Archived: Rosevilla Nursing Home

The inspection was unannounced which meant the service did not know we were coming.

During our inspection, we spoke with five people who used the service and the relative of one person. We also spoke to six members of staff, the registered manager and the regional manager. We looked at seven people's care records to see if their records were accurate and up to date and their needs met. We also looked at records relating to the management of the home. This included incident reporting records and monthly care plan audits.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, a relative and staff told us.

Is the service safe?

We found that the provider did not always take appropriate action to ensure that people remained safe following an incident. We saw that where people had fallen, management plans were not in place to ensure that further falls were prevented.

We saw that people's records were not always accurate and did not reflect the care they received. This meant that people were at risk of receiving unsafe care because accurate records were not maintained.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the care and welfare of people who used the service and maintaining accurate records.

Is the service effective?

Each person had a plan that outlined their needs and preferences. The provider had an effective system in place for monitoring people who were on fluid intake monitoring and took appropriate action when concerns were identified.

We saw that information relating to the care needs of people, and people's care plans did not always contain clear and consistent information required to guide staff on how to meet people's needs in a consistent manner. Staff provided us with conflicting information about how they provided care to people. This meant that people were at risk of receiving unsafe or inconsistent care.

We have asked the provider to tell us how they will ensure that care plans are clear and consistent in order to ensure that effective care is provided.

Is the service caring?

During our inspection, we observed people being treated with dignity, respect and compassion. We observed positive interactions between the staff and the people who used the service.

One person we spoke with said, 'The girls are nice'. Another person we spoke with said, 'It used to be a nice place, but they haven't got time to look after you, they say they are too busy when you need help. They just haven't got time'. The relative we spoke with told us they were happy with the care provided at Rosevilla Nursing Home.

Is the service responsive?

Prior to the inspection, we received information of concern that people had to wait for long periods of time when they needed assistance. One person told us they often had to wait before they received help. They said, 'I've waited hours sometimes to go to the toilet'.

During this inspection, we observed that people's call bells were responded to in a timely manner and people did not have to wait before they received the support they required.

We saw records that other healthcare professionals visited the home regularly. We saw that people were referred to other professionals when there were concerns about their health or welfare.

People who used the service had opportunities to be involved in social activities within the home and in the community. We saw that activities were based on people's individual interests and preferences.

People who were at risk of developing pressure ulcers or had pressure ulcers were at risk of further deterioration because staff did not always provide the care as planned. There was also conflicting information about how care should be provided.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the welfare and safety of people who used the service.

Is the service well led?

Systems were in place to assess and monitor the quality of the care provided so that improvements could be made. Some of the systems in place were not always effective, as the problems we identified with safety had not been identified by the registered manager. The registered manager told us they carried out daily checks on records and signed that required monitoring of care was carried out as planned.

Incidents that occurred in the home were recorded but not always analysed to ensure that actions were put in place to prevent them for reoccurring.

Care plans were audited on a monthly basis but the systems in place for ensuring that actions were recorded and monitored were not utilised. This meant that the registered manager could not be assured that recommendations were acted on.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that they have effective systems designed to enable them to protect people who used the service against the risks of inappropriate or unsafe care.

During our inspection we spoke with seven people who used the service and the relatives of three people. We also spoke with seven members of staff, the registered manager and the operations manager. We looked at four people's care records to see if their records were accurate and up to date. We also looked at records relating to the management of the home. These included audits and minutes of meetings.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People and their relatives told us they felt safe. One person said, 'There is always someone here and the doors are always shut'. A relative said, "I know there are always staff here 24 seven'.

The provider had a system in place that ensured the staff were of suitable character to support the people who used the service. We saw that people were protected from abuse because the staff had received training in how to identify and report possible abuse.

We saw that some of the risks posed to people's health and wellbeing had not been assessed or planned for. We found that where assessments had occurred the risk management plans had not always been reviewed as required. This meant that accurate information to guide staff on how to keep people safe was not always available and people were at risk of receiving unsafe or inconsistent care.

The staff were aware of the systems in place to ensure the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed. These requirements are in place to protect people who are unable to make their own decisions about their health and wellbeing. This meant people could be assured that important decisions about their health and wellbeing would be made in their best interest if they did not have the ability to make decisions for themselves.

