Rosclare Residential Home Limited

Rosclare Residential Home Limited is a residential care home providing personal care for up to 19 people in one adapted building. The service provides support to older people, those with dementia and with a sensory impairment. At the time of our inspection there were 18 people using the service.

People’s experience of using this service and what we found

We have identified that quality assurance systems need to be more effective in identifying areas for improvement across the home. Risk assessments needed further updates to ensure they were more specific in stating steps staff needed to take to mitigate risk. Deprivation of Liberty Safeguards (DoLS) applications were not always applied for in a timely manner and medicines processes were not always clear in the administration of ‘PRN’ [as required] medicines. The home required update and refurbishment to ensure it was homely and hygienic throughout.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People and relatives felt that they were well cared for at the home. Staff respected people well and supported them with dignity. Care plans reflected people’s needs and how they liked to be cared for.

Staff were safely recruited and there were enough of them to meet people’s needs. Safeguarding concerns, and any accidents or incidents were appropriately investigated and shared with the staff team. Complaints were recorded and responded to.

Staff, relatives and people were positive about the support they received from management and found them to be approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider review staffing levels to ensure they could meet people’s needs. At this inspection we found staffing levels were safe to meet the care needs of people at the home.

At our last inspection we recommended that the provider review and update staff knowledge and training in relation to the MCA. At this inspection we found that staff were knowledgeable in this area.

Why we inspected

This was a routine inspection based on the providers last rating and to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

No visitors were being allowed into the service due to the COVID-19 outbreak. Suitable arrangements had previously been put in place to help people maintain safe social contact with their family members and friends. These included window and garden visits.

Staff and people at the home were engaged in the ‘whole-home’ testing programme. People living in the home were routinely tested for COVID-19 every four weeks or as required with staff being tested once weekly. Rapid Lateral Flow Test (LFT) testing was additionally in frequent use due to the COVID-19 outbreak.

People were only being admitted to Rosclare Residential Home following a negative COVID-19 test. Following admission, they were supported to self-isolate for a set period to reduce the risk of introducing infection.

Regular cleaning was undertaken to minimise the risk of infection with a deep cleaning schedule also in place. The age and layout of the home made social distancing more problematic. People using the service were being isolated in their rooms due to the outbreak.

Staff had received training and support in relation to infection control and COVID-19. We observed staff following national PPE guidance.

The service regularly monitored and audited compliance with the infection prevention and control measures in place. We discussed making improvements to the audit processes in place to fully document the checks taking place.

People’s experience of using this service:

Prompt and suitable action was not always taken to ensure the people were protected from the reoccurrence of significant risks. Incidents and accidents were not always appropriately investigated. The premises required improvement to ensure that window restrictors were in place on the ground floor. The registered manager had also failed to notify us of significant events as they occurred. We have made a recommendation in relation to improving staff knowledge of MCA and DoLS and the review of staffing levels.

At our last inspection one staff member had started prior to the receipt of their Disclosure and Barring Service (DBS) checks. Recruitment processes had improved to ensure staff were safe to work with people. Training for staff had improved so that they were able to access training in positive behavioural support.

People felt that staff cared for them well and ensured that their cultural and religious needs were met. People’s meal preferences were met and they were supported to access healthcare services when they need them.

There was a newly developed programmes of activities that ensured people received appropriate stimulation. Complaints were responded to appropriately.

The registered manager continued to improve quality assurance systems so that they had better oversight of the quality of care delivered.

Rating at last inspection: At our last inspection of the service was rated ‘Good’. (Published 21 November 2018)

Why we inspected:

This inspection was conducted following the receipt of whistleblowing concerns and intelligence received in relation to recent incidents.

Enforcement:

At this inspection we found breaches of the regulations in relation to the notification of incidents. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following the last inspection of 21 and 26 March 2018, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good. This is because the service was not meeting some legal requirements.

At this inspection we found that the provider had made the required improvements, and was no longer in breach of the regulations.

Rosclare Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rosclare Residential Home accommodates up to 19 people in one adapted building. At the time of our inspection 18 people were residing at the home.

There was 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.

At this inspection we found some improvement was needed to ensure that staff recruitment checks were obtained prior to them commencing their role. One staff member was supervised whilst the registered manager awaited the return of their recruitment check, and the day after inspection this was returned as satisfactory. We will check on the provider’s staff recruitment processes at our next inspection.

