The inspection took place on 16 and 19 January 2017 and was unannounced. Rotherbank is registered to provide accommodation and support to 21 people; it does not provide nursing care. At the time of the inspection there were 18 people living there. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Although the registered manager visited regularly, the day to day management of the service was carried out by the manager; in addition there was a trainee manager and a deputy manager.
People told us they felt safe and well supported. Staff had undergone safeguarding training and understood their role in relation to safeguarding and the actions they should take to keep people safe from the risk of abuse.
People’s records demonstrated that risks to them as individuals in relation to their care had been assessed and managed safely overall. However, there was a lack of clear guidance in relation to blood sugar monitoring for people’s diabetes care. Although the manager took prompt action to address this, it will take time to embed this into practice and for the provider to be able to demonstrate staff have followed the revised guidance over time.
People told us there were always staff available when needed and that they had the time to support them in the way they liked. No agency staff were used at the service to ensure people received continuity of care, which is important for people living with dementia. People were safe because the provider applied robust recruitment policies and procedures.
The registered manager had not ensured they had consistently followed good practice guidance in relation to the storage, usage and recording of people’s medicines. The manager took prompt action to rectify these issues for people. However, it will take time for the registered manager to embed the changes that were made during the inspection in relation to medicines safety.
The registered manager had not ensured that all staff followed infection control guidance in relation to their nails. This placed people at potential risk from acquiring a skin flap and some staff’s nails were not hygienic. The registered manager has taken relevant action to ensure all staff meet regulatory requirements to ensure people’s safety, however, this needs to be embedded over time.
People said that staff appeared to be well trained and knew what they were doing and supported them in the manner they liked. New staff underwent an induction to prepare them for their role and all staff received regular supervision. Staff were required to undertake a range of training identified by the provider as necessary in order to meet people’s needs. Staff were supported to undertake professional qualifications in social care.
People told us staff always sought their consent before they provided their care, medication and support. Staff were able to demonstrate how the Mental Capacity Act (MCA) applied to their day to day work with people. Where people were subject to the Deprivation of Liberty Safeguards (DoLS) legal requirements had been met.
People said the food was good. Risks to people associated with their eating and drinking had been assessed and relevant measures taken to manage these effectively for them.
Staff supported people to access a range of healthcare services to ensure they could maintain good health.
People said that the staff were caring and supported them the way they liked. Staff were observed to interact with people in a kind and caring manner. Staff received relevant information about people to enable them to form a relationship with them.
People told us they were able to do what they wished and that staff respected their wishes. Staff supported people to make day to day decisions about their care.
People told us they were treated with respect, their dignity was protected and that they were encouraged to be as independent as possible. Staff were observed to treat people with dignity and respect.
People’s care needs were assessed prior to them being accommodated. People were involved in their care planning where possible and they and their relatives were encouraged to participate in reviews of their care. People’s care was person centred to meet their individual needs. Staff had received training in dementia care.
People were supported to access and to be part of their local community. Staff ran a range of activities for people to participate in. They also ensured peoples’ needs for one to one support were met.
People and their representatives told us they could make a complaint if they needed to and it would be acted upon. People were provided with information about how to make a complaint.
People told us they thought the staff were happy and had good relationships with each other and the management. People were cared for in a service which had an open culture where staff were encouraged to speak out about any issues. Staff were observed to uphold the provider’s values in the course of their work with people.
People told us they thought the service was well led; they all spoke highly of the management and said the manager listened to them and acted upon what was said. There was a stable and well-staffed management team who were visible to people and knowledgeable about their needs. Management worked alongside staff and had a good understanding of the service.
The manager had a good overview of any incidents that took place and ensured any actions required as a result were taken for people to protect them. There was an electronic system which enabled the manager to constantly monitor that all required works and training had been completed and were up to date for people. Items identified for action in 2016 had been actioned to improve the service for people, such as the provision of a new patio. People’s views about the service had been sought and acted upon.