Archived: Rosehaven Residential Care Home

At a previous comprehensive inspection in June 2016 the service did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. At the last comprehensive inspection on 21 February 2017, the service had demonstrated improvements and was no longer in breach of the regulations. However we rated the service as requires improvement as further work was required by the service to ensure these improvements were sustained. This required consistent good practice over time so we carried out a further inspection on 30 April 2018.On this inspection the service was rated overall as good.

Rosehaven residential care home is registered to provide accommodation for up to 24 older people. The home is situated close to Stanley Park and local community facilities. Communal accommodation consists of a large lounge and a smaller lounge and dining room on the ground floor. Bedroom accommodation is situated on the ground, first and second floors. An en-suite facility is provided in nine of the bedrooms. There is a passenger lift for ease of access throughout the building.

At the time of the inspection 11 people lived at the home.

There was a registered manager in place. 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 looked around the home to check it was safe and maintained, clean and hygienic. It was clean and hygienic throughout. We found the door to the sluice was unlocked, a door to the basement steps could be opened quite easily and people could access cleaning materials and toiletries throughout the home. The risk assessment showed people who lived at the home when we inspected were not at risk from these actions. The registered manager was aware the risk assessments would need updating on new admissions or where there were changes in an individual’s care needs.

The back door, a fire door, was left unlocked to enable one person to go outside when they wanted. However this reduced the effectiveness of fire safety measures. The registered manager arranged for a keypad to be fitted the following day so fire safety was not compromised.

We found although equipment had been checked, serviced and maintained by external companies, there had been a gap in completing internal safety and maintenance checks and in record keeping. Regular internal checks had been reintroduced and records kept before we inspected, but a lack of consistent checks increased the risk of equipment not being in working order.

We made a recommendation that appropriate internal checks were carried out and records kept according to good practice guidelines.

There were several areas where maintenance or improvement to décor was needed to improve the environment. Several windows were in a poor state of repair. The service was awaiting delivery of new windows throughout the home to replace worn or damaged ones. Because the home was a listed building they had to be specially made so this was delaying replacement.

People we spoke with told us they felt safe and cared for at Rosehaven. They told us they were satisfied with the care they received and were supported by staff who kept them safe. There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place which provided guidance for staff in how to safely support people. This minimised potential risks.

The registered manager had improved the signage and dementia friendly equipment for people with dementia, such as special crockery, eating utensils and coloured toilet seats which contrasted with the toilet itself. However the carpets and décor were not always dementia friendly.

Medicines were managed safely. Medicines were stored, administered and disposed of according to the home’s procedure and good practice guidelines.

People told us staff were kind and helpful. Comments included, “It’s a very good service.” And, “They’re very cheerful here. I like it.” We observed good and caring interactions during the inspection. We saw staff spoke with people in a friendly and respectful way and provided personalised care that helped maintain people’s well-being. A relative told us, “I’m very happy with the care here.”

We saw staff supported people to access healthcare promptly. Staff provided care in a way that respected peoples’ uniqueness, dignity, privacy and independence.

We saw there were sufficient levels of staff to support people with personal care and social and leisure activities during the inspection. People who lived at Rosehaven and relatives spoken with told us there were enough staff. Staff recruitment was safe. Staff had the skills, knowledge and experience required to support people.

We saw staff focused on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered care in the way the person wanted. Care plans were personalised, informative and reflected people’s needs and preferences. They had been regularly reviewed and updated.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said they had nutritious meals]#, the food was varied and they were offered drinks and snacks. Staff knew people’s nutritional needs, likes and dislikes.

There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

The service had a complaints procedure which was made available to people who lived at Rosehaven and their representatives. There had been no complaints made to the home in the previous twelve months. The service had information with regards to support from an external advocate should this be required by them.

The management team completed audits to assess and monitor the quality and safety of the service. Action was taken when any areas for improvement were found.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

At the last inspection in 20 and 30 June 2016 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and was rated as ‘Inadequate’.

During the last inspection, we found multiple breaches of legal requirements. We rated the service as inadequate and placed it in Special Measures. At that inspection the provider failed to protect people from abuse and improper treatment. They had not always assessed risks to people's health and safety or done everything reasonable to mitigate risks. The provider had failed to ensure people received their medicines safely and when they needed these. They had failed to provide person-centred care that met people's needs and reflected their preferences. The provider had disregarded the needs of the person for care or treatment and had deprived people of their liberty unlawfully. Signed consent to care was not obtained. The provider had failed to maintain an accurate, complete and contemporaneous record in respect of each person. They had not implemented effective systems to assess, monitor and improve the quality and safety of the service provided. There was not a thorough recruitment processes to safeguard those who lived at the home from the employment of unsuitable staff. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed. The provider had failed to inform CQC of incidents affecting the health, safety and welfare of people who lived at the home.

We made a recommendation for the provider to further improve people’s safety and welfare and to arrange advocacy support for people who had limited mental capacity to assist with decision making, where they had no one to advocate on their behalf.

