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Inspection carried out on 21 August 2017

During a routine inspection

This inspection took place on 21 August 2017 and was unannounced. It was carried out by two adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Rosecroft is a residential care home that provides care and accommodation for up to 51 people. The home is a purpose built property that has been updated and improved on by the provider. It is situated in a residential area of Workington near to local amenities and with good access to public transport. Accommodation is in single rooms. The home has suitable outdoor areas for people to enjoy. The home has a specially designated area for people living with dementia. This area is secure to ensure people can be as safe as possible.

The home had a suitably qualified and experienced registered manager. 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.

We judged that the staff team understood the safeguarding of vulnerable adults. They knew how to protect people from harm and abuse. The team had received suitable training and were able to talk to senior staff about any concerns.

Staff were recruited appropriately with checks and references taken up prior to the new staff member having contact with vulnerable people. The home was suitably staffed and rostering ensured that staff were available to meet people's needs.

Medication was being managed correctly with suitable systems in place for ordering, storage and administration. Staff received training on the use of medicines.

Staff development was high on the agenda of the registered manager and the home's trainer. Staff displayed good levels of skills and knowledge. Supervision, training and appraisal were up to date.

Staff understood their responsibilities under the Mental Capacity Act 2005. People were asked about consent. Where people found this difficult a 'best interest' meeting was held to ensure the person had help with decision making. Where staff had judged a person to be deprived of their liberty suitable authority was sought so that the team followed the legislation.

People in the home were very complimentary about food on offer. People were helped to get suitable food and fluids. Where there were problems the staff called on health care professionals and included guidance in care plans.

The staff team called on health care professionals appropriately. We met nurses and a GP who were satisfied with the health care support given to people.

The home was clean, orderly and well maintained. We noted that all areas were well decorated and suitably furnished. The provider had made improvements to the property over the years.

We observed staff interactions with people in the home. We judged the team to be very caring. We saw polite and patient interactions. People were treated with respect and given suitable levels of support to ensure dignity was maintained. The team could access support from advocates if necessary. The staff helped people to stay as independent as possible.

Health professionals told us the team worked well with them to ensure end of life care was done appropriately. We had evidence to show that the team helped people, and their families at this time.

Care planning was up to date and most of the care plans gave suitable guidance for staff to give people good levels of care and support.

We made a recommendation which would enhance care planning. We recommended that nutritional planning would benefit from more detail and that, for some people, contingency planning would be of benefit.

Activities and entertainments were varied and regular. People were looking forward to a short break h

Inspection carried out on 26 November 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 21 and 23 April. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosecroft Residential Home on our website at www.cqc.org.uk

This focused inspection took place on the 25 November 2015 and was unannounced. When we previously inspected this service on the 21and 23 of April we found that the service was in breach of regulations relating to medicines and record keeping. During this inspection we found that the service had carried out the necessary improvements and were no longer in breach of the Health and Social Care Act Regulations.

Rosecroft Residential Home provides care and accommodation for up to 51 older people. Situated in Workington it is a large detached property set in its own grounds. The accommodation is over two levels, on the ground floor is a small unit for people who live with dementia.

The service had a registered manager. 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.

We found that the service had made sufficient improvements to the way it managed medicines.

The service had improved the way it planned people's care and the written records of care reflected this.

Inspection carried out on 21st and 23rd August 2015

During a routine inspection

This inspection took place on the 21st and the 23rd of April and was unannounced. We had previously inspected Rosecroft Residential Home on the 11th September 2014.

Rosecroft Residential Home provides care and accommodation for up to 51 older people. Situated in Workington it is a large detached property set in its own grounds. The accommodation is over two levels, on the ground floor is a small unit for people who live with dementia.

The service is currently in the process of registering a manager. 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 our previous inspection we found the service was in breach of the regulations relating to medicines and record keeping. We saw that the service had made some improvements. However they remained in breach of regulation 12 (f) and (g), management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

The service had sufficient appropriately recruited staff available to support people.

Staff were well trained and supported people to live independently.

The food that was available was nutritious and people had been assessed to ensure they took appropriate diet.

Staff were caring and friendly and knew the people they looked after well.

Some care plans were comprehensive and based on thorough assessments. Other care plans were basic and did not outline strategies to support people in enough detail. We judged that this required improvement.

The home had undergone a change of leadership. The new manager demonstrated that they were keen to improve and implement new ideas. There was a quality assurance system in place at the service.

