• Care Home
  • Care home

Roseacres

Overall: Requires improvement read more about inspection ratings

80-84 Chandos Avenue, London, N20 9DZ (020) 8445 5554

Provided and run by:
Roseacres Care Home Limited

Important: The provider of this service changed. See old profile

All Inspections

21 June 2022

During an inspection looking at part of the service

About the service

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.

5 October 2017

During a routine inspection

This inspection took place on 5 and 9 October 2017 and was unannounced. At our previous inspection in February 2016, the service’s overall rating was improved to Good following specific checks. However, this inspection was the first time the service achieved a Good overall rating through checks of all five key questions at the same time, otherwise known as a comprehensive inspection.

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.

23 February 2016

During an inspection looking at part of the service

We carried out an unannounced focused inspection of this service on 5 November 2015. A breach of legal requirements was found. This was because some people’s care plans were not kept consistently up-to-date so as to address risks of receiving unsafe care. This was important because staff, including occasional agency staff, used care plans to inform them of people’s care needs and how they should be providing safe support. The provider subsequently wrote to us to say what they would do to meet legal requirements in relation to this breach.

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.

05/11/2015

During an inspection looking at part of the service

We carried out an unannounced focused inspection of this service on 21 July 2015. Breaches of legal requirements were found. This was because people did not always receive appropriate continence support that met their needs. There were a number of instances where records about the care provided to people, including for continence support, were either inaccurate, incomplete, or not kept promptly up-to-date. We served enforcement warning notices on the registered provider and manager for these two breaches, because of the potential impact on people using the service. We also found that systems for preventing, detecting and controlling the risk of infections were not ensuring the safe care of people. The provider subsequently wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this unannounced focused inspection of 5 November 2015 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 30 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 Roseacres had a welcoming atmosphere. Staff attended to people’s requests in a friendly and unhurried manner, and people’s choices were listened to. There was a range of positive feedback about the service.

We found that action had been taken to address the concerns we found at the previous inspection.

People received timely support, where needed, with their toileting needs and other specific support needs. Care delivery records were being kept up-to-date, which helped to ensure responsive care delivery.

Systems for preventing, detecting and controlling the risk of infections were now ensuring the safe care of people. People’s rooms were kept clean, and prompt attention was paid to any cleanliness concerns in support of people in lounge and dining areas. The laundry area was also better organised so as to minimise infection control risks.

However, we found that some people’s care plans were not kept consistently up-to-date so as to address risks of receiving unsafe care. This was important because staff, including occasional agency staff, used care plans to inform them of people’s care needs and how they should be providing safe support. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

21 July 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 24 March 2015. Breaches of legal requirements were found. This was because some safety shortfalls identified by professional checks of the premises had not been addressed. Additionally, the agreed delegation of blood-sugar testing arrangements from a community healthcare team was not suitable to protect the health, safety and welfare of people using the service. We rated the service as Requires Improvement. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced focused inspection of 21 July 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements. However, since our last inspection in March 2015, we received some information of concern about how the service operated, which we also looked into at this inspection. 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 30 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 Roseacres had a warm atmosphere. Staff attended to people’s requests in a friendly and unhurried manner, and people’s choices were listened to. There was a range of positive feedback about the service.

The service took appropriate action if they believed a person needed to be deprived of their liberty for their own safety, including involving community health professional and people’s closest contacts. Consent to care and treatment was now being sought in line with the requirements of the Mental Capacity Act 2005.

The agreed delegation of blood-sugar testing arrangements from a community healthcare team was now suitable to protect the health, safety and welfare of people using the service. The service was aiming to meet people’s diabetic needs.

Action had now been taken to promptly address some shortfalls identified by professional checks of the premises.

The service supported people to move around safely, and action was taken to minimise the risk of people falling and injuring themselves. We also found that people received adequate support with their medicines.

However, we found that people did not always receive appropriate continence care and support that met their needs. This was because we saw two people to be wearing wet clothing and needing continence support during the inspection. There were also inconsistencies in the care planning for people in respect of their continence needs.

We came across a number of instances where records about the care provided to people, including for continence support, were either inaccurate, incomplete, or not kept promptly up-to-date. This failed to support people to receive responsive care that met their needs.