We also made two recommendations to the registered manager. One was in relation to the delivery of training for behaviour that challenges, and to streamline the recording of quality assurance audit findings.

People felt the home delivered safe care, and there were enough staff to meet their daily needs. Medicines were managed safely, and staff ensured people received them at the right time. Any risks to people were assessed and steps were in place to mitigate any identified risks. Measures were in place to prevent the spread of infection and the premises were kept clean. Improvements had been made to ensure that the premises were fit for purpose. Incidents and accidents were appropriately investigated, with staff aware of how to report any safeguarding concerns.

People’s care needs were assessed in line with best practice. Access to healthcare professionals was arranged at times that people needed them. The cook sought people’s food preferences and people were supported to receive food of their choosing. Staff received training, supervision and appraisal to support them in their roles.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported to make decisions in their best interests.

Staff knew how to care for people, and meet their individual needs. People’s privacy and dignity was respected when staff were supporting them. People were supported to express their views and receive care in line with their preferences.

People’s independence was promoted and they were encouraged to undertake tasks for themselves. People were supported to undertake a range of activities both inside the home and in the community. Where necessary, people were supported to express any end of life wishes. A suitable complaints policy and recording system was in place to address any concerns raised.

The registered manager had taken action to improve the service following our last inspection. Quality assurance systems were in place to review people’s care plans and actions taken to improve the care received. People, staff and other stakeholders were encouraged to feedback on their experience of the home. The registered manager took steps to work with other agencies to share learning.

There was a registered manager in place at the time of our inspection. 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.

Rosclare Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rosclare Residential Home accommodates up to 19 people in one adapted building, at the time of our inspection there were 16 people residing at the home.

Following the last comprehensive inspection on 17 January 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. We conducted a focused inspection on 09 August 2017 to check on improvements that the provider had made and found that appropriate action had been taken to meet the requirements.

However, at this inspection we identified on-going concerns about risks posed to people by the premises. The provider had not taken action to address hot water temperatures exceeding permitted safe levels in some parts of the home. A substance hazardous to health was not safely stored. This meant people were not sufficiently protected from the risk of injury or harm that could arise from scalding or burning from hot water and drinking hazardous substances.

We found that food items were not always appropriately stored or in date meaning people were at risk of eating foods that were not fit for consumption.

Action was not always taken to mitigate risks to people where issues had been identified. People had risk assessments in place but these were not always promptly updated to reflect a change in people’s needs and provide guidance for staff on how to support people.

We also found the provider's current arrangements for monitoring the quality and safety of the service were ineffective. The registered manager had not reviewed checks they and the deputy manager had undertaken to identify any issues or concerns that may have posed a risk to people's safety, health and wellbeing. Staff were not fully up to date with the provider’s training requirements. We were also concerned current checks and audits did not review all aspects of the service to give the provider the assurance they needed that the service was operating safely.

We identified three breaches of regulations during the inspection. These were in regards to safe care and treatment, staffing and good governance. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

We have also made recommendations. The first was in regards to the provider ensuring staff knowledge, skills and competencies to manage and administer medicines safely, was reviewed annually. The first was about the home’s environment and design not being as dementia ‘friendly’ as it could be. Although we saw there were some signs displayed throughout the care home to help people identify toilets and bathrooms, most bedroom doors lacked any visual cues in order to make the room more recognisable to people. We have also made a recommendation in relation to the review of activities at the home to ensure these provided personalised stimulation for people.

People were not provided with a choice as to their meal preferences, however they were offered fluids and snacks. People were supported to access healthcare professionals, however this was not always done in a timely manner to meet the needs of people at the home.

Staff were aware of how to report any concerns relating to abuse and there were enough staff to meet the needs of people at the home. The home appeared clean and hygienic.

Consent was sought from people in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff were caring and treated people with compassion. People’s privacy and dignity were respected and people were invited to express their views in relation to their care and treatment. Staff knew the people they cared for well and we observed that people were treated kindly and with compassion.

The provider had a complaints procedure in place and staff were clear on how to respond to any concerns raised. People’s end of life preferences were recorded to enable staff to support people with their choices.

We undertook this focused inspection on 9 August 2017. We checked the provider had followed their plan and made the improvements they said they would to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosclare Residential Home Limited on our website at www.cqc.org.uk

Rosclare Residential Care Home provides accommodation and personal care for up to 19 older people, including people who have dementia. At the time of this inspection there were 17 people using the service.

