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Roseland Requires improvement

Reports


Inspection carried out on 20 November 2019

During a routine inspection

About the service

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.

Inspection carried out on 4 May 2017

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

Roseland is a care home which provides accommodation and personal care for a maximum of 39 older people, some of whom may also be living with dementia. The service does not provide nursing care and the provider was in the process of removing the regulated activities associated with nursing care. There were 35 people living at Roseland at the time of our inspection.

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.

Inspection carried out on 7 December 2016

During a routine inspection

Roseland is a care home which provides accommodation and personal care for a maximum of 39 older people, some of whom may also be living with dementia. The service does not provide nursing care and the provider was in the process of removing the regulated activities associated with nursing care. There were 37 people living at Roseland the time of our inspection.

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.

Inspection carried out on 14 May 2014

During a routine inspection

During our inspection we set out to answer our five questions; Is the service safe?, Is the service effective?, Is the service caring?, Is the service responsive?, Is the service well led?

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.

Inspection carried out on 24 May 2013

During a routine inspection

We consulted with eleven people who used the service. They spoke positively about their care and support. Comments included, "The staff always help with my personal care", "I am very happy with the care I receive","the staff are very caring and always take time to talk with us".

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.

Inspection carried out on 30 April 2012

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

We spoke with seven people using the service. Five people said that that their care needs had been discussed with them and they were aware of their care plan. A person�s carer also said that they were consulted about their relative's care plan.

All people we spoke with said that they were happy with their care and support. People said 'the staff were helpful, caring and friendly'.

Inspection carried out on 14 November 2011

During a routine inspection

People using the service were satisfied with the care and support they received. One person said that little things could be better such as the decoration in the home. People using the service said that staff were kind and caring.

Some people said they were able to choose whether they would like to join in the activities orspend time in their rooms. During this visit one person made a choice not to have their lunch in the dining room. We observed this person�s decision was respected by staff. People spoke positively about the variety of meals provided. They told us the food was very good and they had a choice of menu.

People we spoke with did not know about their care plan. The care plans we looked at did not show people using the service were involved in the care planning review process.

Staff had received some training but there were some training shortfalls, which needed to be addressed to ensure people get the right care, which is safe,

Although people were satisfied with their care there was no quality monitoring systems, which included seeking people�s views about the service through user meetings or feedback questionairres.

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