Rotherlea

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection undertaken on 14 November 2019, we found the provider had not ensured that there was sufficient staff to meet people's assessed levels of need. At this assessment, improvements had been made and the provider. There was improved oversight on the management and deployment of staff at the home. Staff continued to receive training to allow them to support people safely and effectively. Medicines were safely managed and administered. People’s concerns were listened to and acted upon. Risks to people’s health and support were assessed and managed well by staff. Staff were trained in safeguarding and understood how to protect people from the risk of abuse. The environment of the home was safe, clean and met people's needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People said they could tell staff about and make changes to suit them.

The registered manager was focussed on continuous improvement and learning from when things went wrong. Incidents and accidents reports were monitored and reviewed daily so that appropriate actions could be taken, and any learning put in place. The registered manager had worked with the provider in developing a new incident reporting system which we viewed during the assessment. Incident reporting systems were in place, and staff understood their role in ensuring that incidents were raised appropriately. Reports viewed were clear, detailed, considered any safeguarding risks and identified any learning. There were processes to ensure that lessons are learnt when things go wrong, and from examples of good practice. The provider had reviewed its policy and procedures following a death at the service. The provider reviewed areas of policy to ensure that procedures were robust and provided staff with the guidance they needed.

The registered manager was confident that staff were reporting all incidents as this is checked during the daily monitoring meetings. Staff are asked about any incidents that have occurred and check they have completed incident reports. The registered manager told us that they were using the reporting system to develop trends analysis and gave the example of falls analysis as an example of improved learning. Complaints system and processes were in place. The registered manager stated that being available and always accessible for relatives helped to resolve issues as they arise. Duty of candour letters were completed when accidents or safeguarding incidents had occurred. Duty of candour is a requirement that ensures providers are open and transparent with people who use services.

People told us that staff were proactive in seeking additional support for any health needs. One person said, “Whatever they think they need to do they do. I am in safe hands with them.”

Feeback from professionals and partners was positive on how staff and management worked together with them to provide consistent, effective care. One professional said, “Each resident is very well known by the carers and managers. At our weekly ward rounds, any problems are presented in a clear detailed way with clear in-depth background knowledge and information easily available. This is tremendously important in facilitating good care and healthcare for the residents.” They stated, “There are many evident systems in place to enhance safety for residents- medication reviews are sought in a timely manner in addition to the ones that we would routinely undertake as the primary care team.” Another professional said, “Throughout my involvement with Rotherlea, I have always been impressed with the level of care and attention the team have provided to their residents. They have always been prompt in escalating concerns, and thorough in their assessment of their resident’s needs.”

There were embedded and consistent systems in place to facilitate safe pathways and transfers for people. When people were admitted to the home, people had tailored transitions to the home to ensure that they were comfortable and happy. Staff had developed positive links with the local surgeries and processes in place to register admissions to the home. Staff managed discharges and transitions from hospitals well. When people were admitted to hospital, systems were in place for staff to provide health colleagues with up-to-date and relevant information about people’s support. Senior staff linked with community nurses and the GP in weekly multi-disciplinary meetings to ensure that people were referred appropriately to other agencies. Systems were in place that meant appropriate referrals were made to external agencies and professionals when specialist support was needed, for example to the Falls Team or the Speech and Language Therapist.

The registered manager stated they are constantly looking to improve communication and systems between health and social care agencies to ensure people received good care. The registered manager was complimentary about the local primary health support. They said, "I've never had such a supportive GP surgery."

We observed staff supporting people safely and with kindness.

There were effective systems and processes in place to manage safeguarding risks. The manager and staff were clear on their safeguarding responsibilities. Statutory notifications had been submitted to CQC and LA alerted to any potential safeguarding incidents. Staff were knowledgeable about safeguarding processes and when to escalate incidents. Management understanding of the Deprivation of Liberty Safeguards (DoLS) was good. Appropriate and relevant applications had been made to protect individuals who lacked capacity and completed in their best interests.

