CQC report explained · a residential care home
What the CQC found at Roseacre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, December 2020
Rated Good; inspectors found major improvements, but noted gaps in as-required medicines guidance and delayed outdoor improvements.
This was a focused inspection on 13 October 2020. Two inspectors spoke with people, staff, managers, relatives and professionals. They observed care at lunchtime and checked care records, medicine records, staff recruitment files and management records.
The home had improved since the previous inspection. Infection control, risk assessments, care plans, investigations of incidents, premises and quality checks were better. Staff used protective equipment appropriately during the visit, and planned staffing levels were usually achieved.
The inspectors rated Safe, Effective, Responsive and Well-led as Good. They recommended clearer guidance for as-required medicines, a sheltered smoking area, completion of outdoor improvements and better support for trips into the community. Caring was not inspected during this visit, so its previous rating was carried forward.
Improved infection control
Problems found previously had been addressed. Hand washing and drying facilities were available, and staff used protective equipment appropriately during the inspection.
“At this inspection infection control practices had significantly improved.” from the report
Better risk management
Care plans gave staff clearer guidance about falls, skin care and behaviour. Accidents and incidents were investigated to identify learning.
“At this inspection we found these issues had been addressed.” from the report
Clearer care plans
Care plans were available for everyone and gave staff enough information to meet people's needs. Daily records described care, mood, wellbeing and changes in support needs.
“The care plans are all really easy to understand. They have everything we need to know” from the report
Activities and relationships
People could join in games, crafts and other activities within the home. Staff also supported contact with families through video calls during visitor restrictions.
“There was a programme of activities planned which staff supported and encouraged people to participate in.” from the report
Management improvements
Quality checks were carried out regularly and action was taken when issues were found. Managers had addressed the problems identified at the previous inspection.
“At this inspection we found the service's quality assurance systems had been effective” from the report
As-required medicines
needs fixingSome as-required medicines did not have clear instructions explaining when they should be used. Records also did not show how people responded after taking them.
“There were no protocols in place detaining the circumstance in which these medicines should be used or notes available on how the person had responded when these medicines were used.” from the report
Outdoor space
needs fixingImprovements to the outdoor space had been delayed. Inspectors also noted that some people with restricted mobility who smoked spent considerable time near the bins in the parking area.
“We recommend the service makes arrangements to provide a sheltered, accessible smoking area and completes the repeatedly delayed improvements to the service's outdoor spaces in time for summer 2021.” from the report
Trips into the community
minorThere was little evidence that people were supported to take trips outside the home. The inspectors recognised the effect of Covid-19 restrictions but still recommended reviewing these arrangements.
“There was little evidence available of people being supported on trips outside the service to visit local sites of interest.” from the report
Weekend staffing
needs fixingPlanned staffing levels were considerably lower at weekends than during the week. Some professionals raised concerns, although staff told inspectors the levels were sufficient.
“Staffing levels at the weekend were planned to be considerably lower than during the week and some professionals raised concerns about staffing levels in the service.” from the report
- 01What instructions and records do you now use for as-required pain or anxiety medicines?
- 02How do you check how a person responds after an as-required medicine is given?
- 03What are the actual staffing levels at weekends, and how do you make sure they meet residents' needs?
- 04When will the sheltered smoking area and other outdoor improvements be completed?
- 05How do you support residents to go outside or visit local places when Covid-19 restrictions allow?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected and the other relevant previous ratings were carried forward. This explanation was written from the published report of 12 December 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2019
Rated Requires Improvement; inspectors found kind care and safe medicines, but serious gaps in risk management, care records, premises and leadership.
This was an unannounced comprehensive inspection on 4 June 2019. Inspectors spoke with people using the home, staff and health professionals. They reviewed care and medicines records, staff files, complaints, incidents and quality checks.
People generally said staff were kind, respectful and quick to respond. Medicines were managed safely, staff were trained, and people were supported to access healthcare. However, some people did not have care plans, and records did not always give staff enough guidance about risks, repositioning, nutrition or personal preferences.
Inspectors found unsafe or poorly maintained parts of the building. These included a bolted fire door, damaged surfaces, missing sink plugs, empty soap dispensers and no towels in a communal toilet. The home also did not always identify or act on risks to people and staff, falls, infection control problems or poor records.
The overall rating fell from Good at the previous inspection to Requires Improvement. Caring remained Good, but Safe, Effective, Responsive and Well-led were all Requires Improvement. CQC required an action plan and said it would monitor progress and return under its re-inspection programme.
Kind interactions
People generally felt happy, safe and respected. Inspectors saw staff spending time talking with people and protecting their privacy.
“Staff were kind and spent time chatting with people as they moved around the service.” from the report
Medicines
Medicines were given as prescribed and stored safely. Staff had medicines training and competency checks.
“Medicine systems were organised, and people were receiving their medicines when they should.” from the report
Staff recruitment and training
The home had enough staff to meet people's needs at the inspection, and recruitment checks were completed before staff started.
“All pre-employment checks had been carried out before staff started work, such as criminal record checks and references” from the report
Healthcare support
People were referred to health professionals when needed. Community nurses visited regularly and had no concerns about the service provided.
“People were supported to maintain good health and were referred to appropriate health professionals as required.” from the report
Unmanaged risks
seriousTwo people had presented risks to staff, but their care files had no risk assessments or guidance. Guidance was also unclear for behaviour that could put people at risk.
“The lack of robust risk management was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.” from the report
Food and drink records
seriousWhere intake was being recorded because of concerns, records were not totalled or checked daily. This meant the home could not show that people were receiving enough food and fluids.
“The lack of robust monitoring of records is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.” from the report
Incomplete personalised care
seriousSome people did not have care plans, and existing plans did not always explain people's needs, preferences or repositioning requirements. Activities also did not always reflect recorded interests.
“The lack of person-centred care and support provided at the service is a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak quality checks
seriousThe home's audits had not identified several problems or led to effective action, including risks, falls, infection control, premises and incomplete care plans.
“The lack of robust processes to ensure the audit cycle was effectively improving the service provided was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.” from the report
- 01Have all residents now got complete care plans, including clear guidance about risks, repositioning, communication and personal preferences?
- 02How are risks to residents and staff from behaviour, falls and access to alcohol now assessed and reviewed?
- 03What action has been completed to repair damaged walls, sinks, doors and other areas, and how is infection control checked?
- 04How do you now record and monitor people's food and drink intake to make sure they receive enough?
- 05How are audits and staff feedback used to identify problems and confirm that improvements have been completed?
This was an unannounced comprehensive inspection covering all five key questions and was brought forward after anonymous concerns; the previous overall rating was Good in 2017. This explanation was written from the published report of 27 July 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Roseacre
6 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- December 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016Goodstayed GoodSafe: Good
- December 2015Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Good
- August 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 4 April 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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10 live-in carers within about two hours of Cornwall
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,200 a week. 8 can care for a couple. 12 years' experience on average.
“He had been a little anxious before she arrived, but has since stated that he would be very happy for her to care for him again”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.