At this inspection we found the provider had taken the action they said they would and now met legal requirements. Our checks of hot water temperatures from outlets in the premises found these did not exceed permitted safe levels. Records maintained of these checks showed these consistently remained within these levels. This improvement meant people were now better protected from the risk of scalding from hot water.

Restrictors had been fitted on windows on the first floor of the home. This meant people were now better protected from the risk of injury or harm that could result from a fall from these windows.

The provider had introduced a new quality assurance system which enabled them to monitor, assess and review the quality and safety of the service. Shortfalls or gaps in expected standards identified through these checks was dealt with appropriately by the provider. Staff were supported to reflect on their working practices and the provider used people’s feedback more effectively to drive improvements at the service. These changes helped to enhance the quality of support people experienced.

We asked the provider to take action to make improvements in respect of the breach in regulation. We went back to the service in May 2016 to check that improvement had been made and found the breach of regulation was met.

Rosclare Residential Home provides accommodation for up to 19 people who require personal care and support on a daily basis. The home can accommodate people living with dementia and/or older people living with mental health issues. At the time of our inspection there were 18 people living at the home.

The service has 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.

At this inspection we identified new concerns about risks posed to people by the premises. The provider had not taken action to address hot water temperatures exceeding permitted safe levels in some parts of the home. They had also failed to identify that some window restrictors fitted on first floor windows would not have prevented a person from climbing out. This meant people were not sufficiently protected from the risk of injury or harm that could arise from scalding or a fall from upper floor windows.

We also found the provider’s current arrangements for monitoring the quality and safety of service were ineffective. The registered manager had not reviewed checks undertaken by staff to identify any issues or concerns that may have posed a risk to people’s safety, health and wellbeing. We were also concerned current checks and audits did not review all aspects of the service to give the provider the assurance they needed that the service was operating safely.

We identified two breaches of regulations during the inspection. These were in regards to safe care and treatment and good governance. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

The provider had continued to maintain the improvements that we saw in May 2016. Our checks found people’s records were accurate and up to date. Records, including information relating to staff, were easily accessible and kept secure. Senior staff continued to document their ‘out of hours’ visits to the home. We saw other improvements had been made. The provider had appointed a new deputy manager in October 2016. The registered manager acknowledged that current governance arrangements needed to improve and this appointment would give them the capacity they needed to fulfil their management duties particularly with regard to oversight and scrutiny of the service.

The provider continued to ensure appropriate checks were undertaken on new staff of their suitability and fitness to work at the home. We found some improvement had been made to checks of existing staff’s on-going suitability. Staff now completed an annual self-declaration relating to any criminal convictions incurred. The registered manager said they would look at introducing extra checks to seek additional assurances about staff’s on-going suitability.

Arrangements for ensuring there were enough staff to meet people’s needs had been improved. Staffing levels were now reviewed as the dependency levels of people in the home changed so that senior managers could assess there were enough staff on duty to meet all of the peoples’ needs safely. We saw staff were available to support people around the home when needed. Staff said they felt better supported in their roles. They received regular training and supervision from managers to help them to meet people’s needs effectively.

People and staff were positive about the new deputy manager who they said had had an immediate and positive impact at the service. They had made improvements in relation to the quality of activities that people participated in and to care records. People’s care records had been updated and staff had access to up to date information about how to support people. People’s care records reflected their choices and preferences for how support should be provided. Where people lacked capacity to make specific decisions there was involvement of their representatives and relevant care professionals to make these decisions in their best interests. People’s care and support had been reviewed to check this continued to meet their needs.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services when they needed this, particularly if they became unwell. Medicines were managed safely and people received them as prescribed. Staff treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs.

Staff assisted people to do as much for themselves as they could and wanted to do. The service continued to work within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Conditions on authorisations to deprive a person of their liberty were being met. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests, and there is no other way to look after them.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. Notwithstanding the issues identified above, the provider had maintained a regular programme of maintenance and servicing of the premises and equipment to ensure these were safe. The premises were clean and free of clutter and malodours.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted. The provider ensured the complaints procedure was easily available if people wished to make a complaint.

