The Old Roselyon Manor Nursing Home

Updated 29 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 30 May 2018 and was carried out by one adult social care inspector, a specialist nurse advisor and an expert by experience. The specialist advisor had a background in nursing care for older people. An expert by experience is a person who has experience of using or caring for someone who uses this type of service. Their area of expertise was in older people’s care.

We reviewed the Provider Information Record (PIR) and previous inspection reports before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed the information we held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with ten people living at the service, five relatives and a visiting healthcare professional. We looked around the premises and observed care practices on the day of our visit.

We also spoke with four care staff, two nurses, the registered manager/provider and the assistant manager. We looked at five records relating to the care of individuals, three staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service.

Updated 29 June 2018

We carried out an unannounced inspection of The Old Roselyon Manor Nursing Home on 30 May 2018. The Old Roselyon Manor is a ‘care home’ that provides care for a maximum of 30 adults. 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. At the time of the inspection there were 27 people living at the service. The service is on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 10 April 2017. In April 2017 we found the registered manager/provider had not kept up-to-date with changes in legislation in relation to the recruitment of staff and protecting people’s rights. Some audits, carried out by nurses to monitor the nursing care, had fallen behind due to nurse vacancies and sickness. We found there were missing risk assessments, incorrect air mattress settings, lack of analysis of falls and gaps in charts for when people needed to be re-positioned.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection the service’s recruitment systems had been updated to ensure all the relevant recruitment processes, including Disclosure and Barring Service (DBS) checks, had been completed before new staff started to provide care for people. This helped to ensure new staff were suitable and safe to work in a care environment.

People’s legal rights were protected because management understood the legal requirements of the Deprivation of Liberty Safeguards (DoLS). Some people lacked the mental capacity to recognise the decline in their physical capabilities, which potentially put them at risk of harm, such as sustaining injuries from falls. These people were subject to restrictive practices or continuous supervision to protect them from the risk of harm and keep them safe. DoLS applications had been made to the local authority to seek the legally required authorisation to have these restrictions in place.

There were effective quality assurance systems in place and audits were routinely completed. This included the introduction of new audits to check air mattress settings, the dating of creams on opening and the completion of re-positioning charts. A system had also been put in place for the analysing of incidents, such as falls, and where necessary changes were made to learn from events or seek specialist advice from external professionals.

Care records were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. In particular risks in relation people’s skin care and nutrition were being effectively monitored.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005.

People told us they were happy with the care they received and believed it was a safe environment. Comments included, “I feel safe, I’ve used my call bell and they come quite quickly”, “I feel safe because staff know what they are doing”, “I know my relative is safe, I see it every time I come in. The staff know what they are doing great respect for them all”, “There’s laughter here and that’s important” and “It’s a happy atmosphere everyone is very cheerful.”

There were enough suitably qualified staff on duty and additional staff were allocated if peoples’ needs increased, such as when someone was unwell. Staff were supported by a system of induction, relevant training, one-to-one supervision and appraisals. Staff knew how to recognise and report the signs of abuse.

Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. A visiting healthcare professional said, “The way staff have worked with me to support one person to have a bath and the communication with the home has been fabulous.” Relatives told us staff always kept them informed if their relative was unwell or a doctor was called.

People had a choice of meals and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. Comments included, “We get given a choice of things and can always get a salad if we don’t want what is offered”, “The food is very good, it’s different every day”, “I have a choice of what I would like”, “The food is good, they give me a choice of two or three things.”

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

People were able to take part in activities supported by staff and external entertainers. These included, singing sessions, music entertainers, bingo, pamper sessions and visiting therapeutic animals from a local farm.

People and their families were given information about how to complain. People and their families were all positive about the management of the service and told us they thought the service was well run. Comments included, “One of the managers is always available to talk to”, “The manager is here every day”, “The girls know what they are doing, they get on with the job, very competent. It’s runs well here”, “It runs like clockwork and very well. Everyone appears to be cheerful and very competent” and “If you mention something they try to do it. The manager does what he can and the girls are very willing and always cheerful.”

Staff told us they felt supported by the management commenting, “The management is very good”, “The rotas are good, the manager tries to take each staff’s circumstances into account”, “Lovely management”, “The manager is very approachable” and “The manager always supports you if you have any personal problems, you know you can trust him as he keeps what you tell him private.”

The environment was clean and there were no unpleasant odours. Some areas of the premises were in need of re-furbishment, particularly two bathrooms. Work to build a single storey extension, to provide additional shared living areas, was planned to start shortly after the inspection. The two bathrooms were due to be upgraded as a part of the extension work. There was an on-going programme to re-decorate people’s rooms. Appropriate safety checks were completed to help ensure the building and utilities were safe.