There were embedded and consistent systems in place to facilitate safe pathways and transfers for people. When people were admitted to the home, people had tailored transitions to the home to ensure that they were comfortable and happy. Staff had developed positive links with the local surgeries and processes in place to register admissions to the home. Staff managed discharges and transitions from hospitals well. When people were admitted to hospital, systems were in place for staff to provide health colleagues with up-to-date and relevant information about people’s support. Senior staff linked with community nurses and the GP in weekly multi-disciplinary meetings to ensure that people were referred to outside agencies appropriately. Systems were in place that meant appropriate referrals were made to external agencies and professionals when specialist support was needed, for example to the Falls Team or the Speech and Language Therapist.

There was a good understanding of safeguarding by all staff. Safeguarding training provided to all staff and records showed good compliance of this training. Staff demonstrated a good understanding of safeguarding triggers, awareness of types of abuse and how to report potential abuse.

People told us that staff supported them safely. They told us they had the equipment they needed to move around the home independently and with the help of staff. One person said, “I feel very happy here, I couldn’t look after myself where I was. I feel good, gracious, I have my stick. I use it and a trolley.”

We observed people being cared for safely throughout the assessment. When people needed support with their mobility needs, transfers were completed safely and effectively, using the correct equipment. We observed the daily monitoring meeting where updates to people’s care and any present risks were discussed. This provided staff with information they needed to manage current risks.

Management and staff were knowledgeable about people’s needs and the risks to those they supported. Management ensured that risks to people were regularly reviewed, and guidance updated if needed. When asked about whether the home managed risks well, one support worker said, "Yes I do think they do. With moving and handling, I support them when they are using frames and supporting them from the back and make sure they are safe. They gave us training on how to use the hoist safely." Another support worker said, “For example with moving and handling, we make sure we use two carers. We make sure to use the correct sling and size and that all the checks are done. We make sure the resident is calm and inform them what we are going to do. Good communication between the two carers is needed."

Risk assessments were detailed, person centred and provided detailed guidance for staff to manage these. There was a good analysis of people’s health, environmental and behavioural risks. Records showed that these were regularly reviewed and updated when risks or needs had changed. All people were assessed for risks such as skin integrity, falls, moving and handling, nutrition and hydration for example. Staff had assessed in detail more specific risks relating to that individual and included what guidance and actions staff needed to take to mitigate those risks and support the person safely. For example, when people had been assessed at risk of choking, referrals had been made to Speech and Language Therapists, and subsequent guidance had been included in their care plans.

Regular maintenance checks of the environment were completed, while records confirmed that equipment was serviced, and quality monitored. Fire safety processes and checks were completed regularly, while records showed regular testing and auditing of equipment and systems within the premises.

People told us they felt safe and secure around the home. People had personal evacuation plans in place that guided staff to support them in the event of an emergency. These considered any physical, emotional or sensory needs that would impact them.

The registered manager described a situation where a resident who suffered from anxieties and resulting stress could not always find her way back to her room if staff weren't available. The registered manager said, "One of my fantastic support workers came up with the idea of putting direction markings up all over the ground floor to help her find her way. This lady was still able to read very well and had a good understanding of what she read so these signs had a fantastic effect on her mood and also gave her back some independence." One Support Worker said, "I didn't experience those risks before in domiciliary care. For example, if the door is not working well here, they will sort it out."

People were cared for in safe environments that met their needs. Facilities, equipment and technology were well-maintained. There were effective arrangements to monitor the safety and upkeep of the premises. Equipment used to support people’s needs looked well maintained and in good condition. Bathrooms and communal facilitates were of good use and presentation. Service has good quality working lifts for residents with mobility needs. Hallways and communal areas were wide and permitted free access. Consideration had been made to how the environment of the home could support people who were living with dementia for example. Dementia friendly signage for communal areas and facilities were observed, while most communal rooms had large glass windows to allow people to see where they were. Décor in most areas was simple to reduce confusion.

Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. New staff completed a full induction and probationary period. Training had been identified and provided to staff according to the needs of the people living at Rotherlea. These included safeguarding, Mental Capacity Act (MCA), medication, fluids and nutrition, and moving and handling. The registered manager had good oversight over staffing numbers at the home and used a dependency tool to calculate how many staff were needed to safely meet people’s need. This factored in areas such as people's mobility, eating and drinking needs, personal care and hygiene. Staffing levels were consistently reviewed. Records showed that daily rotas were consistently scheduled based on these calculated needs.

