Roseleigh Care Home

We found the following examples of good practice.

• Relatives and external professionals were supported to safely visit the service.

• Staff were trained in the use of personal protective equipment (PPE) and ample stocks of this were in place.

• Regular COVID-19 testing was taking place.

• The home was clean and tidy, and regularly cleaned.

Roseleigh Care Home is a care home which provides care for up to 50 people. The service does not provide nursing care. Care is primarily provided to older people, some of whom have mental health conditions or are living with a dementia. At the time of the inspection there were 35 people using the service.

The service accommodates people across two floors. There are communal lounges, dining rooms and bathing facilities. There is an enclosed garden for people to use.

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

People were supported by staff who knew them and their needs well. Staff treated people with respect and maintained their dignity when supporting them.

Risks to people's health, safety and wellbeing were assessed and plans were put in place to ensure these were reduced as much as possible. Medicines were safely managed.

There was enough staff available to support people. Staff were safely recruited. The home was clean and well maintained.

Accidents and incidents were recorded and analysed. The registered manager and staff understood their safeguarding responsibilities.

The service had benefitted from redecoration and the purchase of new furniture. People and relatives told us they were pleased with the home’s refurbishment.

Staff had the skills and knowledge to deliver care and support in a person-centred way. 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 did support this practice.

People told us their privacy and dignity were respected and their independence encouraged. People were able to participate in a range of activities if they chose to do so.

The management team were open and approachable, which enabled people to share their views and raise concerns. People told us if they were worried about anything they would be comfortable to talk with staff or the registered manager.

The provider monitored quality, acted quickly when change was required, sought people's views and planned ongoing improvements.

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

The last rating for this service was requires improvement (published 2 October 2018) and there were four breaches in 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This 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.

The service was last inspected in May and June 2017 and was rated requires improvement. At that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to governance and management processes. We took action by requiring the provider to send us action plans setting out how they would improve the service.

When we returned for this inspection we found that the provider was still in breach of this regulation. We also identified additional breaches of regulation in relation to medicine management, person-centred care and premises and equipment.

This is the third time the service has been rated as Requires Improvement.

Roseleigh Care Home is a ‘care home’. 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. Roseleigh Care Home accommodates up to 50 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with a dementia. At the time of our inspection 40 people were using the service.

There was a registered manager in place. 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. At the time of our inspection the registered manager was on planned long-term leave. The deputy manager had been acting as manager since the beginning of July 2018.

Medicines were not always managed safely. The premises were not always clean, suitable for the purpose for which they were being used or adapted for the comfort and convenience of people living at the service. Records of decisions made under the Mental Capacity Act 2005 or in people’s best interests were not effectively recorded. People did not always receive person-centred support. Care plans sometimes contained limited information and were not always person-centred. The provider’s quality assurance and governance processes were not always effective.

Plans were in place to support people in emergency situations. Risks arising out of people’s health and care needs were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored to see if improvements could be made to keep people safe. People were safeguarded from abuse. Staffing levels were monitored to ensure enough staff were deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

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. People were supported with food and nutrition. People were supported to access external professionals to monitor and promote their health. Staff were supported with training, supervisions and appraisals.

People spoke positively about the support they received, describing staff as caring and kind. Relatives also described the support people received as caring. People were usually treated with dignity and respect. People told us staff supported them to maintain their independence. Policies and procedures were in place to support people to access advocacy services where needed.

People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody at the service was receiving end of life care, but policies and procedures were in place to provide this if needed.

Feedback was sought from people, relatives and staff. The service had a number of community links with local agencies and groups for the benefit of people living there. The deputy manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicine management, person-centred care, premises and equipment and good governance. You can see what action we took at the back of the full version of this report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a further comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

We inspected the service again on 24 May and 14 June 2017. The first day of the inspection was unannounced, which meant the staff and provider did not know we would be visiting. We informed the provider of our visit on 14 June 2017. At this inspection we found the provider had followed their plan and legal requirements had been met. However, we identified different breaches of legal requirements and rated the service as ‘Requires Improvement’.

Roseleigh Care Home is purpose built and can accommodate up to 50 people. The service provides care for people with mental health conditions and people living with a dementia. There are two separate units. The ground floor of the service accommodates people who have mental health conditions and people living with a dementia. The first floor of the service accommodates people living with a dementia. Within this unit there are five ‘time to think beds’. These beds can be occupied by older people living with a dementia who are medically fit for discharge from hospital. Assessment, care and support is provided at the service for a maximum of 6 weeks. At the end of this time the person’s ongoing needs are reassessed and they either return home with or without a package of care or remain at the service permanently (if a bed is available) or alternatively find another care home. At the time of the inspection there were 37 people who used the service.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. People subject to DoLS had this recorded in their care records. However, mental capacity assessments were not decision specific and best interest decisions were not recorded.

