Roseacre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulations in relation to oversight of the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Aspects of the care and support provided at Roseacre did not reflect a positive, person-centred and empowering culture for people living there. People were frequently unoccupied, particularly those more reliant on staff because of frailty and disabilities. A member of staff commented, “I would not recommend Roseacre to anyone, and certainly would not entertain the idea of placing a relative of mine there.”

The service was not well maintained and there was an air of neglect. Areas of the building were tired, there were signs of water damage in people’s bedrooms. The front and rear gardens were untidy, garden furniture was tipped over and there was a large amount of discarded furniture and equipment at the front of the building.

Some members of the staff team who sometimes worked together were related, and others were in a relationship. There was no policy for this scenario. This meant managers and staff did not have appropriate guidance to follow to mitigate these inherent risks. Following the inspection the provider told us they had now developed a policy.

However, staff displayed a kind and empathetic approach. They knew the people they supported and there was an easy camaraderie between people and staff.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

We asked to review records for staff training. These were not made available for inspection either on-site or in the week following the inspection visit.

Records showed people had been involved in altercations. These had not been reported to either the local authority or CQC. One person had made an allegation against an unnamed agency worker. The provider had spoken with the person who had withdrawn the allegation and the provider concluded there was no evidence to substantiate it. There was no record of this investigation, and it had not been reported to the local authority or CQC.

The provider told us they completed background criminal (DBS) checks before new employees started work but there was not always a note of this on staff files.

There had been no registered manager in post for 21 months at the time of the inspection. A care manager and facilities manager were overseeing the service. The care manager had only been in post for 6 weeks. They had identified areas for improvement and told us they were committed to making the necessary changes. We observed people and staff were relaxed with managers who were both visible in the service.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

We asked to see meeting minutes for any recent staff meetings. However, these could not be located. A staff meeting had been planned to take place shortly after the inspection visits.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The service was geographically isolated and there were no public transport links. The provider had set up a mileage scheme to help recruit and retain staff. Staff were encouraged to take paid breaks. All staff had access to a healthcare scheme funded by the provider. The managers told us they were well supported by the provider.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

On the first day of the inspection the provider was away. Managers overseeing the service were unable to access any electronic records. This impacted on their ability to monitor the service. For example, they were unable to access staff files, they did not know what training staff had completed and if any was coming up for review.

A facilities manager was employed. They told us they were responsible for overseeing the safety of the premises. There was no job description to clearly outline their areas of responsibility.

Audits were not being completed in all areas. For example, there were no audits of accidents and incidents, care plans had not been reviewed for several months. The provider told us processes had not been consistently followed by previous managers and these issues would be addressed.

The service did not have effective systems for identifying people’s needs and care plans were not available for 3 people. This meant staff did not have access to the information they needed to safely meet people’s support needs.

Some records were missing or lacked detail. There was no system for checking mattress settings for people at risk of poor skin integrity. Daily records lacked detail and incidents were not always clearly highlighted.

The managers recognised the need to make significant improvements and were introducing new systems. This included a new care planning system and a system for allocating staff on shift with oversight of named residents to help ensure everyone received the appropriate care. However, it was too early to assess if these new processes would be effective and become embedded. Managers told us they were keen to start making improvements but recognised there was a lot to do. One commented, “I’m firmly in.”

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

We saw evidence external health care professionals were involved in people’s care. For example, GP’s and district nurses, however advice provided had not been consistently included in people’s care records. Feedback from external health care professionals was mixed. However, all felt the new managers were beginning to introduce some positive changes. One commented; “Clearly there has been some significant staff changes which has affected the overall organisation within the care team. However, the new team seem responsive and effective in their roles.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

There were no audits to monitor incidents and accidents, this meant opportunities to identify any trends and implement learning might have been lost. Staff supervisions had not been taking place, these are an opportunity for staff to identify any training needs and gaps in their knowledge.

However, the service was working with the local authority quality team to make improvements.