Archived: Roseland Care Limited

Roseland Care is a care home providing personal and nursing care to 55 people some who are living with dementia. At the time of the inspection 31 people were living in the service.

The service is situated in a retirement village complex with access to communal facilities such as a restaurant, swimming pool, gym and extensive landscaped grounds. Roseland Care is a purpose-built care service with two floors.

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

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service.

All equipment was checked and serviced regularly. Suitable mobile lifting equipment was in place to meet people’s needs. However, the beds, designed to raise and lower, to protect staff posture where found not to go high enough to protect some staff. The area director, visiting the home during our inspection, made immediate arrangements to discuss this issue with the company.

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring. A tour of the service showed no bedroom doors closed unless personal care was being carried out. People who wished to remain in their bedroom did so. Those spoken with confirmed this was their choice.

Food offered and provided at lunchtime was piping hot, a good choice and appetizing. People spoken with said the food was; “Very Good” and “Very nice.” People mentioned in the concerns raised told us they made their own food choices on what was offered and had no concerns.

There were sufficient trained and qualified staff on duty to meet people’s needs. The manager informed us they were in the process of recruiting additional nurses and care staff.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per new government guidance.

People received their medicines safely and on time. One person confirmed their dressing was checked and changed regularly. They said; “They are very good at looking at it.”

Care plans included risk assessments and guidance for staff on how to meet people’s support needs. Risk assessment procedures were satisfactory so any risks to people were minimised.

The service was managed effectively. Staff were working well together, and one staff said; “X [the manager] is really supportive, they are a good role model.” The new manager has started the process of registering with CQC. There were had appropriate audit and quality assurance systems in place.

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 2 October 2020).

Why we inspected

We undertook this targeted inspection to check because we received concerns in relation to the management of medicines and dressing changes, shortness of staff including qualified staff in the service overnight, broken and faulty equipment, high/low bed not raising to a suitable level to enable staff to move people safely, people who we considered noisy left in their bedrooms with doors shut, poor diet and food choices and staff not working well together.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roseland Care provides accommodation with personal and nursing care for up to 55 people. There were 36 predominantly older people using the service at the time of our inspection.

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

Infection control measures were in place to prevent cross infection. The service held good stocks of Personal Protective Equipment (PPE) and staff had been trained in the safe use of this. The service had implemented regular testing for people and staff in accordance with Public Health England guidance. The service had experienced a significant impact from the Covid-19 virus. At the time of this inspection all people and staff had tested negative.

Since the last inspection improvements had been made to the cold storage of medicines. People received their medicines safely and on time from staff who had received training in medicines administration.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. Staff were well supported by a system of induction, training and supervision. Staff told us they felt well-supported by senior staff and the management team.

Staff understood risks to people and how to help reduce them. Systems were in place to safeguard people. People and relatives told us of the negative impact of the necessary visiting restrictions due to the Covid-19 pandemic. Some told us that technology had not been utilised as a way of keeping in touch, such as Skype. Some relatives told us that it was often difficult to get through on the telephone. Visiting in person was being offered outside with social distancing and full PPE was in place. The provider was planning inside visiting in line with current guidance. There were plans in place to allow families to see people in a relaxed convivial environment in poor weather.

Some relatives told us they felt they had not been kept informed of the extent of the outbreak of Covid-19 at the service. Whilst families were made aware of the outbreak, it was not possible for the registered manager to give continuous updates during the unprecedented pressure at that time. This unfortunately led to families hearing information for the first time through the media.

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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. People were able to make choices about their life and how their care and support were provided.

People and relatives agreed the staff were kind and caring. Staff respected people’s diverse characteristics and were clear that each person’s individual needs were their priority. People told us they felt listened to and their privacy and dignity were respected. Families told us, “We are very happy, Mum seems to have settled well” and “I cannot praise them enough, they are so good with Dad. They are straight on to everything and nothing is too much trouble for the staff.”

Everyone had a care plan which was regularly reviewed and updated. Since the last inspection improvements had been made to how changes in people’s needs were managed and recorded. Care plans provided staff with guidance and direction to enable them to meet people’s needs. People’s preferences were sought and respected.

A programme of activities was provided for people. Wellbeing co-ordinators supported staff to provide activities for people. Whilst the Covid 19 pandemic had restricted people’s movements around the service, staff held games and quizzes in the corridors, which people could join from their room doorways.

Since the last inspection action had been taken to improve the effectiveness of the audit process. Audits were carried out regularly to monitor the service provided. Actions from these audits were being followed up to further improve the service.

Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to. People and relatives told us they were confident that any issues raised would be addressed.

People and staff told us the service was well led. People were given various opportunities to provide feedback about the service.

Staff told us they enjoyed working at the service and that the team worked well together.

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:

At the last comprehensive inspection the service was rated as requires improvement (report published 24 February 2020). Requirement notices were issued.