We found that systems for preventing, detecting and controlling the risk of infections were not ensuring the safe care of people. We saw that people were not supported to clean their hands before eating, lounge chairs were not always cleaned promptly if people were incontinent on them, and bedrooms were not kept sufficiently clean after people were supported to get up.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and registered manager for two of these breaches because of the potential impact on people using the service and due to there being breaches of regulations at this service for four consecutive inspections. You can see what action we have told the provider to take at the back of the full version of this report.

24/03/2015

During a routine inspection

This unannounced inspection took place on 24 March 2015. Our previous inspection of 16 September 2014 found that the service had made improvements to the safety and welfare of people because the service was keeping people’s care needs and areas of risk under review, and we saw many positive interactions between staff and people using the service. However, improvements were needed for the support of people against the risks of malnutrition, and for consistent record-keeping. Our inspection before that took place on 16 April 2014 when we found a number of breaches relating to the care and welfare of people.

Roseacres is a care home for up to 35 older people. There were 32 people using the service when we inspected, and we were informed that their maximum practical occupancy is 34. The service’s stated specialisms include dementia, physical disability and sensory impairment. The accommodation is an adapted home with passenger lift access to the first floor.

At the time of our visit, the service’s manager had been registered for six months. 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 Roseacres had a very open and welcoming atmosphere. Staff attended to people in a friendly and unhurried manner, and people’s choices were listened to. There was a range of positive feedback about the service.

People received meals that were appetising and freshly prepared. Improvements had been made to people’s support with food and drink, as people’s weight and support needs were kept under regular review, and actions were taken to address any concerns identified.

Staff underwent a robust procedure to check they were appropriate to work with people before they started work. Staff received good support to deliver care to people appropriately, including through regular training and supervision. The service had enough staff, with little reliance on using agency staff.

The quality and consistency of record keeping had improved, which helped to demonstrate that appropriate care took place.

The registered manager knew the service and people using it well, and was accessible to anyone at the service. There were systems of auditing quality and risk at the service, and we could see that action was taken to address identified shortfalls.

The service took appropriate action if they believed a person needed to be deprived of their liberty for their own safety, including involving community health professional and people’s closest contacts. However, further work was needed with ensuring that the principles of the Mental Capacity Act 2005 were consistently applied for everyone using the service.

Medicines were managed appropriately and people received good overall support with health matters. However, the agreed delegation of blood-sugar testing arrangements from a community healthcare team was not suitable to protect the health, safety and welfare of people using the service.

There were adequate systems to infection control. However, the service was not consistently safe because action had not been taken to promptly address some shortfalls identified by professional checks of the premises. This may have put people using the service at unnecessary risk.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

16 September 2014

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 16 April 2014. Breaches of legal requirements were found. As a result we undertook a focused inspection on 16 September 2014 to follow up on whether action had been taken to deal with the most significant breaches.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 16 April 2014

Roseacres residential care home provides accommodation and personal care for up to 35 people who have dementia. There is currently no registered manager for the service. The recently appointed manager is in the process of submitting an application to register.

We found that the service is not always safe for people because care is not always planned and delivered to meet people’s needs safely. People are not always protected from harm in the delivery of care and from some hazards in the home. Medicines are being managed safely.

We observed several aspects of care provision that are not effective. Care needs are not fully assessed, care is sometimes not delivered to meet people’s needs and capacity assessments are not made.

Most people and those significant to them told us that staff are caring and kind. However we did observe some disrespectful actions from some staff.

The care provided is not always responsive to people’s needs or delivered in a timely way. This includes people not always having access to their call bells whilst in bed and people’s continence needs not responded to in a way that maintains their dignity.

Most people and staff were supportive of the manager. Staff and the manager told us of improvements that had been made. However we were told of significant problems that had been encountered in managing the home and that further improvements were planned.

The provider is not meeting the requirements of the Deprivation of Liberty Safeguards as some restrictions were being placed on people’s movements without obtaining the necessary approvals. People’s human rights are therefore not being properly recognised, respected and promoted.

The problems we have found breached twelve health and social care regulations. You can see what action we told the provider to take at the back of the full version of the report.

Focused inspection of 16 September 2014

After our inspection of 16 April 2014 the provider wrote to us to say what they would do to meet legal requirements for the breaches we found. We undertook this unannounced focused inspection to check that the most significant breaches of legal requirements, which resulted in enforcement action, had been addressed. We checked to see that the provider had followed their plan and to confirm that they now met legal requirements.

