Archived: Roseacre

Roseacre is a residential care home providing personal care for up to 40 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 24 people living at the service.

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

People were not protected against risks associated with their care. The environment and equipment were not always clean or properly maintained. These concerns were raised at the last inspection and continued at this inspection. Staff were not confident in raising concerns around neglect and abuse and had not received appropriate training in safeguarding to ensure their knowledge in this area.

Although there were elements of good infection control practice, the systems in place to protect people from the COVID virus were not robust. People’s medicines were not always being managed in a safe way. Accidents and incidents were not always recorded, and not enough action was taken to reduce further risks to people.

There were insufficient staff deployed to ensure that people received their care when needed. The registered manager and provider did not have appropriate systems in place to review people’s dependency levels to ensure sufficient staff were on duty.

We observed instances of staff being kind and caring. However, people were not always treated with respect and dignity. The leadership at the service was not robust and there was a lack of auditing to review the quality of care. Staff did not always feel supported or valued. Notifications were not always being sent to the CQC where it was appropriate to do so. Relatives said communication was poor and people did not have opportunities to give their views about the service.

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 13 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 not enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 5 December 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, Caring and Well Led which contain those requirements.

The inspection was also prompted in part by notification of an incident whereby a service user sustained a serious injury. The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.

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 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.

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

Roseacre is a residential care home which can provide care and support to up to 40 people ages 65 and over. At the time of our inspection 32 people were living at Roseacre. Care was provided in the main building which was divided across two floors and a separate high dependency unit for people living with dementia.

People’s experience of using this service

People acknowledged the condition of the building could be improved. We found shortfalls in the maintenance of premises and equipment. The governance arrangements at Roseacre had not acted effectively to identify and address these issues. Improvements were needed to strengthen the audit arrangements to include medicines and reviews of incidents and accidents to ensure lessons were learnt.

People told us they received their medicines as they needed them. There was clear information about people’s medicines to guide staff about how to administer them. We have made a recommendation about medicines auditing to bring this into line with best practice guidance.

People and staff told us Roseacre felt short staffed. Recruitment practices ensured staff were suitable but had not always been recorded properly. Roseacre did not use any assessments to determine their staffing levels and we have made a recommendation about determining staffing levels.

People told us they felt safe and that staff were kind and compassionate. People and relatives emphasised the family driven culture of the home. People received highly personalised care based on detailed care plans from staff who knew and cared about them. People and their relatives were involved in planning and reviewing care. People were encouraged and supported to plan for the last stages of their life in a kind and compassionate manner. People’s dignity was promoted and independence maintained.

People told us their relationships, culture and faith were supported and respected. People told us they were able to participate in activities that reflected their interests and preferences. Records confirmed this was how care was delivered. People knew how to make complaints but had not felt this was necessary.

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 the training and support they needed to perform their roles. Records showed the provider recognised the impact of staff wellbeing on their work life and made adjustments to facilitate staff where this was possible.

People spoke highly about the registered manager and the values they displayed and instilled in the service. Although engagement was mostly informal, people and relatives felt their views were considered and acted upon.

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 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to premises and equipment and, good governance. This was due to the failure to ensure equipment was appropriately maintained, and the lack of effective governance and quality assurance within the home.

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 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 17 January 2017 and 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.

Roseacre was last inspected on 29 July 2014 when we had no concerns.

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.

Roseacre was a friendly and inclusive service that provided support to people in a ‘Home from home environment.’ Many people had lived at the service for a number of years and had built friendships and new lives within the service.

The service was well-led and people’s needs were met by a team of staff who worked effectively together. Sufficient staffing levels were maintained. 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. The leadership team had fostered an open culture and coached staff to deliver high standards of care.

The service had good 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 lest restrictive way.

Each person was appropriately assessed and had an individualised plan of care which outlined how their needs would be met. People were involved at each stage of planning their care to ensure staff provided support in a way that met their needs, preferences and expectations.

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. Roseacre had an active residents’ group who were routinely consulted about proposed changes and developments for the service.

We found the provider had ensured there was a contingency plan in place for foreseeable emergencies. Restrictors had been fitted to all windows in the home. Allocations had been changed for staff that ensured people were supported at meal times in both units.

People that we spoke with on the day told us they were very happy living at the home. We were told it felt very homely and there was always plenty to do. 'The staff are very kind' one person told us.' Another told us 'I love my room it's just been decorated and I have an ensuite with a view of the gardens.'

People were able to choose their meals. People we spoke with said that they enjoyed their meals. Comments included,"The meals are good" and the service "Provides good home cooked meals".

People who used the service lived in a well maintained environment but window restrictors had not yet been applied to ensure people's safety and welfare.

We found people were cared for in a clean, hygienic environment. People we spoke with said that that they found the home clean

We found people were mainly cared for, supported by, suitably qualified, skilled and experienced staff but a needs analysis had not been undertaken to ensure there was always sufficient numbers of staff to meet people's needs.

We found that the provider had systems in place to monitor the quality of service that people receive.

We found that there was an effective complaints system in place. Comments and complaints people made were responded to appropriately.