This was a focused inspection carried out to review the enforcement action taken following the last inspection. We found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a scheduled inspection /to review the action taken by the provider following our previous inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roseland Care provides accommodation with personal care for up to 55 people. There were 34 predominantly older people using the service at the time of our inspection.

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

The provider had implemented increased monitoring checks and requirements for staff to complete additional records, since the last inspection. This was aimed at addressing some of the concerns found at the last inspection and to help ensure improvements were made in the records completed.

These records checks were mostly being completed. However, staff were not always checking if the information they were recording was correct and these records were not always effectively monitored. For example, staff had signed to say that a mattress was set correctly when it was not. The person’s weight had changed, and this had not been effectively communicated.

Care records were not always completed in a timely manner following care and support provided. Changes to people’s needs did not always prompt a review of their care plan. Care plans did not always guide and direct staff to carry out necessary care and support. This meant care records were not always accurate. However, we found staff were providing appropriate care.

The management of medicines was not always safe. The medicines audit was not identifying the concerns found at this inspection. People received their medicines on time from staff who had received training in medicines administration.

Audits were carried out regularly by both the registered manager and the provider, to monitor the service provided. However, these checks had not identified inconsistencies in the records found at this inspection and had not always been effective in making improvements to the service provided.

People’s views about the food provided was mixed. Comments included, “The food is excellent, first class and the quantity is good. It’s exceptional for the number they have to cook for. The choice is good, the presentation is excellent,” “The food is cheap and nasty and reminds me of old school dinners,” “You can ask for anything you want, and they will bring it; they are very good that way. It’s the quality of the food that’s the problem” and “It’s not a high standard.”

The registered manager had worked hard to make improvements at the service since the last inspection. However, further improvement is required to ensure records are consistently accurate at all times.

People told us they felt safe being supported by staff. Staff understood risks to people and how to help reduce them. Systems were in place to safeguard people.

Infection control measures were in place to prevent cross infection.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. Although some people reported having to wait for staff to respond to them.

Staff were well supported by a system of induction, training and supervision. Staff told us they felt well-supported by senior staff and the registered manager.

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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. People were able to make choices about their life and how their care and support were provided. This information was reflected in people’s care plans. Staff understood the importance of respecting people’s wishes and choices.

People and relatives agreed the staff were kind and caring. Staff respected people’s diverse characteristics and were clear that each person’s individual needs were their priority. People told us they felt listened to and their privacy and dignity were respected.

People told us they would recommend the service. Comments included, “I would recommend it overall, it’s run very well, the carers are lovely, and they always make me feel welcome and they are always nice to [Person’s name].” Other comments included, “It’s like a hotel, so I’ve no reason not to be happy or safe” and “I feel very, very, very happy and safe; it’s the actual people around you that give you a feeling of being safe”

Relatives told us, ““[Person’s name’s] demeanour has improved somewhat in the five days that they have been here; she is a much calmer person” and “Yes I do feel [Person’s name] is happy; and I feel comfortable knowing the girls are very good.”

Records were stored appropriately and accessible.

There were activities provided for people by three activity co-ordinators. People were able to access the local area on the minibus.

Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to. The registered manager told us there were no on-going complaints at the time of this inspection.

People and staff told us the service was well led. People were given various opportunities to provide feedback about the service. The registered manager and senior staff had developed positive relationships with local agencies, which helped ensure people had their needs met promptly.

Staff told us they enjoyed working at the service and that the team worked well together.

Rating at last inspection and update:

At the last inspection the service was rated as requires improvement (report published 7 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, however, the provider remained in breach of regulations.

Why we inspected:

This inspection was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern.

Roseland Care is a care home that provides care for a maximum of 55 adults. At the time of this inspection there were 32 people living at the service. The service comprises of two separate

buildings, Roseland Care (nursing) and Lowen House (residential). Roseland Care is a purpose built care service with two floors, one for general nursing and one for dementia nursing. Each floor has a shared lounge and dining room and access to private garden areas. Lowen House is part of an older house situated a short distance from the main building.

What life is like for people using this service:

• People told us they were happy living at the service. However, two people raised concerns to us about not being able to access staff assistance when needed. The acting manager spoke with these people and was actively resolving their concerns.

• Staff were not always provided with accurate and up to date information relating to people’s needs in some care plans.

• Risks to people had been identified and assessed in care plans, but the assessments did not always provide staff with clear guidance and direction on how to reduce those risks. For example, where a falls risk and specific situations when the person would stand unaided had been identified in a risk assessment, it did not then provide guidance for staff on how to mitigate that risk. However, we found staff were supporting this person in bed currently, so the person could not fall. When they were out in the chair staff ensured their chair was reclined and they kept a close watch on them.

• We were able to evidence from the daily monitoring records that staff were providing suitable care to people despite the lack in some cases of accurate care plan records.

