lifting equipment had been assessed and provided by healthcare professionals. People’s mobility equipment was within close reach to them and staff told us this was always the case.

People’s dietary needs were recorded and staff were aware of how to meet these needs. They told us they had recently attended training on diabetes.

Staff told us they had received an induction and training relevant to their job role and records confirmed this.

Staffing levels had been increased recently and people, staff and professionals felt there were enough staff to meet people’s needs. Some staff only had an eight hour break between shifts. This does not comply with The Working Time Regulations (1998). The registered manager told us they would review the rota and shift times to improve this.

A concern had been raised that one person was not able to get downstairs safely. This person had moved to a room downstairs. Another concern had been raised about someone sustaining an injury due to staff not checking on them regularly enough. A healthcare professional told us they saw this person regularly and had no concerns about the level of care they received.

Inspection carried out on 18 November 2015

During a routine inspection

The inspection took place on 18 November and was unannounced. Roseacre provides care and accommodation for up to 22 older people some of whom are living with dementia. On the day of the inspection 15 people resided at the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

We inspected Roseacre on 1 December 2014 and found breaches of legal requirement under Regulation 21(a) and (b) HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers. The registered person was not ensuring staff recruitment procedures confirmed the fitness of the person prior to commencing work. The provider sent us an action plan detailing how they would make improvements and these actions have been completed. Recruitment records showed the registered manager had obtained full employment history and references in place before staff commenced work.

People were protected by safe recruitment procedures. There were sufficient staff employed to meet people’s needs and new staff completed an induction programme. Staff had undertaken training and had the right skills to meet people’s needs.

People looked relaxed with the staff and there was a friendly and calm atmosphere. People were chatting and enjoying the staff’s company. Comments included; “Couldn’t ask for better care.” People who were able to told us they were happy living there.

People’s privacy and dignity were maintained. We observed staff supporting people and being kind and compassionate. People told us staff were kind and caring. People’s privacy and dignity were respected by staff who provided individual and personalised care.

People, relatives and a visiting professional were happy with the care the staff provided. They agreed staff had the skills and knowledgeable to meet people’s needs. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives.

People received visits from healthcare professionals, for example GPs and district nurses, to ensure they received appropriate care and treatment to meet their health care needs. Staff acted on information given to them by professionals to ensure people received the care they needed to remain well.

People’s medicines were managed safely. Medicines were managed, stored and disposed of safely. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.

People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected and worked with others in their best interest. People’s safety and liberty were promoted.

People were better protected from harm as staff had completed safeguarding of vulnerable adults training and had the knowledge on how to report any concerns and what action they would take to protect people. Staff were confident any incidents or allegations would be fully investigated. The registered manager had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights.

People were supported to maintain a healthy balanced diet. People told us they enjoyed their meals, there was plenty of it and we observed people were not rushed. People had opportunities to take part in a variety of activities.

People’s care records contained detailed information about how people wished to be supported. Records were updated to reflect people’s changing needs. People and their families said they were involved in the planning of their care.

Staff told us they were happy working at the service and told us the registered manager was very supportive, approachable, kept them informed, listened to them and acted on any concerns raised.

The registered manager had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

There were quality assurance systems in place. Feedback was sought from people and their relatives to assess the quality of the service provided. Audits were carried out to help ensure people were safe, for example environmental audits were completed.

Inspection carried out on 01 December 2014

During a routine inspection

This inspection took place on 01December 2014 and was unannounced.

When we inspected the service in April 2014 we found breaches of legal requirements relating to respect and dignity, care and welfare, suitability of premises, supporting workers and assessing and monitoring the quality of the service. This was because we observed practices which did not respect people’s dignity. Care and treatment was not planned and delivered in a way that ensured people's safety and welfare. The provider had not taken steps to provide care in an environment that was adequately maintained. People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

The provider responded by sending the Care Quality Commission (CQC) an action plan of how they had addressed the breaches identified. We found the improvements the provider told us they had made were continuing to be developed.

Roseacre is registered to provide care without nursing for up to 22 people. The service provides residential care for people with age related needs including dementia conditions. The service has a registered manager 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 and associated Regulations about how the service is run.

Recruitment processes were in place but not always followed. Suitable fitness checks had not been completed. This meant people were not protected from the risks associated with being supported and cared for by unsuitable staff.

The dining experience was not seen to be positive due to the positioning of tables and absence of table linen. People were grouped together which did not make it a personal experience. People were not supported to choose where they ate and who with. One person had difficulty holding and using their cutlery. The one carer on duty came to provide assistance but was not able to provide one to one attention due to others also requiring support.

