Roscarrack House

Roscarrack House is a residential care home providing personal and nursing care to up to 19 people. The service provides support to older people. At the time of our inspection there were 16 people using the service.

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

Some risks had not always been identified, assessed and reviewed regularly. The prompt for this inspection was that the service had recently had a fire in a person’s room which required the fire service to attend. The post fire investigation found the fire to have been caused by an electric heater with a radiator cover pressing on the cable. The service has now taken remedial action to address these risks.

Some people had been assessed as needing pressure relieving mattresses to protect their skin from damage. There was no system in place for staff to record regular checks to help ensure these mattresses were always set correctly for the person using them. We found they were not always set correctly.

One person, who was living with dementia, had managed to leave the service, unnoticed by staff. They left the service unnoticed in October and again in December 2022. They had walked alone to the main road and the service was unaware until alerted by a neighbour.

Medicines were not always recorded safely. We found a box of medicines, that required stricter controls, which was being stored by the service but was not recorded as being stored, as is legally required. Prescribed creams were not dated when they were opened despite this having been identified in a May 2022 audit.

People received their medicines as prescribed. The staff used paper Medicine Administration records (MAR), when they administered medicines. We found no gaps in the MAR.

Roscarrack House had an electronic system which held the care plans for people living at the service. However, care staff told us they did not have easy access to this information as there were only two laptops available downstairs on which this information was held. The provider purchased new electronic tablets for the staff after this inspection.

There was a programme of audits being completed at the service. However, these audits were not always effective. For example, the medicines audits had not identified the presence of medicines that required stricter controls. The mattress audit had not identified the settings were not always accurate.

The service had sufficient staff to meet people’s needs. Whilst many staff had worked at Roscarrack House for many years, some new staff had recently joined. The recruitment process for these staff was not safe. The registered manager had not recorded a full employment history.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible but not always in their best interests; the policies and systems in the service did not always support best practice.

Staff were provided with training. There were some updates that were due, and the registered manager was in the process of arranging for staff to complete these. Staff meetings did not take place, but staff told us they felt communication was good and the management team were visible and approachable.

Staff comments included, “We get observed for our competency and have an annual appraisal,” “(Registered manager’s name) is absolutely brilliant, I can ask for what I need for the kitchen and we get it” and “I have worked in many care places and I like Roscarrack House the best, it’s a good place to work.”

The registered manager understood their responsibilities under the duty of candour. When a vulnerable person had left the service on two occasions they had not notified CQC of these events as they are required to do. The service had raised the concern with the safeguarding unit.

Staff knew what actions to take to help ensure people were protected from harm or abuse. Concerns had been shared with the safeguarding unit when appropriate.

Relatives comments were mixed, “I am very happy as Mum has just come in for respite and she is settling really well, we are hoping she might like it enough to stay permanently. She likes the activities” and “Sometimes (Person’s name) is not always wearing their own clothes. I think the reason they try to leave is that they are bored. They have always been a very busy minded person and there is not enough to keep them occupied. They enjoy the food though.”

People and families had not had their views and experiences formally sought. However, the registered manager and the deputy spoke with people and visitors every day and were very visible. Families knew how to raise any concerns they may have.

Visiting healthcare professionals told us, “They (staff) are pretty good at raising concerns to us in a timely way” and “We don’t have any concerns. However, there was a delay in them obtaining a piece of equipment we asked for. There was no deterioration in the person but no improvement either. It got sorted eventually.”

We looked at infection prevention and control and found we were mostly assured the provider was protecting people, staff and visitors from the risk of infection. There were no regular infection control audits taking place. However, the service was clean with no odours.

The registered manager admitted they were finding the workload challenging. The registered manager had a deputy manager, a clinical lead and an administrator to support them. However, roles and responsibilities had only very recently been discussed and had not yet been embedded.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

Rating at last inspection was Good, (Published 10 September 2020). At this inspection the rating has changed to requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

The service had managed well after some of the people who used the service and staff members had caught the virus in the spring. Everybody had made a full recovery.

The service was now providing a range of social activities for people. People were enjoying the entertainment which was taking place at the time of the inspection.

Staff had received suitable training and guidance regarding infection control, and how to respond to the coronavirus pandemic.

Staff helped people to stay in touch with family and friends through phone calls and visits in the garden. Physical distance guidance was being maintained.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

Suitable audit systems were in place to check infection control standards, and ensure people stayed safe. The service looked very clean.

The service had updated its infection control policy in response to the coronavirus pandemic, and had developed a specific policy about how staff should respond to the pandemic. Staff were aware of the policy. The policy was updated as guidance and knowledge about the pandemic had changed.

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.

Roscarrack House is a detached historic house in its own grounds situated on the outskirts of Falmouth. The service provides single room accommodation for up to nineteen predominantly elderly people who need assistance with personal care. At the time of the inspection there were nineteen people using the service.