• People received care from staff who had not always completed mandatory training as required. The provider was aware of this and was putting together a comprehensive plan to address this concern.

• People did not always have their legal rights protected as the service did not know which people had Deprivation of Liberty Safeguards authorisations in place, and could not therefore effectively uphold any conditions that had been put in place in the authorisation. The provider had not notified the Care Quality Commission about the authorisations as they are legally required to do.

• People had experience low staffing levels for a period of time before this inspection. This had impacted on their experience of care provided. An additional nurse had recently been added to the day shift by the provider, following concerns by the local authority safeguarding unit.

• Staff were kind and caring but morale was low they reported being very tired, stressed and did not feel valued and well supported. Supervision had not been regularly provided to all staff.

• Quality assurance processes were not effective and did not pick up the concerns identified at this inspection.

• People had completed a survey in 2018 giving their views and experiences of living at Roseland Court, the responses were mainly positive at that time.

• The premises were in good condition and provided a spacious, warm and relaxed environment for people.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 18/09/2018)

Why we inspected: We bought this inspection forward due to the high number of concerns raised to the Care Quality Commission (CQC) by the local authority safeguarding unit, the clinical commissioning group and whistle-blowers. Concerns had been raised about low staffing levels which had led to poor care provision for people. There were concerns raised about poor personal care, dirty bed linen, some people did not have call bells available to them. Some people had pressure damage to their skin and this had not been appropriately escalated and referred to external professionals for advice. One person had lost a considerable amount of weight but the care plan had not been reviewed to address this concern. Communication between nurses was of concern with changes in people's condition not always being effective escalated for advice. Dressings were not always being effectively and robustly managed. There had been medicine errors reported and there was concern that people did not always receive their medicines in a timely manner.

We found that people had experienced low staffing levels which had led to two people raising their concerns to staff. People were clean and received appropriate care. However, some people did not always have calls bells within their reach and one person's call bell was missing completely until inspectors raised this issue. There was concern about how some dressings were documented and managed by nurses. Weight loss was being appropriately managed by care staff, however, the care plans did not always accurately reflect what care was being provided. Medicines were managed and administered safely, although we have made a recommendation about one aspect of medicines management in the Safe section of this report.

Follow up: We have asked the service to provide us with an action plan with a specific deadline addressing the key concerns identified during this inspection. We will meet with the provider once this has been sent to us to check what improvements have been and are planned to be made.

The service is situated in a retirement village complex with access to communal facilities such as a restaurant, swimming pool, gym and extensive landscaped grounds. The service comprises of two separate buildings, Roseland Care (nursing) and Lowen House (residential). Roseland Care is a purpose built care service with two floors, one for general nursing and one for dementia nursing. Each floor has a shared lounge and dining room and access to private garden areas as well as the communal garden areas within the complex. There are stairs and lifts to access each floor. All bedrooms have ensuite facilities with wet rooms and there are shared bathrooms with assisted baths. Lowen House is part of an older house situated a short distance from the main building. All bedrooms have ensuite facilities and there are shared bathrooms and living areas as well as access to outside spaces.

This was the first inspection for the service since it re-registered as a new legal entity in August 2017.

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.

During the inspection we spent time in the shared living areas across the service to observe staff interaction with people and how people responded to the care and support provided. We observed that people were relaxed and comfortable with staff, and had no hesitation in asking for help from them. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff are so compassionate, they make me feel safe and looked after", "They look after us so well, there is nothing to worry about" and "It’s just a lovely atmosphere that makes me feel safe."

Care records were personalised to the individual and detailed how people wished to be supported. They contained accurate and up to date information to enable staff to provide the agreed care and support for people. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risks in relation people’s skin care and nutrition were being effectively monitored.

Management and staff had developed good working relationships with healthcare professionals to help ensure people had timely access to services to meet their health care needs. These services included tissue viability nurses, physiotherapists, GPs and speech and language therapists (SALT).

People were supported to eat a healthy and varied diet. Comments from people about their meals included, "They make me lovely bacon and egg for breakfast", "You can always have something else if you don't fancy what's on the menu" and "All the food tastes lovely and fresh."

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals. Staff all told us they were very well supported and felt valued by management. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes. Staff completed a thorough recruitment process to help ensure they had the appropriate skills and knowledge.

There were safe arrangements were in place for administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained and Medicine Administration Records (MARS) were completed appropriately. We found the medicines fridge was not locked and there were some out of date eye drops. The eye drops were disposed of and replaced during the inspection and a new fridge was ordered and put in place a few days after our inspection.

People were able to take part in a range of group and individual activities. These included jigsaws, board games, craft work, pet therapy, art class and quizzes. In addition there were visits by external entertainers and trips out. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership. Comments from staff included, “It’s a good staff team and we work well together”, “The manager and clinical lead are very supportive” and “It is a good place to work.”

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. Where complaints had been received these had been well managed and effectively resolved. The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.