Roseside

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There was an organisational lack of understanding of people’s human rights in respect of the Mental Capacity and Deprivation of Liberty Safeguards. There was also a cultural failure to ensure people with communication difficulties had access to suitable aids to help them communicate, where this was appropriate. There was an inconsistent safety culture with regards to medicine errors and omissions and oversight of people’s care to enable the provider to be assured people’s care was safe and appropriate.

There were significant shortfalls in the care and treatment of some people which increased the risk of poor health and wellbeing outcomes. There was also a failure to protect people from improper treatment and possible abuse.

The provider’s governance processes were not used effectively to monitor the quality of the service, manage risks and drive improvement. There was a lack of managerial and clinical oversight of people’s care including nursing care. People’s daily care records contained gaps and anomalies that had not been explored to ensure people’s care and treatment was safe. Medicines management was unsafe and the governance arrangements in place had failed to be effective in driving up improvements to protect people from avoidable harm.

We found that a culture of continuous improvement was not fully embedded at the service. Some of the issues identified at this inspection had been found previously during a recent local authority quality assurance visit, or by the provider’s own audits, yet no effective and sustainable improvements had been achieved.

Staff felt able to speak up and raise any concerns related to the service, people’s care or their own employment and working life. All of the staff spoken with told us it was a nice place to work and that the manager and provider were supportive and responsive. Some staff acted as ‘Values Champions’ on behalf of the provider.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We identified however that there was an organisational lack of understanding of people’s human rights in respect of the Mental Capacity and Deprivation of Liberty Safeguards. There was also a cultural failure to ensure people with communication difficulties had access to suitable aids to help them communicate, where this was appropriate.

There was also a lack of a consistent safety culture with regards to medicine errors and omissions and oversight of people’s care to enable the provider to be assured people’s care was safe and appropriate.

We found the culture of the service to be positive in terms of staff interactions and supervision. All of the staff spoken with told us it was a nice place to work and that the provider was supportive and responsive.

Some staff acted as ‘Values Champions’ on behalf of the provider. Values Champions were responsible for actively promoting and role modelling the provider’s core values of fun, integrity, responsive, success and teamwork.

There were some processes in place to enable a shared direction and culture to be embedded. For example, policies and procedures, lead roles in various subject areas such as Values, Safeguarding, Infection Control, Dignity. Staff meetings and other daily meetings also took place.

The processes in place however were not fully effective in driving up improvements and creating a culture of continuous improvement that ensured care and treatment aligned to best practice.

There were significant shortfalls in the care and treatment of some people. There was also a failure to protect people from improper treatment and possible abuse. Managers and leaders did not demonstrate an awareness of the issues or the reasons why such shortfalls were found on this assessment.

People we spoke with were however complimentary about the staff team supporting them. However they told us they had little interaction with the manager of the service.

The staff team told us they felt supported by the manager, who they said was approachable and accessible.

Complaints had been responded to appropriately by the manager in an open and honest way.

There were processes in place to support staff including the manager to develop their skills, experience and credibility within the service. Staff had access to suitable training and there was expertise within the provider’s wider organisation to provide support and guidance in various aspects of service delivery such as recruitment, health and safety, positive behaviour support and the use of restraint.

We found however that the experience of the wider organisation was not always accessed or used effectively with regards to the management of mental health conditions, positive behaviour support and restrictive practices.

Staff felt able to speak up and raise any concerns related to the service, people’s care or their own employment and working life.

There were safeguarding and whistleblowing polices in place to guide staff on who to raise and report concerns. The provider also had a confidential telephone helpline for staff to raise any concerns anonymously.

Staff told us they were treated equitably and fairly. They said they had access to a range of training and other development opportunities and received regular supervision from their line manager.

The provider is an equal opportunities employer with detailed policies covering Recruitment and Selection, and Equality, Diversity and Inclusion.

The manager and nursing team were aware of their roles and responsibilities. However, they were not always able to demonstrate an understanding of the fundamental standards and best practice or identify key areas of risk.

The provider’s governance processes were not used effectively to monitor the quality of the service, manage risks and drive improvement. There was a lack of managerial and clinical oversight of people’s care including nursing care. People daily care records contained gaps and anomalies that had not been explored to ensure people’s care and treatment was safe.

Processes were not sufficiently robust to detect the missing and / or contradictory information we identified in care records. Processes were not effective in identifying or addressing ongoing serious concerns with the management of medicines and health conditions such as PEG nutrition or Diabetes.

Processes were not effective in ensuring restrictive practices were recognised, reported and approved by the Local Authority in accordance with people’s legal rights. As a result, the processes in place failed to protect people from improper treatment and the risk of abuse.

The service worked in partnership with a range of other health and social care professionals, including the Local Authority.

Staff told us they had handover meetings with Senior Carers who cascaded information about people’s progress across the staff team.

Staff members did not provide any feedback on how information was shared with partners. However, records showed appropriate referrals were made in support of people’s health and wellbeing.

Health and social care professionals did not provide any feedback about how they worked in partnership with the provider to ensure seamless care. The Local Authority told us they had not been informed of the increased restrictions placed on some people’s lives by the service and took action after the inspection to contact the service.

Staff worked together as a team to provide care and make referrals to outside organisations in support of people’s wellbeing.

Processes in place however to ensure appropriate information was shared with the local authority safeguarding team and CQC in respect of safeguarding events and changes in people’s deprivation of liberty safeguards was not robust. This meant that the local authority and CQC had no knowledge of some specific events that had occurred at the home or the increased restrictions placed on some people’s lives.

The manager told us improvements to care plans had been made however at the time of our inspection, concerns were again identified with the quality and sufficiency of information about people’s needs, risks and care. The manager and staff told us that learning was shared at staff meetings but records did not evidence this.

We found that a culture of continuous improvement was not fully embedded at the service. A Local Authority Quality Assurance Visit had recently taken place. This visit and the provider’s own audits had identified that improvements in care planning, record keeping overall in respect of people’s care, and the team’s consistency with applying and recording decisions made under the Mental Capacity Act, all required improvement. At this assessment, we found the same. This did not show a culture of responsive or effective learning had taken place to improve standards in these areas.