There was evidence to show where families had been informed of people’s changes in need and what action was being taken to meet their needs. The registered manager acknowledged more work was required to demonstrate peoples’ involvement in the quality monitoring processes for service development.

Records we looked at showed all quality monitoring and policies and procedures had been audited and updated where necessary to include legislative requirements and current good practice. For example, the medication policy included relevant pharmaceutical guidance for staff. The complaints procedure had been reviewed. It guided people through the process of making a complaint and how it would be investigated as well as including relevant external addresses including the Care Quality Commission.

There was a programme in place to provide a range of daily activities including therapeutic hand massage and pampering, board games and memory games for people with dementia. External entertainers visited the service on occasions.

Suitable arrangements were in place to protect people from abuse and unsafe care. Staff understood their responsibilities to report unsafe care or abusive practices.

Steps had been taken to carry out mental capacity assessments and best interest decisions were being recorded where necessary The registered manager demonstrated an understanding of the legislation as laid down by the Mental Capacity Act (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). Staff understood what was meant by restrictive practice in respect of depriving somebody of their liberty.

We observed interactions between staff and people who lived at the home. We saw that staff were kind and respectful to the people they were supporting.

We found a Breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the end of the full version of the report.

Inspection carried out on 23 April 2014

During an inspection in response to concerns

We carried out the care homes annual inspection in response to concerns that one or more of the essential standards of quality and safety were not being met. This was an unannounced inspection.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

This is a summary of what we found-

Is the service safe?

The majority of people who lived at Roseacre were unable to verbally communicate with us about how they felt about the staff and whether they felt safe. However, through our observations we saw people responded to staff and approached staff in a relaxed manner.

Upon arrival at Roseacre we found arrangements were in place to keep the building secure during the night and early morning.

People who lived at Roseacre were cared for in an environment which required re-decoration. Although the provider had recognised the internal decoration and fabric was in need of repair and improvement, we were particularly concerned with the decoration of some of the bedrooms. Flooring was ripped, and some walls were severely damaged. We noticed in one bedroom the flooring had become ruffled, which could increase the risk of falls to the person and to staff. In some bedrooms furniture was damaged.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The recent judgement made by the Supreme Court on 19th March 2014 places a responsibility on providers to ask two key questions; is a person subject to continuous supervision/control? and is the person free to leave? If a person is subject to both continuous supervision/control and not free to leave, then a person is being deprived of their liberty. We found there was a code on the front door to the home, which meant people who lived at Roseacre where unable to come and go as they pleased and the garden was secure. However, it was not clear from people�s care plans how the provider had considered this having regard to the DOLs legislation.

Is the service effective?

Prior to our inspection the Commission received information of concern regarding a number of aspects relating to the care and welfare of people who lived at Roseacre and as part our inspection we looked at the concerns which had been raised. As one of the concerns raised related to the time at which people were being assisted out of bed in the morning, we started our inspection visit at 6.00am.

During the time between 6.00am and 7.00am we observed there were seven people dressed in the lounge, four of these people were asleep in their chair. People who had been awake and up since approximately 5.00am did not receive a drink until approximately 6.40am.

At about 8.15am the night carer handed over to a member of the day team that there were just three people who remained in bed out of the 18 who lived at Roseacre. Although, care records said that it was people�s preference�s to get up at this time, we were concerned about how people�s wishes were being assessed and about how people were supported during this time. It was not clear how the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLs) was being used to ensure that the decisions which were being made for people, were being made in the persons �best interest�. The MCA and DOLs provide a legal framework that protects people who lack the mental ability to make decisions about their life and welfare.

Is the service caring?

During our inspection we observed the majority of people were supported by staff who were respectful in their approach. It could be observed and through our conversations with staff we saw that they were passionate about the people they supported and that they cared for them. However, we found staff were not always tactful in their approach, particularly when dealing with sensitive care issues, such as continence.

One person we spoke with told us, staff were �pretty good, I can�t grumble�. However, this person also told us that they felt staff did not always have time talk.

Is the service responsive?

We saw staff, were responsive to people when they required assistance. Care records detailed people were able to access services outside of the care home to ensure their health and wellbeing.

We found care records and risk assessments were not always reflective of people�s care needs. This meant the manager and provider could not demonstrate the care being delivered was in line with people�s choice, wishes and expectations.

Is the service well-led?

The service had a manager who was registered with the Care Quality Commission. People who lived at Roseacre where unable to verbally communicate with us to share whether they found the manager approachable and whether they felt the service was well-led. Our observations of people showed the manager approached people in a kind manner and people responded in a relaxed way.