We found that the provider had followed their plan in relation to these regulations. There were improvements to the safety and welfare of people because the service was keeping people’s care needs and areas of risk under review. Care plans guided staff better on how to support people’s key care needs. There had been training on some key topics such as manual handling and diabetes. We saw that people were supported with manual handling transfers safely.

Most people we spoke with said that they would recommend the service to friends and family. Staff were praised as kind and caring, and we saw many positive interactions between staff and people using the service. People were more engaged overall. Activities had been improved upon, and there was a designated activities worker.  

The care provided was more responsive to people’s needs, for example, in terms of continence care. People had access to their call bells whilst in bed, which they confirmed as effective at acquiring staff support. The views of people, and their relatives where appropriate, had been sought, to plan care that reflected people’s preferences more effectively.

This means legal requirements had been met for the most significant breaches.

There was now a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We identified two areas of further concern during our visit. Whilst people’s need and preferences for food and drink had been established, we found that systems to support people to eat sufficiently were not effective at protecting them against the risk of malnutrition. This was primarily because weight and malnutrition monitoring processes were not identifying people’s increased needs for support. Appropriate action to address these risks had not therefore been taken.

We also found that some care records were not consistently accurate, and so provided staff with contradictory support advice on some occasions. This put people at risk of inappropriate care.

Overall, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what actions we told the provider to take at the back of the full version of the report.

We will undertake another unannounced inspection to check on all outstanding legal breaches identified for this service.

16/04/2014

During a routine inspection

Roseacres residential care home provides accommodation and personal care for up to 35 people who have dementia. There is currently no registered manager for the service. The recently appointed manager is in the process of submitting an application to register. 

We found that the service is not always safe for people because care is not always planned and delivered to meet people’s needs safely. People are not always protected from harm in the delivery of care and from some hazards in the home. Medicines are being managed safely.

We observed several aspects of care provision that are not effective. Care needs are not fully assessed, care is sometimes not delivered to meet people’s needs and capacity assessments are not made.

Most people and those significant to them told us that staff are caring and kind. However we did observe some disrespectful actions from some staff.

The care provided is not always responsive to people’s needs or delivered in a timely way. This includes people not always having access to their call bells whilst in bed and people’s continence needs not responded to in a way that maintains their dignity.

Most people and staff were supportive of the manager. Staff and the manager told us of improvements that had been made. However we were told of significant problems that had been encountered in managing the home and that further improvements were planned.

The provider is not meeting the requirements of the Deprivation of Liberty Safeguards as some restrictions were being placed on people’s movements without obtaining the necessary approvals. People’s human rights are therefore not being properly recognised, respected and promoted.

The problems we have found breached twelve health and social care regulations. You can see what action we told the provider to take at the back of the full version of the report.

3 January 2014

During an inspection looking at part of the service

We carried out this inspection to check whether improvements had been made since our last inspection of the service in October 2013. At that inspection we found that records relating to people who use the service were not accurate or up to date. Although staff knew how to care for people, we saw that there were various gaps and issues with records. Staff told us that they sometimes found it difficult to complete records and had to stay after work to complete these.

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.

24 October 2013

During a routine inspection

During our last inspection on 15 August we found the provider did not meet essential standards of care and safety in the following areas; care and treatment, medication, staff recruitment and quality assurance. The provider submitted an action plan to address non-compliance and at our inspection on the 24 October 2013 we found that the provider had made some improvements.

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.

15 August 2013

During a routine inspection

At the time of our visit there were 30 people living at the home. We observed lunchtime and spoke with people in the dining room. One person told us that staff were, 'good and do the best they can for me.' Another person said, 'I like it here. The staff know and care for me well.' One relative told us, 'I'm very happy. I come at least once a week, sometimes twice. My relative is very settled.'

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.

12 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) Inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

People told us that they were treated well by staff and did not feel rushed. One relative told us that 'staff are brilliant' and another person told us 'staff are really very pleasant, they don't rush you.' We observed that staff treated people with dignity and respect by knocking on people's doors before entering.

People who used the service were offered a choice of hot or cold meals. We saw menu options displayed on notice boards in the dining room and daily menu choice record sheets were used to identify people's choices for lunch and dinner

People told us that they felt safe at the home. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the staff if they needed to.