Roscarrack House

Updated 18 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector

Service and service type

Roscarrack is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We also reviewed information that we held about the service such as notifications. We used information sent to us by the provider in their PIR. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed the electronic records for 1 person in detail and 2 other people's care plans focusing on the monitoring of their intake and weights. We reviewed 3 recruitment files and other records relating to the running of the service. Following the inspection visit we were sent updated staff training and support records and references for 1 new staff member.

We spoke with the registered manager, deputy manager, administrator, 9 staff, 3 people and 2 relatives. We spoke with 1 visiting healthcare professional.

Updated 18 February 2023

About the service

Roscarrack House is a residential care home providing personal and nursing care to up to 19 people. The service provides support to older people. At the time of our inspection there were 16 people using the service.

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

Some risks had not always been identified, assessed and reviewed regularly. The prompt for this inspection was that the service had recently had a fire in a person’s room which required the fire service to attend. The post fire investigation found the fire to have been caused by an electric heater with a radiator cover pressing on the cable. The service has now taken remedial action to address these risks.

Some people had been assessed as needing pressure relieving mattresses to protect their skin from damage. There was no system in place for staff to record regular checks to help ensure these mattresses were always set correctly for the person using them. We found they were not always set correctly.

One person, who was living with dementia, had managed to leave the service, unnoticed by staff. They left the service unnoticed in October and again in December 2022. They had walked alone to the main road and the service was unaware until alerted by a neighbour.

Medicines were not always recorded safely. We found a box of medicines, that required stricter controls, which was being stored by the service but was not recorded as being stored, as is legally required. Prescribed creams were not dated when they were opened despite this having been identified in a May 2022 audit.

People received their medicines as prescribed. The staff used paper Medicine Administration records (MAR), when they administered medicines. We found no gaps in the MAR.

Roscarrack House had an electronic system which held the care plans for people living at the service. However, care staff told us they did not have easy access to this information as there were only two laptops available downstairs on which this information was held. The provider purchased new electronic tablets for the staff after this inspection.

There was a programme of audits being completed at the service. However, these audits were not always effective. For example, the medicines audits had not identified the presence of medicines that required stricter controls. The mattress audit had not identified the settings were not always accurate.

The service had sufficient staff to meet people’s needs. Whilst many staff had worked at Roscarrack House for many years, some new staff had recently joined. The recruitment process for these staff was not safe. The registered manager had not recorded a full employment history.

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

Staff were provided with training. There were some updates that were due, and the registered manager was in the process of arranging for staff to complete these. Staff meetings did not take place, but staff told us they felt communication was good and the management team were visible and approachable.

Staff comments included, “We get observed for our competency and have an annual appraisal,” “(Registered manager’s name) is absolutely brilliant, I can ask for what I need for the kitchen and we get it” and “I have worked in many care places and I like Roscarrack House the best, it’s a good place to work.”

The registered manager understood their responsibilities under the duty of candour. When a vulnerable person had left the service on two occasions they had not notified CQC of these events as they are required to do. The service had raised the concern with the safeguarding unit.

Staff knew what actions to take to help ensure people were protected from harm or abuse. Concerns had been shared with the safeguarding unit when appropriate.

Relatives comments were mixed, “I am very happy as Mum has just come in for respite and she is settling really well, we are hoping she might like it enough to stay permanently. She likes the activities” and “Sometimes (Person’s name) is not always wearing their own clothes. I think the reason they try to leave is that they are bored. They have always been a very busy minded person and there is not enough to keep them occupied. They enjoy the food though.”

People and families had not had their views and experiences formally sought. However, the registered manager and the deputy spoke with people and visitors every day and were very visible. Families knew how to raise any concerns they may have.

Visiting healthcare professionals told us, “They (staff) are pretty good at raising concerns to us in a timely way” and “We don’t have any concerns. However, there was a delay in them obtaining a piece of equipment we asked for. There was no deterioration in the person but no improvement either. It got sorted eventually.”

We looked at infection prevention and control and found we were mostly assured the provider was protecting people, staff and visitors from the risk of infection. There were no regular infection control audits taking place. However, the service was clean with no odours.

The registered manager admitted they were finding the workload challenging. The registered manager had a deputy manager, a clinical lead and an administrator to support them. However, roles and responsibilities had only very recently been discussed and had not yet been embedded.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

Rating at last inspection was Good, (Published 10 September 2020). At this inspection the rating has changed to requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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.