There were systems in place to monitor and improve the quality of the service provided, however, these were not effective and had not detected the further areas we identified as requiring improvement. The provider visited the service on a regular basis, however did not make actual checks on systems and documents to ensure the effective running of the service. Audits had taken place, however action plans were not put in place identifying improvements needed or if work had been completed.

These findings constitute a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people's safety had been assessed by staff.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Medicines were managed safely with an effective system in place. Staff competencies, around administering medicines, were regularly checked. However, we did find for one person that eye drops, which were needed to be stored in the fridge were in the medicine trolley.

Most people and relatives told us there were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff told us they felt well supported and received supervision.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People told us the service provided good care and support. They told us they felt safe, the staff were caring, kind and respected their choices and decisions.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. The provider was moving to a digital system of care planning, however, further work was needed to ensure the system was effective.

People who used the service had access to a range of activities and leisure opportunities. The service had a clear process for handling complaints.

Roseleigh Care Home is purpose built and can accommodate up to 50 people. The service provides care for people with mental health conditions and people living with a dementia. There are two separate units. The ground floor of the service accommodates people who have mental health conditions. The first floor of the service accommodates people living with a dementia. Within this unit there are seven ‘time to think beds’. These beds can be occupied by older people living with a dementia who are medically fit for discharge from hospital. Assessment, care and support is provided at the service for a maximum of 6 weeks. At the end of this time the person’s ongoing needs are reassessed and they either return home with or without a package of care or remain at the service permanently (if a bed is available) or alternatively find another care home.

The home had a registered manager in place. 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 looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help registered providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. Senior management visited the service on a regular basis; however, records of these visits were not available to confirm this. This meant we could not determine what checks had been completed during the visit. The registered manager said the findings from the visit and any actions needed were discussed. Surveys for people who used the service and / or relatives were not completed in 2015 by the registered provider

Effective supervision with staff was not happening as often as it should be. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff.

Risk assessments for people who used the service were insufficiently detailed. They did not clearly identify what the risks were. This meant that staff did not always have the written guidance to keep people safe. Accidents and incidents were monitored to identify any patterns or trends.

People and relatives told us there were enough staff day and night to meet the needs of people who used the service.

Medicines were managed safely for people and staff responsible for the administration of medicines had their competency to handle medicines checked.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However, we did note on the first day of the inspection that the water temperature of a sink in an area accessible to people who used the service was too high. By the second day of the inspection the registered manager had taken action to address this.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. We saw that staff had received an annual appraisal.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However, further work was required on some care plans to ensure that decision specific capacity assessments were completed.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive and patient with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People had been weighed on a regular basis and staff had completed nutritional screening.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people had been assessed and care plans were in place.

The service employed two activity co-ordinators to plan activities and outings for people who used the service. People told us they were happy with the range of activities and outings that took place. Staff encouraged and supported people to access the local community.

The registered provider had a system in place for responding to people’s concerns and complaints. People who used the service were asked for their views during meetings.

We wrote to the provider and asked them to make improvements. The provider wrote to us and told us that they had taken action to address the concerns.

At this inspection we reviewed the actions the provider had implemented. We spoke with the registered manager and discussed record keeping.

We looked at the care records for two people living at the home, four acute care pathways and distressed behaviour records. We saw that improvements had been made and care records were regularly reviewed.

During the inspection we looked at a range of records and saw that records were accurately completed and fit for purpose.

At this inspection we reviewed the actions the provider had implemented. We spoke with the registered manager and discussed the management of care and welfare of people living at the home. We looked at the care records for four people living at the home. We saw that improvements had been made to the care plans. The manager had put in place an audit tool to monitor the quality of the care plans and ensure they were regularly reviewed.

We looked around the home and saw that concerns we raised about the environment had been addressed. The manager told us there was a plan in place to continue to update the environment.

During the inspection we saw that records were not always accurately completed and fit for purpose and we included Outcome 21 in the inspection.

We observed the staff being attentive, respectful and interacting well with people. We saw that staff communicated well with people, we observed them laughing and joking with with people. We visited the service at the evening time; many people were in the lounge watching the football match on the television.

We reviewed the medication systems and found processes for the administration and management of medicines were being followed.

We found that the safety and suitability of the premises had not been adequately maintained.

We saw that there were suitable staffing arrangements in place and staff felt supported by the management team.

We found that processes were in place to assess and monitor compliments and complaints.

We found that care records did not always provide information to ensure care was delivered appropriately.