Archived: Roseland

Roseland is a residential care home providing support for up to 39 older people. The service provides support to people who have frailty, disabilities and may be living with dementia. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

The management of risks to people were unsafe which included people’s nutrition, hydration, health, and mobility risks. People did not all have fire evacuation plans in place and the environment was not always safe for people. People were having frequent incidents and accidents and insufficient steps were being taken to mitigate these risks. People’s medicines were not being managed in a safe way which put people at risk of harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider failed to ensure that safeguarding concerns were investigated and reported appropriately. There were not sufficient staff to support people at the service. The recruitment of staff was not robust.

There was a lack of provider oversight of care at the service. The provider failed to have a registered manager in place which is a requirement of their registration. Audits were not effective in identifying shortfalls. Staff did not always feel valued or listened to.

There were people who felt they were safe with staff. People, relatives and staff fed back positively about the manager at the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 December 2023)

Why we inspected

We received concerns in relation to the management of risks associated with people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant key question safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roseland on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the unsafe management of risks to people, poor management of medicines, safeguarding concerns not being investigated and reported, deployment of staff not being effective and poor leadership and oversight.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Roseland is a residential care home providing personal care, diagnostic and screening procedures and treatment of disease, disorder or injury to up to 39 people. The service provides support to people over 65, some of whom live with dementia. At the time of our inspection there were 26 people using the service. Roseland accommodates all people in one adapted building spread over two floors.

People’s experience of using this service and what we found

People were not always protected from the risk of harm. Risk assessments were not always included in care plans and risks to the environment were not always safely managed to ensure a good level of safety in the home. Medicines were not always safely managed, this included two people sharing a prescribed medicine and various management records being inconsistently completed.

Quality audits had not always identified the concerns we found at this inspection. Staff meetings and resident meetings were not held regularly to ensure people had an opportunity to express their views.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People received support to maintain a balanced diet.

Staff were kind and caring towards people. We saw interactions between staff and people that were respectful and dignified.

People were supported to take part in activities that were aligned with their preferences. There was a complaints procedure in place and people spoke highly of the management team and the staff approach to any concerns raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 27 January 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Roselands is a residential care home providing personal care for up to 39 older people some of whom were living with dementia. The home is a large purpose-built care home run by Banstead, Carshalton and District Housing Society which is a Not for Profit Charitable Society. At the time of the inspection there were 19 people living at the service.

People’s experience of using this service and what we found

Since the last inspection a new manager had started at the service who had submitted an application to register. Improvements were still required around the environment of the building however the manager was committed to driving forward these required improvements. There were sufficient staff at the service who provided safe care to people. Risk associated with people’s care was managed well by staff. People told us they felt safe at the service and staff ensured they were protected from the risk of abuse and neglect.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff received appropriate training in relation to their role and were encouraged to progress.

People enjoyed the meals at the service and where they were nutritionally at risk staff assisted them with this. Staff ensured that people were supported with their ongoing health. Staff were valued and this impacted, in a positive way, how they undertook their role. The provider was facilitating visits for people living at the service in accordance with the current guidance.

Rating at last inspection

The last rating for this service was Requires Improvement (published 29 October 2021) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out a focused inspection of this service on 30 September 2021. Breaches of legal requirements were found that were repeated breaches from previous inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, the assessment of people’s capacity to make decisions where needed and oversight and audits of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roseland on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roselands is a residential care home providing personal care for up to 39 older people some of whom were living with dementia. The home is a large purpose-built care home run by Banstead, Carshalton and District Housing Society which is a Not for Profit Charitable Society. At the time of the inspection there were 20 people living at the service.

People’s experience of using this service and what we found

The leadership at the service was not robust and there was a lack of auditing to review the quality of care which impacted the care people received. There had been continuous breaches of regulations since 2019. Where shortfalls in care had been identified with staff around the recording on medicine records this had not been addressed. Staff did not always feel supported or valued. Risks associated with people’s care was not always being managed in a safe way. Incidents and accidents were not always followed up on to avoid the risk of reoccurrence.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People and relatives fed back there were enough staff at the service and we observed this during the inspection. Staff ensured that health care professionals were contacted when people became unwell. People received their medicines when they needed. Staff told us they felt the training they received had improved.

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 August 2021) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found there were some improvements however the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 8 July 2021. Breaches of legal requirements were found for safe care and treatment, need for consent and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseland on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment, consent and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roselands is a residential care home providing personal care for up to 39 older people some of whom were living with dementia. The home is a large purpose-built care home run by Banstead, Carshalton and District Housing Society which is a Not for Profit Charitable Society. At the time of the inspection there were 21 people living at the service.