Inspection carried out on 11 September 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with use and management of medicines because they were not administered and recorded correctly. We found that care plans for the management of medicines and associated medical conditions were either not followed or did not address the needs of the people who lived at Rosecroft Residential Home. This meant that staff did not always follow or have clear guidance available to them to make sure that people received appropriate care.

Is the service effective?

People were protected from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were cared for by warm and friendly staff who were knowledgeable about the people they cared for.

Is the service responsive?

People were cared for effectively because the staff worked in conjunction with other providers to ensure people's needs were met.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who used the service and staff had been consulted with about changes and they had been listened to. The manager provided leadership and was aware of areas that required improvement.

Inspection carried out on 22 April 2014

During an inspection in response to concerns

The inspection was carried out by a pharmacist inspector. We set out to answer three key questions; Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and people who use the service, looking at supplies of medicines and looking at records.

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

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with use and management of medicines.

People did not receive their medicines at the times they needed them and in a safe way. Medicines were not administered and recorded appropriately, and were not kept safely.

Is the service effective?

We found that care plans for managing medicines were poor and staff did not have clear guidance available to them to make sure that people received appropriate care.

Is the service well led?

We saw that audits, or checks of medicines, were done to assess the way medicines were managed. However, we had concerns about the way medicines were handled and these were not identified or managed appropriately through the audits.

Inspection carried out on 24 March 2014

During an inspection in response to concerns

This responsive inspection was undertaken because concerns had been raised about the care and support provided to the people who lived in this home. We had also been told that there was insufficient staff employed to provide the level of care to meet people's assessed needs.

During our visit, we walked around the building, spoke to people who lived in the home and talked to the staff on duty. This included care staff, domestic and catering staff.

People told us:

“I am very happy here and I made up my own mind. I just couldn’t manage on my own any longer”.

“There is always plenty of staff and when you ring the bell they are there in seconds”.

We looked at the care and support documents and found the care plans and risk assessments still did not fully reflect people’s individual needs and preferences. Nor did they clearly direct staff in the safe delivery of care. In all the care plans we looked at none of them were sufficiently robust to ensure staff were given enough information to fully meet the needs of the people they supported.

Dietary requirements were not always recorded which meant people could become malnourished or dehydrated.

We found that staff did not routinely read the care plans to familiarise themselves with all the assessed needs.

We looked at the staffing levels on the day of our visit and found there was sufficient numbers of staff on duty to provide care and support to those who used the service. Although we saw, in the dementia unit, good interactions between the staff and the people they supported staff had not completed any training in dementia care.

Inspection carried out on 8 August 2013

During a routine inspection

People we spoke with told us they were "very happy" with the care provided in the home. They told us, "The staff are wonderful, they are very kind and nothing is too much trouble”.

People we spoke with told us the food was good. One person told us,''Sometimes they give you too much, but it's all good.'' Another person told us,''It's very tasty.'' A relative we spoke with told us how they were invited to stay for meals whenever they visited. We were told by staff that this was normal practice.

One person who used the service told us, "Everything here is very good. They look after me well. I only have to ask and they attend to it. The staff can't do enough for me. I just wish there was more of them (staff)." We asked this person if they had all their needs met in a timely manner and this was confirmed.

One person we spoke with told us about the suggestions made by a number of people living at Rosecroft had been acted upon. They had recently requested a greenhouse and this had been ordered. This would allow people to grow their own vegetables and support their gardening projects.

We found that people's personal records including medical records were accurate and fit for purpose. Staff records and other records relevant to the management of the services were properly maintained. Records were kept securely and could be located promptly when needed.

Inspection carried out on 27 June 2012

During a routine inspection

The people we spoke with confirmed they had been involved in the ongoing assessment of their care which had identified their religious and cultural, care, nutritional and relationship needs and that they had agreed with the level of support to be provided. They told us their views about how they wished their support to be delivered had been listened to and respected.

People told us they were well cared for and treated with respect in the home.

One person said, “I feel very well cared for, you get the attention when you need it.”

People also told us:

“Staff are brilliant, I am definitely well looked after.”

"The staff are very attentive, they always come very quickly when I need assistance."

“You get well treated here, I have no complaints.”

"The staff are very good, they will do anything for you."

“Staff are very friendly, they always have a good laugh with you.”

Reports under our old system of regulation (including those from before CQC was created)