Archived: Rosemont Residential Home

During the previous inspection in September 2014 we found there were breaches of regulations. Care plans did not always provide enough information about how risks associated with care were going to be managed. There was no evidence staff were being supported in their role. The service was not being monitored for quality and audit purposes. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’.

The service had a registered manager in post. 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.

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed staff had a good relationship with people and supported them in a caring and respectful way. People were being cared for by competent and experienced staff. A family member told us, “I just can’t thank the staff enough. (Person’s name) has settled so well but a lot of that is because the staff have been wonderful.”

The service had taken action to improve the recording of people’s care needs and associated risks. Development was on-going to transfer the current care planning system onto an electronic system which would provide a more structured information record and include prompts for staff. For example, staff would be automatically alerted when care plan reviews were due.

Systems for supporting staff had been improved. Staff were receiving regular supervision meetings with the registered manager and annual appraisals to look at personal development and training. A staff member told us, “I feel very supported by the manager. Always there for you.” Staff meetings and regular daily updates were used to share information about operational issues.

Action had been taken to improve how Rosemont monitored the quality of the service people received. This included regular meetings with staff. Informal and formal meetings with people using the service and their families. The registered manager was carrying out regular reviews of policies and procedures as well as being part of an external care association which looked at current good practice in the care sector.

Checks had been made and were in date for the maintenance and servicing of gas, electric and fire systems. All other equipment used by the service to support people were well maintained and regularly serviced as per equipment guidance.

Staff understood the needs of people they supported, so they could respond to them effectively. They told us they felt supported and had the resources they needed to carry out their role. Comments included, “(Registered managers name) is very supportive to us (staff). They help us out if we need that extra support” and, “There have been a lot of changes”.

Staff supported people to be involved in and make decisions about their daily lives. There were systems in place to help ensure staff acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was to protect people and uphold people’s rights where they faced restrictions due to lack of mental capacity.

There were a range of activities for people to be involved in. This included games to support people with memory loss. A bowling set designed specifically for people with hand or co-ordination issues had recently been delivered and was providing a lot of interest. In addition entertainers visited the service on a regular basis. There was a library available and one person told us they particularly liked to use this as they were a keen reader. Where people chose not to be part of any activities this was respected by staff.

Staff received a thorough induction when they started working at the service. Training was regularly refreshed and staff told us it was effective. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure staff were suitable to work in the care sector.

People were protected from the risk of abuse because staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff told us they supported people in a way that kept people safe.

People received their medicines when they needed them and staff knew how to administer and record medicines safely.

People told us they knew how to complain and would be happy to speak with the provider if they had any concerns. No concerns had been reported since the previous inspection.

People using the service and visitors all described the management of the service as open and approachable and thought people received good care and support. Relatives told us, “We chose this home because it’s local and when we visited we knew it was right for (Persons name)” and “I am always made to feel welcome. The manager and the staff tell me what’s going on with (Persons name).”

The inspection was carried out by one inspector. The information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who live at Rosemont, relatives, and other professionals, and staff. We looked at a number of care planning records to support our judgements.

Is the service safe?

At this inspection we found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and detailed care plan records were not always maintained. However we did see evidence care planning and risk management systems had recently been reviewed and were now being implemented so risk management had improved.

Records of an incident had not been accurately recorded. There was no analysis of this incident undertaken. This showed us the risks posed to people had not been safely managed. However we did see improvements had been made in how incidents were now being reported and acted upon which ensured they were being responded to and managed more effectively.

Notifications regarding serious injuries to people were not being completed and reported to the appropriate authorities including the Commission.

Is the service effective?

It was clear during our observations and by speaking with staff and relatives of people who used the service, that staff had an understanding of people's needs. However communication might not be effective due to some staff having limitations in their ability with language This was because for some staff English was not their first language.

At this inspection we found there were no systems in place to take account of people's mental capacity. Care planning had not taken account of where an assessment might be required or how staff might support people who lacked capacity. This meant staff may not recognise or act in a person's best interest should it be necessary for their protection.

Is the service caring?

We observed people around the home during the inspection. We saw staff supported people in a caring and considerate manner. People responded positively to this approach.

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were happy with the care being provided. One person said, 'They look after me really well. We only have to ask if there is anything we want. I love living here.' A relative commented on how considerate the staff were. 'The staff are very kind here. I wouldn't want x' to be anywhere else'.