Staff we spoke with told us they felt the management of the home was supportive and that they could speak with the manager or provider at any time.

During our inspection the management team was visible to staff and to the people who lived at Roseacre.

We found the manager and provider did not have effective systems in place to monitor the quality of the service being provided. We found the monitoring and auditing of care records required improvement.

Inspection carried out on 10 December 2013

During an inspection in response to concerns

We spoke with three people living in the home, manager and three care staff. One person living there told us �they treat me well.�

We saw that people�s plans of care reflected individual needs and were personalised. These were up to date and included accurate information about how people�s health should be managed.

Medicines were being safely administered and recorded.

There were suitable numbers of experienced staff to look after people and their varying needs.

Inspection carried out on 4 June 2013

During a routine inspection

Some of the people who lived at the home were unable to fully express their views because of their dementia. We therefore spent time talking with staff and observing care practices as well as talking to people who could tell us their experience of living at the home. We were also able to meet with two visitors and one visiting professional.

We observed that staff spoke with people in a friendly and polite manner. People told us that staff were always polite and respectful. People said that they were able to make choices about their day to day lives. One person said "I pretty much do as I like." We saw that anyone who wished to move into the home had their needs assessed before a place was offered. This ensured that the home had the skills and facilities to meet each person's individual needs. From the initial assessment a care plan was written which demonstrated how needs would be met. Care plans that we looked at were personal to the

individual and gave clear information for staff to follow. This made sure that people received care and support which meet their individual needs.

There were suitable safe storage facilities for medication including storage for medication which required refrigeration. Medicines were handled in a safe way so that peoples health was promoted

Throughout the day we saw that staff were competent and cheerful. There was a very relaxed atmosphere and everyone had opportunities to take part in activities according to their abilities and interests.

The home kept a log of all complaints and concerns raised. We read the log and saw that all concerns were responded to.

During a check to make sure that the improvements required had been made

We followed up one area of non compliance identified in the previous inspection. We reviewed evidence provided by the service that demonstrated the providers compliance in this area.

Inspection carried out on 25 June 2012

During an inspection looking at part of the service

We (the Care Quality Commission) carried out this inspection to follow up on what progress had been made with those standards of care which were not compliant with the Health and Social Care Act 2008 at our inspection in December 2011.

We reviewed all the information we held about this provider and we made an unannounced visit to the home on 25 June 2012. We talked with people who used services and a visiting health professional, talked with three staff, checked the provider�s records and looked at the care records for three people who use services. We spoke with the registered manager of the care home.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people�s choices and preferences. We saw that people were spoken with in an attentive, respectful, and caring way which supported their dignity.

We talked with two people who lived in the home. We were not able to communicate effectively with everyone due to their physical or mental health needs. Comments from people who lived in the care home included, �Staff have all been very kind' and '(I have) no problem with the staff�.

We found that the home was cleaner than our previous visit and there were no offensive odours. There was evidence that the management of the home had taken a robust approach to addressing the hygiene and infection control issues. Considerable work had been done, and was continuing to be done, to refurbish and redecorate areas of the home identified at the previous inspection in December 2011.

We saw that medication systems had been audited and work undertaken to address the shortfalls in practice to ensure that the systems used at Roseacre were safe for people using the service.

We pathway tracked three people who used the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them and observed staff working with them. We found that care plans were not sufficiently detailed or reviewed to ensure safe and appropriate delivery of care. However, we saw care being given by staff and people's needs being met.

We looked at the auditing systems of the service. We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified. However some areas of monitoring need to be addressed to ensure that all areas are reviewed and action taken to address any issues identified.

Inspection carried out on 1 December 2011

During a routine inspection

Prior to this inspection we had received concerns that the home has equipment which was in poor condition and the home has a poor standard of hygiene

People we spoke with, said they were very happy living in the home. One person said that �You can�t find much wrong here, you would be lucky to find anywhere perfect but this is as good as it gets�. People, who were able to speak with us, were very positive about the staff support they received.

We saw people�s privacy and dignity being respected and staff being helpful. There were no issues raised by people using the service or staff.

People told us that they are able to get up when they want and have choices about where they spend their time and what they do. They told us that visitors and were made very welcome and we saw people being supported to speak to their relatives by telephone.

People said �The food is very good here; we have a choice of what to eat�

�I am very happy here, it is a very nice place to be�

�Staff are pleasant and nice, they always seem to find the time for you�.People using the service, who were able, said that they can speak to any of the staff about anything.

Staff told us they enjoy working in the home. Staff said they felt that the people using the service could �happily� approach staff with any questions or concerns or they could tell if something was wrong because they knew people so well.