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The Old Roselyon Manor Nursing Home Good

Reports


Inspection carried out on 30 May 2018

During a routine inspection

We carried out an unannounced inspection of The Old Roselyon Manor Nursing Home on 30 May 2018. The Old Roselyon Manor is a ‘care home’ that provides care for a maximum of 30 adults. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 27 people living at the service. The service is on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a dining room, garden and patio seating area.

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 2008 and associated Regulations about how the service is run.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 10 April 2017. In April 2017 we found 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 nurse vacancies and sickness. We found there were missing risk assessments, incorrect air mattress settings, lack of analysis of falls and gaps in charts for when people needed to be re-positioned.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection the service’s recruitment systems had been updated to ensure all the relevant recruitment processes, including Disclosure and Barring Service (DBS) checks, had been completed before new staff started to provide care for people. This helped to ensure new staff were suitable and safe to work in a care environment.

People’s legal rights were protected because management understood the legal requirements of the Deprivation of Liberty Safeguards (DoLS). Some people lacked the mental capacity to recognise the decline in their physical capabilities, which potentially put them at risk of harm, such as sustaining injuries from falls. These people were subject to restrictive practices or continuous supervision to protect them from the risk of harm and keep them safe. DoLS applications had been made to the local authority to seek the legally required authorisation to have these restrictions in place.

There were effective quality assurance systems in place and audits were routinely completed. This included the introduction of new audits to check air mattress settings, the dating of creams on opening and the completion of re-positioning charts. A system had also been put in place for the analysing of incidents, such as falls, and where necessary changes were made to learn from events or seek specialist advice from external professionals.

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. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. In particular risks in relation people’s skin care and nutrition were being effectively monitored.

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 were happy with the care they received and believed it was a safe environment. Comments included, “I feel safe, I’ve used my call bell and they come quite quickly”, “I feel safe because staff know what they are doing”, “I know my relative is safe, I see it every time I come in. The staff know what they are doing great respect for them all”, “There’s laughter here and that’s important” and “It’s a happy atmosphere everyone is very cheerful.”

There were enough suitably qualified staff on duty and additional staff were allocated if peoples’ needs increased, such as when someone was unwell. Staff were supported by a system of induction, relevant training, one-to-one supervision and appraisals. Staff knew how to recognise and report the signs of abuse.

Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. A visiting healthcare professional said, “The way staff have worked with me to support one person to have a bath and the communication with the home has been fabulous.” Relatives told us staff always kept them informed if their relative was unwell or a doctor was called.

People had a choice of meals and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. Comments included, “We get given a choice of things and can always get a salad if we don’t want what is offered”, “The food is very good, it’s different every day”, “I have a choice of what I would like”, “The food is good, they give me a choice of two or three things.”

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

People were able to take part in activities supported by staff and external entertainers. These included, singing sessions, music entertainers, bingo, pamper sessions and visiting therapeutic animals from a local farm.

People and their families were given information about how to complain. People and their families were all positive about the management of the service and told us they thought the service was well run. Comments included, “One of the managers is always available to talk to”, “The manager is here every day”, “The girls know what they are doing, they get on with the job, very competent. It’s runs well here”, “It runs like clockwork and very well. Everyone appears to be cheerful and very competent” and “If you mention something they try to do it. The manager does what he can and the girls are very willing and always cheerful.”

Staff told us they felt supported by the management commenting, “The management is very good”, “The rotas are good, the manager tries to take each staff’s circumstances into account”, “Lovely management”, “The manager is very approachable” and “The manager always supports you if you have any personal problems, you know you can trust him as he keeps what you tell him private.”

The environment was clean and there were no unpleasant odours. Some areas of the premises were in need of re-furbishment, particularly two bathrooms. Work to build a single storey extension, to provide additional shared living areas, was planned to start shortly after the inspection. The two bathrooms were due to be upgraded as a part of the extension work. There was an on-going programme to re-decorate people’s rooms. Appropriate safety checks were completed to help ensure the building and utilities were safe.

Inspection carried out on 10 April 2017

During a routine inspection

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 carried out on 12 May 2015

During a routine inspection

We carried out this unannounced inspection of The Old Roselyon Manor Nursing Home on 12 May 2015. 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 28 people using the service. The service was last inspected in October 2013 and was found to be compliant.

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.

On the day of our inspection there was a calm and relaxed atmosphere and staff interacted with people in a kind and sensitive manner. There was a stable staff team who had a good knowledge of each person’s needs. People and visitors spoke well of staff and said staff had the right knowledge and skills to meet people’s needs. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

People told us they felt safe living at The Old Roselyon Manor Nursing Home and with the staff who supported them. People told us, “I feel safe”, “I am happy and safe here”, “very good I am happy here” and “no problems”. A visitor told us they had “no concerns” about the service.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

All health professionals told us staff had good knowledge of the people they cared for and made appropriate referrals to them when people needed it. People and visitors told us they were confident that a doctor or other health professional would be called if necessary. People were well cared for and were involved in planning and reviewing their care. There were regular reviews of people’s health and staff responded promptly to changes in need. Staff had good knowledge of people including their needs and preferences.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors in one of the lounges, the garden or in their room.

Staff were well trained; there were good opportunities for on-going training and for obtaining additional qualifications. Recruitment processes were robust and appropriate pre-employment checks had been completed to help ensure people’s safety. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

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 home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. People told us they knew how to complain but said they had never had any reason to complain. They told us the registered manager and staff were so good at asking for their views and listening to what they wanted that any situations that might give cause for concern had not occurred.

There was a management structure in the home which provided clear lines of responsibility and accountability. People told us the registered manager and staff were very approachable and regularly asked them for their views of living at The Old Roselyon Manor Nursing Home.

Inspection carried out on 18 October 2013

During a routine inspection

During our inspection we spoke with the registered manager and registered provider, six members of staff, three people who were living in at Old Roselyon Manor, and one person who was visiting their relative. People told us the staff were “caring and dedicated”.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Each person had a care plan in place which stated their individual needs. People had access to a range of services including hairdresser, chiropodist and GP’S.

People who used the service had their medicines at times they needed them in a safe way.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People told us their rooms were “nice” and “comfortable”.

The staff were supported by the registered manager. Training had been provided for areas such as manual handling, fire safety and infection control.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Inspection carried out on 22 May 2012

During a routine inspection

Some of the people using the service were not able to comment in detail about the service they receive. We did speak to 6 people who lived at Old Roselyon Manor, and a visiting relative. All the comments we received from people who lived at Old Roselyon Manor were positive. Comments from people included “I like it here, they make you so comfortable”, “nothing is too much trouble”, “there's always someone there if you need help”. We saw people’s privacy and dignity being respected and staff being helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.