Roselands Residential Home

Roselands Residential Home is a residential care home providing accommodation and personal care to 28 older people, some of whom were living with dementia. The service can support up to 35 people.

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

The registered manager and staff team had worked hard to address the areas for improvement following the last inspection. Although improvements had been made, further time was needed to fully embed these changes into day to day practice.

Changes had been made to record keeping, but further improvements were required to ensure that records fully reflected people’s needs and contained all the information staff may need. Quality assurance systems identified areas for improvement, but further time was needed for these areas to be fully addressed.

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. However, further improvements were needed to ensure mental capacity assessments and best interest decisions were recorded, and included peoples, and their relative’s involvement.

There were systems in place to ensure people were safe. Infection prevention control measures meant people were protected, as far as possible, from the risk of COVID-19. The registered manager and staff were proud there had not been an outbreak at the home. During the pandemic staff had moved into the home for a short while to help protect people from the risk of infection. Visitors were welcomed back to the home in line with government guidelines. Throughout the pandemic visits for people receiving end of life care had been supported.

People were treated with kindness and care. One relative told us their loved one was, “Happy, well fed, warm and safe.” Staff knew people well, understood their care needs and interests. People were involved in making decisions about their day to day care and support. People’s privacy was respected, and dignity upheld. People received care and support that was person-centred and met their needs. They were supported to take part in a range of activities throughout the day.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff received regular training and supervision which enabled them to provide the care and support people needed.

Staff knew people well and understood the risks associated with their support. Risk assessments provided guidance about individual and environmental risks. People received their medicines safely, when they needed them. Recruitment procedures ensured only suitable staff worked at the service. Peoples nutritional needs were met. They were supported to eat and drink and variety of homecooked meals throughout the day. People were supported to access healthcare as needed.

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 19 November 2019). There were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated Requires Improvement. Further time is needed to allow these improvements to be fully implemented and embedded into everyday practice.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings.

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 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.

Roselands is a residential ‘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. Roselands was providing personal care to 30 people at the time of the inspection. The service can support up to 35 people. Three of the people living there were in hospital at the time of the inspection which meant there were 27 people on the day of inspection. The service had three large lounges/sitting rooms and two dining rooms. There was also a well maintained outside space for people to access.

People's experience of using this service:

The home had been through a series of changes in regard to management. The registered manager had been in place for just over 12 months. Before this there had been several changes in the management. The home was working to embed a structure that met people’s needs and offered a person-centred approach.

People told us they were happy living at Roselands. However, risks to people had not always been identified around recording and managing their weights. Risks to people around pressure sores had not been managed. A visiting professional told us pressure sores had not been managed as staff had not been routinely re-positioning people to reduce the risk.

The environment raised concerns as there were several upstairs windows which did not have window restrictors on them. On the day of inspection, the registered manager placed an order for window restrictors to be fitted immediately. The service was unclean in areas, and people’s beds were stained. However, the rest of people’s bedrooms were clean and tidy. The laundry room did not have a separate space for clean items to be sorted and people’s laundry was becoming discoloured due to a poor laundry separation process.

We received mixed comments about the food, with some people describing it as tasteless. The home used a delivery service which brought pre-prepared meals to the home to be heated up. We observed people struggling to eat some of the food or not wanting to eat it. The operational manager told us, “We have a beautiful kitchen. We will revert back to cooking fresh. At the moment it’s not acceptable. I recognise that food is a huge part of their daily life.”

Staff had completed the required training and were knowledgeable about people’s conditions. However, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not always given a choice over personal care or what their preference was. For example, people could not choose to have a bath when they wanted to as they were allocated days by using a shower / bath list.

Care plans lacked personalised information on people’s life histories and did not contain details for some people with specific conditions such as dementia or depression. Care plans did contain in-depth information in regard to an overview of people’s health needs.

People gave positive feedback about staff and how they were treated. However, staff were task orientated and were not always able to spend quality time with people. Some people were left in their rooms for long periods of time and were not given the opportunity to engage in activities. People who were able to leave their rooms without support could access a variety of activities. However, people who remained in their rooms were not always included in the activities or provided with stimulation meaning they were at risk of social isolation. We observed people taking part in basic activities such as bingo or cards. However, people told us they were bored and would like some different activities to take place.

People and relatives told us they felt safe living at Roselands. The provider took care when recruiting new staff to ensure they met the values of the service. Relatives told us that staff were kind, caring, respected people and treated them with dignity.

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 Good (report published DATE May 2017)

Why we inspected:

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

Enforcement:

We have found breaches in relation to person-centred care, dignity and respect, safe care and treatment and good governance.

Follow up:

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

Roselands Residential Home provides personal care and support to people with increasing physical frailty. There had been recent changes to the directors and senior management of Pleasantly Limited. The registered manager has plans to retire as soon as a new manager has been recruited.

At the last inspection, the service was rated Good. At this inspection we found the service remained good and met all relevant fundamental standards.

The registered manager ensured that quality of care was maintained through continuous monitoring on a day to day basis and through monthly meetings with staff, families and people who lived in Roselands. It was acknowledged that the quality assurance systems needed to be developed to drive continuous improvement. There were a range of quality assurance audits but these had not been used to their full advantage. This had not impacted on the care delivery or people's safety at this time due to the depth of knowledge the registered manager and staff had on the people they supported. We were assured by the new area manager that the organisation will be introducing new quality assurance systems immediately to provide an overview of the service. be introduced and developed.

Staff knew how to recognise the signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks of falls for people.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Peoples' care plans were person centred and enabled staff to meet their individual needs. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities.

People were supported to have choice and their independence was promoted by staff who understood their individual needs. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. The activities provided were varied and met people's social needs.

The management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service.

Further information is in the detailed findings below.

We spoke with four members of staff. One care worker told us, 'Care is never rushed here. There is no time limit and this helps us to provide the individual care that people need.' Staff were observed responding to routine and unplanned activities in a calm and professional manner.

We looked at five care plans and reviewed the way the home worked with other providers to ensure the health, safety and welfare of people in the home. Good working relationships had developed and effective recording processes had been put in place.

We found that the premises were well maintained and there was adequately maintained equipment available to meet the needs of people. There was appropriate training available for staff to use the equipment provided.

We saw that the home had appropriate processes for the employment of temporary and permanent staff at the home.

We reviewed the arrangements in place for the management of complaints and feedback. The people we spoke with understood how to raise any issues with the registered manager and the provider. There had been no formal complaints received by the home.

People told us they were given choices about their care and treatment and were looked after in a respectful way. One person said, 'All of the staff here would come and do whatever they could for you'. We found that there were plans in place to look after people safely and in a way that met each person's specific needs. We observed that staff spoke with people in a warm and relaxed way to get people's understanding and engagement. We saw that staff responded promptly and sensitively to requests for help. One relative told us, "This home is fantastic and if I could move in myself I would". People told us they felt safe in the home and were looked after by well trained staff. Most people told us there were enough staff around to look after them.

We found there were a number of systems in place to evaluate and review the quality of the service provided in the home.