Is the service responsive?

The service worked with other agencies including social services, nurses and healthcare professionals to make sure people received care and support in a consistent way. This meant people were supported by responsive services to meet their health and social care needs.

The home was being staffed satisfactorily to meet the needs of people living at the service. Staff members told us they had time to carry out their roles. One told us, "We work as a close knit team and help each other out". However staffing rotas did not reflect the accurate staffing numbers throughout the twenty four hour period. This was because the record did not include additional staff at the busiest time of the day including morning and evening periods. In addition there was no indication on the record to show what capacity staff were working in, including the level of seniority. This would show the skills mix of staff on duty.

We spoke with a visiting health worker who told us the home responded well to people's changing needs and reported any health concerns to them in an appropriate and timely manner.

Is the service well led?

Although the management team had begun to implement a range of systems to monitor the quality of the service, we were unable to measure the effectiveness due to the limited time the systems had been in place. However we did see how changes in care planning had improved to reflect a risk based approach.

This service was currently undergoing a management transition with the implementation of new management systems that aimed to improve and support people who live and work at the home. For example recent audits had taken place for medication supervision and staff training.

There was no documented evidence to demonstrate how the service took the views of people who used the service into account. However people we spoke with told us they spoke with staff members and usually the manager on a daily basis. Whilst there was no documented evidence to demonstrate consultation had taken place, there was no evidence people did not have the opportunity to express their views. Following two incidents affecting people who live at the service the provider had not notified the Commission. This meant that we did not receive all the information about the home that we should have done. We have asked the provider to tell us what they are going to do to meet the requirements of the Care Homes Regulations (2009), where the provider has a duty to report to the Commission any such incidents.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence to support our summary please read the full report.

IS THE SERVICE SAFE?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported. People told us that they felt their rights and dignity were respected. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff had received training in respect of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Through discussion they were able to demonstrate that they understood the principles of this legislation.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager set the staff rotas and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

IS THE SERVICE EFFECTIVE?

People's health and care needs were assessed with them, and some were involved in writing their plans of care. Specialist dietary needs had been identified where required. People said that their care plans were up-to-date and reflected their current needs. We spoke with one person's relative and were told they had regular input to the person's care and how it should be delivered. Other people we spoke with were aware that they could be supported by an advocate if needed.

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

We spoke with three people who lived at the home, comments included 'I am in good hands and the staff are very helpful' and 'I like it here, it' a good place to live."

We saw people, or their representatives, had signed care plan reviews to show they had read and agreed to the content of the care plan.

IS THE SERVICE CARING?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw people were given choices as to where and when they had their meals. We saw people choosing to eat their meals in their rooms; others ate in the communal dining area. People we spoke with told us 'lovely food' and 'I am quite ok here'. We saw one person access their cigarettes independently and go outside to enjoy a cigarette. This showed the home promoted people's rights to make their own choices.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

IS THE SERVICE RESPONSIVE?

We saw a file of compliments received by the service. We saw the complaints procedure clearly set out around the home on the walls. We looked at how complaints had been dealt with and found the procedure had been followed and any issues addressed.

People who used the service told us staff would always assist them when requests were made for help and assistance

IS THE SERVICE WELL LED?

Rosemont had regular support from the district nursing team and GPs from the local GP practices. This ensured people received appropriate care in a timely way.

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the home.

Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

We saw quality assurance procedures were followed and had improved since our last inspection. Further improvement in these systems could be achieved.

We spent time looking around the home and found it to be clean and tidy. One person told us 'They clean my room every day.'

There were suitable safe storage facilities for medication and medicines that had been administered were accurately recorded. Risk assessments had been carried out for people who self- administered their medication.

People told us 'the staff are very good.' We saw that staff who worked in the home had received training in areas to support people's needs.

We found that the home did not record the quality assurance checks. This meant that the provider was not continually monitoring the quality of the service provision.

We reviewed the care records for people currently living in the home and saw that they were offered care that ensured that their health and welfare needs were met.

Medicines were not managed appropriately to ensure that people received medication when it was prescribed for them and was stored safely.

Staff files did not hold the employment checks needed to ensure that the people using the service would be cared for safely. The home did not undertake any quality assurance checks

You can see our judgements on the front page of this report.