The registered manager stated that he felt staff in all homes would say that more staff would be needed or desired but felt that he had fostered an open culture in his time as manager where staff could feed back any concerns in this area. He cited a recent anonymous staff engagement survey where no concerns had been highlighted around staffing levels. Feedback was positive about staffing levels and staff having enough time to carry out their roles. One Support Worker said, “Yes, they are enough. Usually when there is lack of staff, they message other staff and ask if they want to do overtime. There will be enough staff for all the units. Sometimes there are extra support workers here.” Another Support Worker said, “Yes, we have enough staff now. We are good. No concerns with the lack of staff here. We have time to talk to people and chat.” Another Support Worker said, “I think there is enough staff. The numbers each shift are ok.” Staff spoke positively about the induction and training opportunities they undertook to carry out their roles. One support worker said, "Yes it was helpful because they gave us any training that we need. I was comfortable as they made it good for me." Another worker said, “The training is very helpful. The most helpful was the dementia because it can sometimes be tricky to support people who live with it. It showed me how to support them and make them less anxious." Another support worker said, "The induction was really good. They were asking questions. If I ask for training, they will give it me. When I came here, they provided all the training that I needed. I really enjoyed studying about dementia. Showed me how I can support people. It requires patience and guidance for them."

Staffing levels were good and consistent within different units. Staffing was more prominent in communal areas where people had gathered to relax and where support was being provided.

Generally, people were happy with how staff responded when they needed support. People told us that staff came in good time when they pressed their call bells for help. One person said, “If I want staff I call the bell, they come as quickly as they can, I am not the only pebble in the beach. I wouldn’t know how many they have on, for me there’s enough.” Another person said, “I think there are enough, they come quickly if they are not busy when I press the bell. Sometimes they pop in to see me anyway.” One relative said, “I think there are enough, always someone to float around in the lounge. They are all floating about the place.” People responded positively when asked about the skills of the staff that supported them. One person said, “I don’t think (registered manager) would tolerate poor training. Every staff member has different methods, but everything is done properly. They do ask you ask, they say yes, no problem.” Another person said, “Some are well trained, some are novices. The novices are learning, they are getting better over time.”

All areas of the service were seen to be clean, tidy and smelt fresh. Bathrooms were clean, looked sanitary and had been cleaned. Domestic staff were seen addressing touch point areas and communal areas during the assessment. Throughout the service was clean, tidy and well maintained. Staff and residents looked well-kept with good personal hygiene.

The service had a variety of measures to promote good infection prevention. Domestic staff maintained a consistent and thorough cleaning schedule of all areas of the service. Domestic staff had a clear system and process for managing dirty and clean laundry. Staff received training in infection control, health and safety and food hygiene. Staff had access to personal protective equipment (PPE) for when they carried out personal care and administering medicines. The registered manager conducted infection prevention control audits to ensure that processes were being adhered to.

Support staff had received training in medicines but were clear that the role and repsonsibility of day-to-day administration lay with the Team Leaders. One support worker said, "No the Team Leader does the Medicines. We also have the training as back up."

All people we spoke with told us they felt the service was clean. One person said, “They always say can I come in and clean. I am happy its clean.” Another person said, "I am happy with the frequency and standard of cleaning here. My bedding is changed often.” “It’s clean, I am pleased with it.” One relative said, “It’s very clean, one of the things that struck me when looking for dad.”

Support staff had received training in medicines but were clear that the role and repsonsibility of day-to-day administration lay with the Team Leaders. One support worker said, "No the Team Leader does the Medicines. We also have the training as back up."

People’s medicines were managed, administered and stored safely. All staff had received training in medicines with Team Leaders completing medicines administration. Electronic Medication Administration Records (eMAR) showed that people received their medicines as prescribed, and these records were completed accurately. Where people had ‘when needed’ (PRN) medicines, staff were supported by PRN protocols. These protocols guided staff about the prescribed medicine and how to know that the person needed the medicine. Effective auditing systems were in place to check the quality of staff’s administration and management of medicines.

We spoke with people about medicines, and they told us they were happy with the way they were managed. One person said, “They come and tell you if there are changes, I can have my say. I am happy with the way they do things; they are here like clockwork.” Another person said, “They do all my medications, it is important for me.” One relative stated, “Dad has med changes when he came out of the hospital, it was comforting to know staff took over the medication.”