People’s experience of using this service and what we found

The management of medicines was not safe and put people at risk. We found insufficient action had been recorded on accidents and incidents to ensure preventative measures had been put in place. Although people were asked for consent during the inspection, where people lacked capacity to make decisions appropriate assessments of this had not taken place.

Whilst we saw improvements at the service there was a lack of robust audits taking place to ensure quality of care. The deployment of staff required improvement to ensure that people were safe at all times. We have made a recommendation around this.

People and relatives were very complimentary about the caring nature of the staff and management team at the service. Our observations confirmed this. Staff were aware of the risks associated with people’s care and ensured that people were provided the most appropriate care.

People were supported with activities that were meaningful to them. People felt safe with staff and staff understood what they needed to do if they suspected abuse or neglect. There was a choice of nutritious food and drink available to people. Staff ensured that health care professionals were involved in the ongoing care with people. Health care professionals fed back they had seen improvements with the engagement from staff since the last inspection.

Rating at last inspection and update

The last rating for this service was Inadequate (published 24 December 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found there were some improvements however the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roseland on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks related to, safe care being provided to people, ensuring consent to care was being sought and the lack of robust provider and management quality assurance at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roselands is a residential care home providing personal care for up to 39 older people some of whom were living with dementia. The home is a large purpose-built care home run by Banstead, Carshalton and District Housing Society which is a Not for Profit Charitable Society. At the time of the inspection there were 21 people living at the service.

People’s experience of using this service and what we found

People did not always receive care when they needed as there were not sufficient staff deployed at the service. Medicines were not always being managed in a safe way which put people at risk. The maintenance of the environment required improvement and equipment was not always fixed in a timely way.

People told us staff were kind and we did observe this however we found that systems were not in place to ensure that people were protected from the risk of abuse. Risks associated with people’s care were not always being managed appropriately.

There were insufficient audits taking place to review the quality of care. People and staff did not feel there was a strong leadership presence in the service. Staff did not always feel supported or valued. Notifications were not always sent to the CQC when required and the service was not displaying their CQC rating appropriately.

The service was clean, and staff adhered to appropriate infection control measures. However, we have made a recommendation around staff ensuring that visitors attending the service during the COVID pandemic are asked for information on their health.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 14 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This included some continued breaches as well as new breaches of legal requirements since the last inspection.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 November 2019. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they were now meeting legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for this service has deteriorated to ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roseland on our website at www.cqc.org.uk.

Roseland is a residential care home providing personal care to 33 people aged 65 and over at the time of the inspection. The service can support up to 39 people. Care was provided across two floors in one purpose built building, with communal lounges, gardens and a dining area.

People’s experience of using this service and what we found

People told us they felt safe but we found shortfalls with furniture and equipment that could impact on people’s safety. Restrictions had been placed upon people without the correct legal process being followed. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider’s auditing and governance systems had not identified or addressed the shortfalls we found on this inspection and the provider was not notifying CQC of incidents and events that they were legally required to do so.

There was not always sufficient information in records to inform staff about how to administer medicines to people safely. Improvements to medicines and incidents were made after the inspection. People had detailed care plans in place but work was in progress to move these to a new system. People's access to activities and outings was limited, so we made a recommendation about activities.

Care plans and assessment documented information about people’s routines and preferences and people liked the food that was provided to them. People were supported by caring staff who they got on well with and staff provided care in a way that encouraged them to be independent. Care delivery was dignified with people’s privacy being respected.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 25 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to furniture, equipment, consent, reporting and governance.

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 to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 4 May 2017 and was announced.

The home 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 carried out an unannounced comprehensive inspection of this service on 7 December 2016. At that inspection we found one breach of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to maintaining appropriate records. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This inspection found that the provider had taken the action they told us they had. This report only covers our findings in relation to the leadership of the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseland on our website at www.cqc.org.uk”.

The management team had worked hard to improve the standard of record keeping across the service. As such, we found that records were now a much better reflection of the support provided to people. Care plans and risk assessments now provided more information to ensure that new and temporary staff were able to deliver care in the same way as those staff who worked more regularly at the service.

The service was well-led and people praised the way the service was managed. The culture was open and person-centred. People and their representatives were encouraged to share their views and were routinely consulted about proposed changes and developments for the service.

There were systems in place to regularly audit and improve the service delivered. The provider had taken on board the recommendation from our previous inspection to adopt more formal systems for monitoring events within the service.

The inspection took place on 7 December and 12 December 2016. The first inspection day was unannounced.

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.

