Archived: HF Trust - Roslyn House

People’s experience of using this service:

The service had effective safeguarding systems in place, and staff had received suitable training about recognising abuse.

Appropriate risk assessment procedures were in place so any risks to people, staff or visitors were minimised.

Staff were recruited appropriately. Staffing levels were satisfactory, and people received timely support from staff when this was required.

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

The registered manager was able to demonstrate the service learned from mistakes to minimise the risk of them happening again.

The service had suitable assessment and care planning systems to assist in ensuring people received effective and responsive care.

Staff received induction, training and supervision to assist them to carry out their work. All new staff completed the Care Certificate.

People received enough to eat and drink. Some people were encouraged to assist with cooking and shopping to improve their independence. People were involved in planning the menu.

The building was suitable to meet people’s needs and maintained to a satisfactory standard.

People received support from external health professionals and were encouraged to live healthier lives. Support was received, for example, from the learning disability nursing team, GP’s, district nurses and speech and language therapists.

Staff encouraged people to have choices about how they lived in line with legal guidance.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

People had the opportunity to participate in activities and to spend time with the wider community

People felt confident raising any concerns or complaints. Records showed these had been responded to appropriately.

The service was managed effectively. People and staff had confidence in the registered manager.

The service had suitable systems to monitor service delivery and bring about improvement when necessary.

The team worked well together and had the shared goal of providing a good service to people who lived at the home.

The service worked well with external professionals, and other organisations to provide good quality care.

Rating at last inspection: Rating at last inspection: ‘Requires improvement.’ (published on 18 June 2018.)

The service was last rated ‘Good’ in the report dated 6 February 2016.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make improvements to the service.

Why we inspected: We completed this inspection to check whether suitable action had been taken following the last inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working according to the principles of the MCA.

One person had a DoLS authorisation in place but this had expired in February 2017. No application to continue the authorisation had been made to ensure any restrictions were lawful, proportionate and remained the least restrictive option. Families were asked to consent on behalf of people who lacked capacity. There were no records in place to show they had the legal authority to do this.

Monitoring records to demonstrate people had received specific care in line with their care plan were completed. For example, some people had food and fluid charts to help staff check they were receiving enough to eat and drink. However, daily logs in place to record how people had spent their time and what had worked well for them were infrequently completed.

The care service was set up twenty-five years ago and was designed to provide group living for people with learning disabilities. Work had been done to ensure the service was managed in line with the values that underpin the CQC ‘Registering the Right Support’, and other current best practice guidance. This guidance includes the promotion of the values of; choice, independence and inclusion. The service was working with people with learning disabilities that used the service, to support them to live as ordinary a life as any citizen. People had access to private spaces and were able to choose where they spent their time. Staff supported people to access the community regularly. People’s independence was respected and they were encouraged to develop and maintain skills.

The service requires a registered manager and there was one 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.

People were comfortable and at ease with staff. Some people chose to spend time in their rooms and others were in shared areas of the service. People came into the office during the day to ask staff for support or to spend some time chatting. Staff were considerate and respectful when speaking with people. Relatives told us they were confident their family members were safe and well supported by staff who knew them well and understood their needs.

There were enough staff to support people according to their needs and preferences. There was a stable staff team in place who were supported by regular relief staff.

People were supported to have their medicines as prescribed. Systems for recording when people had received their medicine were robust. Some people had specific health needs and staff had received relevant additional training to enable them to support these people with their needs. Staff worked with external healthcare professionals to help ensure people received effective care.

Staff told us they were well supported and confident in their abilities to fulfil their roles and responsibilities. New employees were required to complete an induction and a period of shadowing more experienced staff before starting to work independently. Although staff received supervisions these had lapsed in recent months. We have made a recommendation about this in the report.

Staff had opportunities for career development and progression. They were aware of the organisations visions and values.

There were quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager and staff. However, these had not identified the issues highlighted in this report. Relatives and people’s views about how the service was operated were sought out.

We identified breaches of the Regulations. You can see what action we have asked the provider to take at the end of the report.

The service provided accommodation and personal care for up to eight people living with a learning disability. At the time of our inspection there were six people using the service.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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.

People and their relatives told us they were happy with the care and support provided by staff at Roslyn House and believed it was a safe environment. One relative said, “We are very happy with how Roslyn House cares for [person’s name]”. A person who lived at the service told us they felt happy living at Roslyn House and it was clear people were comfortable with staff and moved freely around their home.

Staff had developed positive relationships with people and understood their needs well. People were encouraged to be individuals and do what they wanted to do to provide them with a fulfilling life. For example, people went out each day to various local community activities, such as voluntary work. People also left the home for trips supported by staff. There were a range of personalised and appropriate risk assessments in place to help keep people safe.

The safety and maintenance of the premises was looked after by the organisation and also by the organisation who owned the building. When needed the registered manger would report required maintenance and this would be organised centrally by HF Trust. This meant the management of the service had done appropriate checks to keep people safe while they were living at Roslyn House. Premises were properly maintained and provided a well decorated and inviting environment. All living areas were clean and inviting.

Staff understood how to keep people safe. Accidents and incidents were recorded and investigated. This meant management could identify recurring events and take action to reduce these.

Support was provided by staff who knew people well and understood their needs. There were enough staff to meet people’s changing needs and wishes. The service used a bank of relief staff to supply more staff at short notice when needed.

Medicines were stored, handled and recorded safely. This meant that people using the service were given the correct medicines at the correct time and this was clearly recorded.

People and their relatives said they were confident in the staff group who provided good quality care. Staff received regular training and demonstrated they were skilled and knowledgeable about their roles who. They were encouraged to complete additional qualifications and regularly received supervision from their managers. Annual staff performance appraisals had been completed.

People were supported to maintain good health, have access to healthcare services and received continuing healthcare support. Staff supported people to eat and drink enough and maintain a balanced diet.

Care records were clear, informative and up to date. Records were regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were recorded in their care plans and provided clear information to enable staff to give effective support. Where risks had been identified staff were provided with guidance on action to be taken to protect people and themselves.

Consent to people’s support arrangements was recorded in care records. This meant people had been asked and had agreed to their current support arrangements. Staff consistently asked for people’s consent before assisting them with any care or support. People were involved in making choices about how they wanted to live their life and spend their time. Where people did not have the capacity to make certain decisions, the service acted in line with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. Relatives told us that management were freely available and acted promptly if there was ever an issue raised. People had confidence that they were listened to and their views mattered.

There was a management structure which provided clear lines of responsibility and accountability. There was a positive culture in the service, the management team provided strong leadership and led by example. Management were visible in the service and regularly checked if people were happy and safe living at Roslyn House.

There were quality assurance systems in place to make sure that areas for improvement were identified and addressed.These included using quality assurance questionnaires to gather people’s views about the service, and audit processes to check that procedures were carried out consistently and to a good standard.

We saw people's privacy and dignity was respected by the way staff assisted people with their personal care.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed.

We found people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. The records showed they went out frequently and saw healthcare professionals when they needed them.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises

Staff said they had received sufficient training to enable them to carry out their roles competently and felt there was sufficient staff on duty to meet people's needs.

The home had a relaxed atmosphere, which was friendly and welcoming on the day of our inspection.

Staff were positive about their roles and the support they received from their immediate manager and the wider organisation. Staff were trained and competent for the role they were recruited for.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had an effective system in place to identify, assess and manage risks to people's health, safety and welfare.