We undertook this focused inspection on 11 May 2016. We checked the provider had followed their plan and made the improvements they said they would to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosclare Residential Home Limited on our website at www.cqc.org.uk

Rosclare Residential Home Limited provides accommodation for up to 19 people who require personal care and support on a daily basis. The home can accommodate people living with dementia and/or older people living with mental health issues. At the time of our inspection there were 18 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider had taken appropriate action to ensure people’s care records contained up to date information about them. We found life histories were now present on people’s records. The registered manager had taken appropriate steps to obtain people’s consent to their care and support. People’s care and support needs had been reviewed monthly since our last inspection. Their care plans had been updated when any charges to their needs had been identified. This meant staff now had access to the latest information about people’s care and support needs.

Records documenting quality monitoring visits had been improved and recorded senior staff’s observations about the care and support provided to people. Staff records had been improved to include a summary of dates of attendance on training that the provider considered mandatory. This enabled the registered manager to monitor more effectively when staff were due to attend refresher training.

The improvements made by the provider since our last inspection meant people were better protected against the risks of poor care that could arise if records were not maintained appropriately.

Rosclare Residential Home provides accommodation for up to 19 people who require personal care and support on a daily basis. The home can accommodate people living with dementia and/or older people living with mental health issues. At the time of our inspection there were 18 people living at the home.

The service has 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 found the provider’s record keeping system was inconsistent and their own monitoring systems had not identified this shortfall. For example, people’s care records were not always updated with their life histories and their care plans were not always signed by people or their relatives to show they had agreed to them.

We identified a breach of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of this report.

Given the layout of Rosclare, we did not consider there were enough staff on duty at the time of our inspection. We have asked the registered manager to review the staffing levels in relation to the current needs of people using the service as our findings showed that their needs might not have been effectively met.

The provider had undertaken numerous recruitment checks prior to staff employment. However, the provider had not renewed police checks after this initial period and therefore could not assure themselves of the staff’s continued suitability for employment.

Staff working at Rosclare were kind and compassionate. They knew people well and were able to respond to their needs effectively. There was genuine warmth from staff towards people. Staff in turn told us they felt supported by the registered manager and deputy. They received training and an opportunity to meet with their line manager to discuss issues about their professional development.

People had their health needs met. This included having access to healthcare professionals when they needed them. People’s nutritional needs were assessed and monitored. They received a variety of meals according to their choices and needs. People received their medicines as prescribed to them.

Care was personalised so it met people’s preferences and needs. There was a range of social activities for people to participate in if they chose to. The home maintained links with the local community such as local schools. Relatives were able to visit whenever they wished.

People were asked for their consent before care was provided. If people were not able to give consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to empower and protect people who may not be able to make decisions for themselves and to help ensure their rights are protected.

The service had a registered manager in post who was aware of their roles and responsibilities. They ensured that people were able to participate in activities of daily life as independently as possible and if this was not possible, then risks were identified and strategies developed to assist people as much as they were able to.

Staff within the service were able to tell us how they helped to safeguard adults at risk who may be at risk of abuse. People felt able to raise any issues or concerns they had with the service. They felt the registered manager and deputy would listen to them and act on any issues of concern.

People we spoke with were complimentary about the meals and told us that they could have alternative choices if they wished. One person told us: "The chef knows what I like and don't like". We also spoke with catering staff who spoke positively about their role and their desire to provide people with good food. The chef was able to demonstrate that he was familiar with people's dietary needs and how he could prepare alternative meals for people when requested.

We found that the home had a policy and procedure on the protection of vulnerable adults and there was some evidence that training had taken place and that other training had been planned for the future. Staff had also been required to undertake a Criminal Records Bureau (CRB) check (now carried out by the Disclosure and Barring Service) at recruitment.

Staff confirmed that they received regular support through access to the manager and through formal supervision and appraisal. We were able to see evidence that staff had regular opportunities for supervision with the manager and that annual appraisals had taken place.

We found that where previously some information was missing or could not be found, for example some recruitment processes, that these had been rectified.

We looked at a sample of records and care plans. These showed that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care Plans were based on an initial care assessment of what each person needed and liked. Preferences and interests were recorded as much as their support needs.

We observed that people were supported to be able to eat and drink sufficient amounts to meet their needs and received appropriate assistance where required.

The person in charge informed us that staff were informed and updated on policy and procedure relating to safeguarding and received training but acknowledged that records did not reflect this as well as they could. Steps would be taken to improve this area.

We found that the home was clean and well maintained. Floors and surfaces were clean and the home was free from malodours throughout.

We found that the provider did not maintain accurate records in respect of each service user or member of staff and the person in charge confirmed this was an area targeted for improvement.