As a result of our findings the service was placed in ‘special measures’ by CQC. This report only covers our findings in relation to the latest inspection. You can read the report from our last inspections on 20 and 30 June 2016 by selecting the 'all reports' link for Rosehaven on our website at: www.cqc.org.uk.

During this inspection on 21 February 2017, the service had demonstrated improvements and is no longer rated as inadequate for any of the five key questions. On this inspection we found improvements had been made and all breaches were met. However further work was required to embed the changes made to the care records and we made a recommendation about this. We also needed to ensure these improvements were sustained, as to do so requires consistent good practice over time.

Rosehaven residential care home is registered to provide accommodation for up to 24 older people. The home is situated close to Stanley Park and local community facilities. Communal accommodation consists of two lounges on the ground floor and a separate dining room. Bedroom accommodation is situated on the ground, first and second floors. An en-suite facility is provided in nine of the bedrooms. There is a passenger lift for ease of access throughout the building.

At the time of the inspection visit seven people lived at the home.

There was a registered manager in place. 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.

People told us they felt safe at Rosehaven. Procedures were in place and risk assessments completed to reduce the risks of abuse and unsafe care. People said there were enough staff to support them well and give them help when they wanted this. Staff had improved the care and attention they provided to people in the home. People told us staff were friendly and helpful. They told us they were treated with respect and valued.

We looked at how the home was staffed. We saw there were enough staff to provide safe care and supervision and social activities. We looked at the recruitment of three recently appointed members of staff. We found appropriate checks had been undertaken before they had commenced their employment. This reduced the risk of appointing unsuitable staff.

Staff had been trained and had the skills and knowledge to provide support to people they cared for. They received regular support and supervision from senior staff.

We looked at how medicines were managed. Staff managed medicines competently. People told us they felt staff gave them their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People were complimentary about the meals and told us they enjoyed them. People were offered a choice of nutritious meals.

Records were available confirming gas appliances and electrical facilities and equipment complied with statutory requirements and were safe to use. The environment was clean and hygienic.

We saw action was taken when people had health care needs. However, although advice was sought, there were concerns that full documentation was not always completed.

We have made a recommendation about staff using report writing guidance when documenting information.

We observed staff providing support to people during the inspection visit. We saw they were kind and attentive and cared for people safely.

Care plans were personalised, involved people and where appropriate their relatives and were regularly reviewed.

People said they knew how to complain if they needed to. They said any comments or complaints were listened to and action taken promptly.

People told us the registered manager was approachable and supportive and listened to their views.

We found systems and procedures were in place to monitor and assess the quality of their service. These included seeking views of people they support through informal discussions and satisfaction surveys.

Although the service had improved since the last inspection we need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Rosehaven Care Home is registered to provide accommodation for up to 24 older people. The home is situated close to Stanley Park and local community facilities. Communal accommodation consists of two lounges on the ground floor and a separate dining room. Bedroom accommodation is situated on the ground, first and second floors. An en-suite facility is provided in nine of the bedrooms. There is a passenger lift for ease of access throughout the building.

There was a registered manager in place. 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.

Not all the people in the home were able to converse easily with us. Therefore, we also observed care and staff interactions with people and spoke with people’s relatives. People able to talk with us told us they felt safe and well cared for. However, the care practice we saw did not always indicate this. Care practice was not always safe. Highly dependent people were left unsupervised. There were not enough members of staff available to support people safely and staff were not deployed in an effective way.

There were significant periods of time where people in both lounges, were left unsupervised, unsupported, unstimulated and inactive. More dependent people had limited interaction from staff and no social or leisure activities. Staff interaction was mainly to assist with meals or drinks. We observed three people in one lounge who were very dependent. They were unsupervised, with little stimulation or attention for long periods of time. There was more supervision in the other lounge, but this was still limited.

We looked at how medicines were prepared and administered. We saw ‘when necessary’ medicines were not always given as prescribed or as needed. Information about foods that adversely interacted with certain medicines were not recorded on MAR sheets or nutritional care plans. Failing to give people their medicines properly placed the health and welfare of people at unnecessary risk.

We looked at the recruitment and selection procedures the provider had in place to ensure people were supported by suitably qualified and experienced staff. We looked at the recruitment records of six members of staff. Suitable arrangements were not always in place to ensure safe recruitment practices were followed.

People told us that staff were caring and kind. They and their relatives said that staff were patient and compassionate. However, care practices were not always safe and had the potential to or caused harm to people. Although staff were pleasant, they did not focus on the wellbeing of more dependent people.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), was not implemented. People had not consented to or been involved in planning and updating their care. People’s mental capacity had not been assessed. The registered manager had not applied for a DoLS for anyone in the home even for those who would meet the criterion for a DoLS because of their lack of capacity. The registered manager had met with the local authority for advice when we inspected, but had not started the DoLS process. They did not have a working knowledge of the MCA.

Care planning was not personalised. Neither were care records always accurate or up to date. Choices of when to receive personal care and support were limited by the staff routines. These were task centred rather than in response to people’s individual needs and preferences. Social and leisure activities were not in place.

