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The Old Roselyon Manor Nursing Home Requires improvement

We are carrying out checks at The Old Roselyon Manor Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 25 May 2017

The Old Roselyon Manor Nursing Home is a care home that provides nursing care for up to 30 older people. On the day of the inspection there were 27 people using the service. Some people living at the service had a diagnosis of dementia.

We carried out this unannounced inspection of The Old Roselyon Manor Nursing Home on 10 April 2017. At the last inspection, in May 2015, the service was rated Good.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run. Comments included, “This is a very well run establishment” and “They are a competent and caring establishment.” However, the registered manager/provider had not kept up-to-date with changes in legislation in relation to the recruitment of staff and protecting people’s rights. Some audits, carried out by nurses to monitor the nursing care, had fallen behind due to two nurses being on long term sick. We found there were missing risk assessments, incorrect air mattress settings, some recording gaps for medicines, lack of analysis of falls and gaps in charts for when people needed to be re-positioned. We judged that the gaps in records and the lack of some audits had not impacted on the care people received. However, it showed that the management oversight of how the service was performing needed to be improved.

At the last inspection the service had a stable staff team, of care workers and nurses, who had worked in the service for many years. In recent months some care staff had left which resulted in the service needing to recruit new care staff. In discussions with the registered manager and assistant manager it was clear that the interview process was thorough. However, the service had not applied for a new Disclosure and Barring Service (DBS) check and instead had used the applicant’s copy of their DBS check, completed by a previous employer. This meant people sometimes received care and support from staff without the appropriate pre-employment checks in place.

There were two students working part time in the service, carrying out domestic duties, and the service had not applied for a DBS checks for either of them. While these staff did not provide direct care for people, it is still a requirement that any staff member, or volunteer, working in a care setting should have a DBS check.

Management did not have a full understanding about the legal requirements of the Deprivation of Liberty Safeguards (DoLS) and what practices might constitute a person being deprived of their liberty. For some people, who did not have mental capacity, the service had put measures in place to protect them from the risk of harm. However, the provider had not recognised these measures as restrictive practices and therefore had not made DoLS applications to the local authority as is required by law.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005.

People told us they felt safe living at The Old Roselyon Manor and with the staff who supported them. People and their relatives told us, “I am happy here”, “Can’t fault it” and “We are very happy with the service.”

We met with several people living at the service but some were unable to tell us their views about the care and support they received. However, we observed people were relaxed and at ease with staff, and when they needed help or support they turned to staff without hesitation.

Staff had received training in how to recognise and report abuse. Staff told us if they had any concerns they would report them to management and were confident they would be followed up appropriately.

On the day of our inspection there was a relaxed and friendly atmosphere at the service. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. People appeared to be well cared for and spoke positively about the care they received. Comments from people and relatives included, “Staff are very good”, “The girls are all very pleasant” and “Carers have a good knowledge.”

Healthcare professionals told us staff had good knowledge of the people they cared for and made appropriate referrals to them. Comments included, “Staff have a good rapport with people and good understanding of their needs”, “Staff kept us informed when necessary” and “I find it to be a lovely caring competent environment with good communication.” People and visitors told us they were confident that a doctor or other health professional would be called if necessary.

Safe arrangements were in place for the storing and administration of medicines. There were some missing signatures where two staff had not signed to confirm the accuracy of handwritten entries for prescribed medicines. Some people had been prescribed creams and these had not been dated upon opening. The provider told us systems in relation to this would be improved and we judged that this had not had an impact on the safety of how people received their medicines.

There were enough staff on duty to meet people’s needs. Staff received appropriate training and supervision. New employees completed a thorough induction and had the opportunity to attain a Diploma in Health and Social Care. However, the induction was not in line with the care certificate, which is an industry recognised induction that replaced the Common Induction Standards in April 2015. The provider assured us that all staff, who were new to the care industry, would complete the care certificate.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People were given plates and cutlery suitable for their needs and to enable them to eat independently wherever possible.

Care records were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff told us they felt supported by the management commenting, “Very good. Always approachable”, “Really happy working here, management are very approachable” and “I would put my Mum in this home.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

Inspection areas

Safe

Requires improvement

Updated 25 May 2017

The service was not entirely safe. Recruitment procedures did not include all of the appropriate pre-employment checks.

Records in relation to people’s care and risk management were not always accurately completed.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs

Staff knew how to recognise and report the signs of abuse.

People were supported with their medicines in a safe way by staff who had been appropriately trained.

Effective

Requires improvement

Updated 25 May 2017

The service was not entirely effective. People’s legal rights were not fully protected because the provider did not have a full understanding of the requirements of the Deprivation of Liberty Safeguards

Staff had a good knowledge of each person and how to meet their needs.

People saw health professionals when they needed to so their health needs were met.

Caring

Good

Updated 25 May 2017

The service was caring. Staff were kind and compassionate and treated people with dignity and respect.

People and their families were involved in their care and were asked about their preferences and choices.

Staff respected people’s wishes and provided care and support in line with those wishes

Responsive

Good

Updated 25 May 2017

The service was responsive. People received personalised care and support which was responsive to their changing needs.

Staff supported people to take part in social activities of their choice.

People and their families told us if they had a complaint they would be happy to speak with the registered manager and were confident they would be listened to.

Well-led

Requires improvement

Updated 25 May 2017

The service was not entirely well led. People, their families and healthcare professionals were positive about the management of the service. However, the provider was not aware of current legislation in relation to the recruitment of staff and protecting people’s rights.

Systems to assess and monitor the quality of the service provided to people were not entirely effective.

The management provided staff with appropriate leadership and support. There was a positive culture within the staff team and with an emphasis on providing a good service for people.