The service is situated over two floors which are served by a stair lift. Five rooms have en-suite bathrooms with twelve with en-suite toilets. Two rooms have no en-suite facilities. There are additional toilets and two assistive bathrooms to support people with personal care.

There is a large lounge on the ground floor with a separate dining room. There are garden areas around the service with an accessible decking area leading from the dining room. There are a range of aids and adaptations to support people with limited mobility.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The atmosphere in the service on the day of the inspection was relaxing, friendly and calm. Staff responded promptly when people asked for help and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness. People told us they felt safe and comfortable living at Roscarrack House. Comments included, “I used to worry about being safe in my flat but I don’t worry any more, I haven’t a care in the world now,” “The staff are amazing, I couldn’t be happier” and “I can talk to anyone about anything.”

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were identified. Care plans had been updated so staff knew how to manage those risks.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely.

Care plans contained information about the person and what their individual needs were and how they would be met. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff responsible for peoples care.

Staff were sufficiently skilled to meet people needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedures in place to manage infection control risks.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. Capacity assessments were in place to justify restrictions in order to keep people safe. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and continuous communication with people which could include families to seek their views about the service provided.

This report only covers our findings in relation to the question ‘is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosecarrack House on our website at www.cqc.org.uk

Roscarrack House is a family run residential home that can accommodate up to 19 older people. On the day of the inspection 19 people were using the service. Roscarrack House is required to have a registered manager and there was one 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.

The service had taken action to improve risk assessments so the directive was clear and all staff had access to the information. Risk assessments identified potential risks to people and provided instructions for staff members as to how to manage and minimise individual risk.

The registered manager and deputy manager had reviewed the way medicines were managed. Regular audits were taking place with evidence of any errors being recorded and responded to through staff training. Medicine records seen were accurate and showed medicines had been administered as prescribed at the time prescribed.

Staffing levels had fluctuated in recent months; however a full staff team were now in place with an additional member of staff covering the busiest times of the day. Staff told us it was busy but there were enough of them to support people safely.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

Roscarrack House is a family run residential home that can accommodate up to 19 older people. On the day of our inspection 17 people were living at the service. Roscarrack House is required to have a registered manager and there was one 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.

Care plans contained risk assessments which identified when people were at risk, for example from falls. However, the guidance for staff lacked detail or information on the action staff could take to minimise the risk.

Gaps in Medicine Administration Records (MAR) meant it was not always possible to establish how much medicine people were receiving or whether the amount of medicine in stock tallied with the amounts recorded.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. They were supported by a head of care and an administrative worker. Team leaders had day to day oversight of the team of care workers. In addition the staff team included kitchen staff, cleaning staff, a maintenance worker and a gardener. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people’s needs. The registered manager was aware people’s needs were increasing and was employing an additional care worker as a result. The new employee would also be able to cover for any staff absence.

People and relatives told us they considered Roscarrack House to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service in terms of its ‘family’ feel. Terms such as ‘homely’ and ‘friendly’ were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people’s needs.

Applications for DoLS authorisations had been made to the local authority appropriately. Training for the MCA and DoLS was included in the induction process and in the list of training requiring updating regularly. The registered manager and staff demonstrated an understanding of the principles underpinning the legislation. For example, staff ensured people consented before giving personal care. Mental capacity assessments had not been completed as required. The registered manager assured us this would be addressed immediately.

The premises were clean and odour free. People were able to use a shared lounge or stay in their rooms as they chose. Improvements to parts of the building were planned. There was a large decking area immediately outside the dining room where people could eat during warmer weather. Staff told us this was well used.

There were two part-time activity co-ordinators employed and people were supported and encouraged to take part in a range of activities organised in the service. Visitors were made to feel welcome at the service and staff recognised the value of these relationships to people.

We identified a breach of the regulations. You can see what action we have asked the provider to take at the back of this report.

We witnessed staff interactions with people which were positive. One person told us the staff were always 'top notch' and 'if I ask for assistance staff come as quick as they can, normally very good, it's a great comfort'. Another person told us the 'Food is very good, if you don't like it there are alternatives, they always offer a choice'.

One person told us their room 'does not have a toilet I share with a male, he turns the tap too tight'.

We saw that people had been offered a choice of whether they would like to have a lock on their bedroom doors.

We heard staff discussing with people what they would like spend time doing in future planned activities at Roscarrack House.

We found that appropriate action had been taken to keep people safe from abuse.

We saw that steps had been taken to ensure a training schedule was in place for all staff, and this was monitored and reviewed.

We found people who used the service benefited from safe quality care, treatment and support due to effective decision making and the management of risks. This was done through quality monitoring and surveys of the people who lived at Roscarrack House the families and carers, and the staff.