People, relatives and staff told us they found the registered manager supportive and approachable. One person told us, “She is lovely. I can always have a few minutes talking to her.” However, we found the home was not well led and the registered manager was not fully aware of their responsibilities as the registered person.

There were procedures in place to monitor the quality of the service. However, the audits were not consistently completed. Neither had the audit systems identified the areas of concern found during this inspection.

There was good dementia signage around the home. Communal areas were clean and tidy and bedrooms were clean and personalised. However, not all bedroom windows could be opened and window frames throughout the home needed attention.

People were complimentary about the meals and told us they enjoyed them. People were offered a choice of nutritious meals.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

To help us understand people's experience of living at Rosehaven care home, we observed how staff interacted with them. We also spoke with relatives and staff. People told us the staff were sensitive to their needs. They said they responded quickly to any requests for help and supported them as they wanted. One person said, 'The staff are great. They give you any help you need and are always willing to go that extra mile to make things better for you.'

When we inspected there were enough staff on duty to support people as they needed. People said they rarely had to wait for help when they asked staff. We observed staff interacting and engaging with people as they supported them. They were able to support people without rushing them. A member of staff told us, 'This is the best care home I have ever worked in. I would recommend it to anyone. The manager expects the best for residents and we have the time to care for people.'

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when an application should be made and in how to submit one.

Systems were in place to make sure the staff team learnt 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.

Service contracts were in place. Maintenance records we looked at showed regular safety checks were carried out. This ensured the home was maintained.

Is the service effective?

People's health and care needs were assessed and reviewed with them. We saw care plans were up to date and reflected people's current individual, dietary, cultural and religious needs.

The individual needs of people were taken into account with the specialist equipment and the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

People confirmed they were able to see their visitors in private and friends and relatives could visit whenever they wished. One relative said, 'We are always made so welcome. Whenever we visit we are treated so well by all the staff.'

Is the service caring?

We observed people being treated with respect and dignity with staff assisting people in a sensitive manner. One person told us, 'I couldn't be looked after any better. All the staff are so willing. They will do anything for you.' A relative said 'The home is brilliant. The staff are lovely. They make so much effort to make things nice for people.'

We saw the main meal being served at lunchtime. Staff were attentive and supported people appropriately as they assisted them with their meals. We saw staff assisting people in a sensitive manner. One person had become anxious. Staff quietly reassured them and encouraged them to get involved in other things. A relative said 'The home is brilliant. The staff are lovely. The make so much effort to make things nice for people.'

Staff respected the diverse needs of people. Religious, cultural, sexual and other diverse needs were taken into account when planning care.

Care plans were being maintained, and regularly updated, recording the care and support people were receiving. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People said they could make their views, ideas or concerns known to the manager and staff team. They had no complaints and were happy in the home. Relatives were also complimentary about the manager and staff team. A relative told us, 'We haven't any complaints about the care. We are so pleased that the staff make so much effort to make the home so good.'

Is the service responsive?

Staff assisted people with personal care discretely and sensitively and in a timely manner. Religious, cultural and other diverse needs were taken into account and these were being met as people wanted. We observed people involved in daily living activities, social and leisure activities or chatting with staff.

People told us the manager and staff asked their opinion on their care and support often. Relatives said senior staff made themselves available to talk with them. They said they were encouraged to tell the staff team if they had any ideas about the care of their family member.

People we spoke with told us staff listened to them. They said the manager and staff team acted on any concerns and explained the reasons behind decisions. They said they were encouraged to discuss any minor issues, so any minor concerns were quickly resolved. One person said, 'The staff here are fabulous they listen to any concerns or worries and deal with them.'

Is the service well-led?

The service had a quality assurance system in place. The manager carried out frequent monitoring checks and worked across a variety of day and night shifts to make sure she was aware of how the home was running. There were some formal audits with records kept but others checks were more informal. This meant it was less easy to check for any repeated errors or omissions.

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt they worked together effectively. Staff had regular meetings so were involved in decisions about the home. There were also regular residents meetings.

We were notified of any incidents or issues relating to the home in a timely manner.

We also spoke individually with four people living at the home. People spoke positive of the staff team describing them as, 'Smashing' and, 'Very good'. We were told us, 'Yes I think I am well looked after, they look after us really well'. Another person said, 'Everyone is good, all of them are kind and helpful'.

Although most people that we spoke with could not remember what they had just eaten for lunch, we were told that they enjoyed the foods served. However one person told us that the meals served was one area that could be improved. The same person did however confirm that following the most recent residents' meeting, Scampi had been put on the menu as this had been requested.

People told us that they felt safe living at the home and that they had no complaints or concerns. One person said, 'Any concerns all you only need to tell the staff and they will try and sort it out. If not they will go to Sheryl (Registered manager).

Staff spoken with said that staff training was given high priority. One person said, 'Everybody is doing some training. We are a well trained team. She (the registered manager) likes you to keep on top of training'.