Archived: Roseland Care Limited

At the previous inspection we had concerns about how staff cared for people in the Penlee unit. We found some staff did not always provide care in accordance with the guidance in people’s care plans. Information was not always communicated effectively between staff and management and this had led to some staff providing care in an inconsistent manner. Medicines were not always managed and administered safely. Regular medicine audits had not been effective in addressing concerns found at the inspection. Care records were not held securely. Staff had not always received adequate training and supervision support from management. This had led to people living at the Penlee unit being exposed to some risk.

We carried out this inspection to check on the action taken by the service to address the concerns found at the July 2015 inspection.

Roseland Care is a care home which provides care and support for up to 55 predominantly older people. At the time of the inspection there were a total of 35 people living at the service. Some of these people were living with dementia. The service is situated in two separate buildings, Roseland Care and the Penlee Unit. The Penlee unit had four people living there. The service was in the process of moving people from the Penlee unit across to the main Roseland Care building, where a floor of this building was being used to care for people with dementia care needs. The Penlee unit would in future support people with residential care needs.

The service had a registered manager in post. 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 walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicines as prescribed. Regular medicines audits consistently identifying if errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had used agency staff to cover shifts on a regular basis however, the service was recruiting for more staff at the time of this inspection to allow for coverage of sickness and holiday leave.

Staff were supported by a system of induction training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided, such as dementia care.

Staff meetings were held regularly. These allowed staff to exchange information with the management team and air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews. Care files were held securely in locked cupboards.

Varied activities were provided by two activity co ordinators. People were encouraged to get involved in a planned programme of events. People who either chose to remain in their rooms or were confined to bed due to their healthcare needs were also regularly visited by the activity co ordinators. Films shows, hand bell ringing, quizzes and singing were all provided.

The registered manager was supported by the nursing team, senior carers and a motivated team of care staff. The registered manager also received support from the provider and managers of other services within the group nationally. A clinical lead was due to join the service in early July 2015. This person would support the nursing team and the registered manager.

At this inspection we found the service had taken action to address the concerns found at the July 2015 inspection and had met the requirements of the regulations.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

At the time of the inspection people told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Roseland alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service.

Roseland had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), and further staff training was planned. This helped to ensure that people's needs were met.

Is the service effective?

At the time of the inspection we found the service to be effective. People, or their representatives, were usually involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

Is the service caring?

At the time of the inspection we found the service to be caring. We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. At the time of the inspection feedback from people was positive, for example, 'I find the staff to be friendly, helpful and kind'.

Roseland had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

At the time of the inspection we found the service to be responsive to changing care needs although staffing levels due to short-notice sickness were an area of expressed concern for staff. Many people who lived at Roseland had complex health needs and were either not able, or chose not to join in group activities. There was evidence to show that people were routinely offered one-to-one time or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of the inspection we found the service to be well-led. Roseland had a registered manager, supported by a deputy manager for each of the two buildings (Roseland and Penlee) and other senior staff.

We saw minutes of meetings held with the staff. We saw minutes of meetings held with relatives and the results of quality assurance questionnaires sent to the people who lived at Roseland. This showed the management had consulted with people who used the service, relatives and staff to gain their views and experiences. We saw examples where the home had responded quickly to information received from people that lived at Roseland.

The service had a quality assurance system, and staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with three visitors to Roseland, who told us they were satisfied with their relative's care. One visitor said the staff were always very nice and welcoming to them. Another told us their relative was happy and positive about life at Roseland.

We spoke with three people who lived at Penlee who expressed satisfaction with the staff and the care and support provided to them. We observed the interactions between staff and people who lived at Penlee. We saw staff spoke with people who used the service in a kind and caring manner and that people approached the staff to initiate conversations.

Written information was provided to staff to instruct and guide them in the action they had to take to meet people's care needs. We saw people who used the service and / or their relatives were included in the development of this information if they so wished.

People were provided with and supported to eat and drink sufficient amounts to meet their needs.

The home had systems in place to promote the control of infection and was clean, tidy and mostly odour free.

We were told that people made choices about how they spent their day and we saw there were a variety of activities people could take part in if they wished. People moved freely throughout the homes and chose where they spent time; in their bedrooms or communal seating areas. People had access to the gardens.

People told us that they felt listened to and involved in the running of the home and two people who lived at Roseland told us about the 'residents committee meeting' they attended.

The home safeguarded people from abuse by providing training and guidance for staff. However, not all staff were clear about the action they should take if they had a concern and we were told about one incident that had not been reported appropriately.

We saw that people lived in an environment that was clean and free from odours. Consideration had been given to the environment to ensure it was homely and met the needs of people who required dementia care.