Is the service effective?

Each person had a care plan that outlined their needs and preferences. However, these plans did not always contain all the information required to guide staff on how to meet people's needs in a consistent manner.

We saw that people and their relatives were involved in the planning of care. This meant there was a system in place to gain information about people's care preferences.

We saw that arrangements were in place to request health and medical support when needed. People were able to access doctors, nurses and dieticians when required.

Is the service caring?

The people and relatives we spoke with gave mixed views about the care. Positive comments included, 'It's absolutely marvellous here' and, 'The rapport I have with the staff is great'. Some of the feedback we received suggested that some people were not happy with the care they received from some of the staff at the home. These comments included, 'If I could pick the bad ones (staff) out, the care would be wonderful' and, 'Some staff are not so good, but I don't want to say as I have to live here'. We informed the registered manager of people's feedback and they assured us they would follow up the themes raised.

During our inspection we observed people being treated with dignity, respect and compassion. We observed positive interactions between the staff and the people who used the service.

Is the service responsive?

People were supported to make choices and decisions about their care. The relevant legal guidance was followed to support people to make decisions when they were unable to do this alone.

We saw that people had the opportunity to participate in social and leisure based activities. Staff told us that these were based on people's individual interests and preferences.

We saw that the registered manager sought feedback about the care from people and their relatives. Feedback relating to concerns and complaints was appropriately acted upon.

Is the service well led?

Systems were in place to assess and monitor the quality of the care provided so that improvements could be made. Some of the systems in place were not always effective as the problems we identified with safety had not been identified by the registered manager.

Incidents that occurred at the home were investigated, acted upon and monitored by the registered manager.

We saw that improvements had been made. People said they were satisfied with their care. One person said: "I am looked after well, the staff seem busy but they care. That's the main thing". Relatives said they were happy with the care. One told us that they felt the home had improved since the previous inspection. They described their relative's care as 'excellent'.

An improved plan of care had been developed and was in the process of being implemented. People's needs were being evaluated every month to ensure that the care provided was appropriate. There was little for people to do at the home. There were few opportunities for people to take part in activities and to meet with other people.

People's nutritional needs were regularly assessed. A new system had been put in place to make sure that people received the correct diet and had appropriate support to eat their meals. The amount people ate and drank was being effectively monitored.

Staffing levels had increased. This meant that people's personal and health care needs were responded to more promptly and effectively.

The provider had improved the way it responded to people's concerns. Complaints were recorded and acted upon to improve the care people received.

An expert by experience took part in this inspection and talked to the people who used the service and their visitors. We met and spoke with the registered manager, two nurses and four care staff. We spoke with 12 people who lived in the home and nine visitors of people that used the service.

To help us to understand the experiences of people less able to talk to us, we used our Short Observational Framework for Inspection tool (SOFI). The SOFI allows us to watch what is going on in a service and see how people spend their time, the type of support they get and whether they have positive experiences.

We looked at three people's care plans which all required further input. We saw staff supervision records and the training matrix which were also incomplete. We looked at how equipment was used in the home to support people's independence or assist staff with moving and handling. Some staff had not been trained. We reviewed the complaints policy and procedure and found issues about their documentation.

During the inspection we identified non-compliance relating to the provider not meeting people's nutritional needs, the poor administration of medicine and inadequate staffing; these outcomes were included in the inspection.

The care home currently had 28 people using the service, one person was in hospital.

One person living in the home told us, "I prefer to stay in my room and the staff respect that. I have some visitors but prefer the peace and quiet". One relative told us, "Sometimes the staff do activities in the lounge for people to join in but I think most people prefer the one to one sessions than big groups. The staff are very caring and attentive, we are delighted with the home".

We looked at the management of medicines in the home and found this to be in order. No issues had arisen with the dispensing pharmacist.

We looked at the staffing rotas and the skill mix in the home. The trained nurses who lead the team of carers were supported by the manager and her deputy. People that lived in the home and relatives we spoke with told us they were very appreciative of the care and attention shown by the staff. We saw that the staff were appropriately trained and supervised.

We saw that the home audited the quality of the service being delivered. The manager had received thank you cards from grateful relatives. Relatives and people that lived in the home spoke very highly of the care and attention they all received.