Roseacres

Roseacres is a residential care home providing accommodation and personal care to older people and people living with dementia. The service can accommodate up to 35 people and at the time of the inspection there were 29 people using the service.

People live in an adapted home spreading across two floors served by a lift. Some people have en-suite facilities while others share communal bathrooms located in close proximity to their rooms. People have access to communal dining, living areas and a large garden.

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

Whilst people and their relatives told us they received safe care, we found risks associated with people’s care and health were not always managed appropriately. In many cases, risk assessments lacked clear guidance for staff which could lead to poor care. Systems were in place to ensure staff were recruited safely, however, we found there were times when the service was short-staffed which could affect people’s care.

The provider had not addressed issues around the crowdedness of the lounge areas which we found at the last inspection. We found some areas in the service to be quite busy and noisy during certain times of the day.

The service had quality assurance systems in place, although these systems were not always effective as they had not identified the issues we found at this inspection.

People received their medicines safely and as prescribed. Staff received training in safeguarding and knew how to recognise and report signs of abuse. The service had implemented appropriate infection prevention and control measures to protect people, staff and visitors from catching infections.

People received a comprehensive assessment before their admission into the home which ensured they received the right care and support.

Staff were supported through robust induction processes, supervision and regular training. People were provided with healthy meal choices and stayed hydrated. Staff supported people to maintain good health and access a range of healthcare services when needed. 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. Where people were unable to make decisions about their care, the service engaged with their relatives and staff for feedback.

There was an open and inclusive culture at the service. People, relatives and staff spoke positively of the management and the support they received. The team worked in partnership with healthcare services and other professionals to achieve good outcomes for people.

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 6 November 2017).

Why we inspected

This focused inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the key questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We have identified breaches in relation to the safe management of people’s risks and good governance of the service, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager who had been in post for over three years. This 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.

Roseacres is a care home for up to 35 older people. At this inspection, the registered manager informed us there were 34 people using the service which was the maximum in practice. No-one shared a room. The service's stated specialisms include dementia, physical disability and sensory impairment. The building is an adapted home with passenger lift access to the first floor.

People who used the service, their relatives, and community healthcare professionals provided much positive feedback about the service. This helped establish the overall Good rating for the service.

Staff demonstrated positive, respectful and friendly attitudes towards people using the service. People received individualised care because staff knew their routines and preferences and supported them well. People could express their views and make decisions about their care, and retain their independence where possible.

There were enough staff working to keep people safe. Further recruitment was taking place to support the service at busiest times. A second activity worker was just about to start, to re-establish the seven-days-a-week activities program.

Systems were in place to ensure people were safe from hazards and abuse. The service was kept clean and there were appropriate infection control procedures in place.

There were strong systems for monitoring people’s health, nutrition and hydration. There was joint working with community healthcare professionals in support of this.

A new computerised system was helping to eliminate risks relating to medicines management, and so people were safely supported to take medicines.

The service ensured detailed and individualised care plans provided a foundation for people’s care and support. A keyworking system had been recently reintroduced, to help ensure care plans remained up-to-date, and to help families have a point of contact amongst staff.

The service was working to ensure consent to care and treatment followed appropriate practices, although there were occasional documentation shortfalls.

There was a positive and empowering working culture in the service, led by the experienced registered manager. Recruitment procedures, training and ongoing support ensured staff had the knowledge and skills needed for their roles and responsibilities.

There were a number of systems in place to promote good quality care and ensure safety risks were identified and addressed. For example, by listening to and addressing people’s concerns and complaints. There were effective governance structures such as ongoing audits to support learning and improvement at the service.

We undertook this unannounced focused inspection on 23 February 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these matters. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseacres on our website at www.cqc.org.uk .

Roseacres is a care home for up to 35 older people. At this inspection, the registered manager informed us there were 32 people using the service and there was a maximum practical occupancy of 34. The service’s stated specialisms include dementia, physical disability and sensory impairment. The premises is an adapted home with passenger lift access to the first floor.

The registered manager was present throughout the inspection. 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 found that the provider had followed their plan to address our previous concerns, and so they were now meeting legal requirements of ensuring appropriate care of people using the service. This was because individual assessments of risk and care plans were now kept up-to-date. This helped to ensure that where people’s care needs had changed, staff could read about their changed needs in their care plan and provide the right care.

We saw evidence that people received safe medicines support in respect of short-term medicines such as antibiotics, and that staffing levels were kept under review and increased when needed. Some new equipment had been bought to help with upholding infection control standards.

We also noted a range of positive feedback about the service, from people using it, their relatives, and community healthcare professionals.

At our inspection of the service on 2 January 2014 we found that some improvements had been made. Most records for people who use the service were accurate and up to date. We spoke with four staff who felt that there were some issues with paperwork which still needed to be improved, such as duplicated activity records. Most said they had attended meetings to discuss this, although not all had the opportunity to attend. The manager told us that weekly meetings were held with staff to discuss general issues, including care plans. Staff who worked part-time were not always able to attend, but this would usually be discussed on a one to one basis.

Care plans and risk assessments had been reviewed and care plan audits had taken place in October 2013. Medicines were now transported around the home in a locked trolley or box and taken to people securely. We noted that people had care plans in place to support the safe and consistent use of medicines to be taken 'when required.' We saw that people were given medicines safely and with consideration for their needs.

Staff recruitment records were up to date and most contained the relevant checks, including Criminal Reference Bureau (CRB). Staff told us they felt supported by their manager and seniors. Most felt able to approach their manager with any concerns, knowing this would be acted on. Staff commented, 'they are very understanding,' and 'things have improved since the new manager started.'

We spoke with people living at the home and observed care. Most people living at the home told us that they felt safe and staff treated them well. When asked if they were happy living at the home, one person responded, 'yeah, staff are nice.' Another person told us the 'food is nice, you get a choice; I like Irish stew.'

Systems were in place to monitor the quality of the service, however we were concerned that records relating to people using the service were not always accurate or up to date.

Although most people told us that they were treated well by staff, care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. Although there were care plans and risk assessments in place, we found that these had gaps. For example, there were no risk assessments to support the decision of the service to restrict people from using the garden.

Staff received training and told us that they felt supported by senior management. Nonetheless, we were concerned that the provider did not follow their own recruitment procedures in respect of staff employed by the service.

Medicines were kept safely. However, we were concerned that medicines were not always administered safely. Care records did not include guidelines or information about medicines prescribed that were to be given 'when required' (PRN). This meant people's needs may not have been met in a consistent manner.

There were some systems in place to gather information about the quality of the service provided to people. However, we were concerned that systems were not effective in ensuring care plans correctly identified people's needs and the provider's own recruitment practices were monitored.