Roseland was last inspected on 14 May 2014 where we had no concerns.

We found one breach 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 made one recommendation as a result of this inspection. As such we asked the provider to consider adopting a more strategic oversight of falls so as to be more readily able to identify any themes or trends across the service.

Roseland is a friendly and inclusive service in which people were central to the care that was provided. The standard of record keeping at the service however did not accurately reflect the quality of care provided. In particular, whilst people received appropriate care, their care plans and risk assessments had not been kept up to date.

Staffing levels were sufficient and people’s needs which were met by a core team of staff who knew them well. Where temporary staff were used to cover staff vacancies, these were regular to the service and therefore they too had a good knowledge about people’s needs and preferences. The appropriate recruitment and ongoing monitoring and appraisal of staff had ensured that only suitable staff worked at the service.

Staff received training and support from the management team in order to deliver their roles and responsibilities in line with best practice. Roseland had an open culture and the management team coached staff to deliver high standards of care.

The service had systems in place to identify and manage risks to people and to maintain the safety of the service as a whole. People were further protected from the risk of abuse or avoidable harm, because staff understood their role in safeguarding them.

People had positive relationships with staff who took steps to ensure care was provided in a way that protected their privacy and dignity. People were encouraged and supported to both maintain and develop their independence and spend their time doing things that were meaningful to them.

People were actively involved in making decisions about their care and these choices were effectively communicated and respected by staff. Staff ensured appropriate consent was gained from people and delivered care in the least restrictive way.

People were supported to maintain good health and there were systems in place to ensure people received their medicines as prescribed. People had choice and control over their meals and were effectively supported to maintain a healthy and balanced diet.

People and their representatives were able to share their feelings and staff ensured that when people raised issues that they were listened to and people’s opinions were valued. Roseland had an active residents’ group who were routinely consulted about proposed changes and developments for the service. No formal complaints had been made against the service, but people and their relatives felt confident to raise concerns if needed.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

People who used the service told us they had no complaints, and felt safe at the home.

Staff knew about the risk management plans that had been written for people with particular needs.

Records showed that the provider had taken people's care needs into account when making decisions about the number of staff.

We saw people had a risk profile to identify potential risks and where identified there were individual and specific risk assessments to protect people from any identified risks.

At this inspection we found the previous concerns with safety, the environment and hygiene had been addressed and there were no new concerns identified at this inspection.

Is the service effective?

People who used the service told us they had no complaints.

People who used the service said the staff were nice and treated them well.

People's health and care needs had been assessed and care plans were in place. We saw that people had been involved in assessments of their needs and planning their care.

Is the service caring?

People who used the service said the staff were nice and treated them well.

A relative of a person who used the service that was visiting told us they thought the care was good, the staff were caring.

Two people sitting together said they used to be lonely but it's a friendly place and they had found friends at Roseland.

We saw several examples of staff speaking in a clam and respectful manner to people and saw them knock on doors before they entered to ensure respect and privacy was maintained.

We saw that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's care plans.

We noted that people were offered a trial period so that they could decide if they liked the home and staff and wanted to live there before they committed to stay.

Is the service responsive?

People who used the service told us they had no complaints and felt listened to.

The provider had a quality assurance process to assure that people who use the service could affect the way the service was run. The provider gave us an example of changes to the service that came about through this process. The example was a change in supper time following people saying it was difficult to make the original time.

We also noted there was an involvement document to record people's involvement in changes to the home. This recorded people's choices and the action taken.

We noted there were sufficient numbers of staff available to assist people in a timely fashion.

Is the service well-led?

Staff told us they did not have the support of one to one supervision sessions with their manager or regularly team meetings and there was no other support system, for example an employee support and counselling line.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction surveys and the provider had analysed these and made changes to service provision to ensure they provided good quality care.

We saw that the home was subject to external audits, including for example, finances and medication.

We noted that the chairman attended the home on a regular basis to keep updated and in touch and also did their own audits and checks with any actions required recorded.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We noted that the complaints system was monitored for appropriate action needed, and to identify any overall trends where practice changes may be required to improve quality for everybody.

We found that written procedures had not been put in place to plan for all forseeable emergencies that could arise.

People who used the service were not always being protected against the risks of unsafe or unsuitable premisis.

There was no system in place to assess that there was sufficient numbers of staff to be able to meet people's needs.

We found that not all staff training was up to date and they were not being regularly supervised.

Effective systems were not in place to identify, assess and manage all the risks to the health, safety and welfare of people who used the service.

There was a complaints system in place. People we spoke with that they knew who they could raise any complaints with if they needed to.