Roseside

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found breaches of the legal regulations in relation to assessing people’s needs and the delivery of evidence based treatment. We found that best practice guidelines in respect of diabetes, PEG support, nutritional care and restrictive interventions were not always followed. This increased the risk of poor outcomes for people in respect of their physical and medical health conditions. Some people’s communication needs were also not appropriately supported in accordance with the Accessible Information Standard and other associated best practice.

Teams were led by nursing staff and senior carers who directed care staff in the delivery of people’s care. During our visit, we observed care staff worked well together in the provision of people’s day to day support. The nursing team however did not work effectively to ensure that people received the medicines and clinical support they needed. The manager and nursing team also failed to have sufficient oversight of people’s support to ensure it was co-ordinated effectively across all areas of their care.

People’s consent for some decisions about their care had been obtained in accordance with the Mental Capacity Act 2005. We found some decisions relating to increased restrictions on people’s day to day lives had not always followed the correct process to ensure these restrictions were lawful and in the person’s best interests. We also found there was a lack of communication tools or support systems in place to support people with communication difficulties to participate in decisions made about their care.

People had access to the support of other health and social care professionals including their GP, Telemeds, and other specialist services such as physiotherapy, speech and language therapy, dieticians and mental health. Staff said there was a daily handover meeting and handover document shared between shifts which provided updates on people’s well-being.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had been included in discussions about their needs and care. Records showed however the assessment of people’s needs and risks did not take account of the whole person. Not all of people's needs and risks were assessed with appropriate care or risk management plans in place to guide staff in the safe delivery of care.

Information on people's needs was sometimes contradictory or out of date and when people's needs had changed, care plans had not always been updated appropriately.

People’s mental health needs were not properly assessed which meant staff lacked clarity and guidance on how these conditions presented and impacted on people’s lives. They also lacked guidance on how to proactively support people’s mental health in to achieve positive outcomes and prevent distress.

These shortfalls in assessment and care planning increased of people experiencing inappropriate and unsafe care that was not effective in driving up health improvements.

Staff told us that they had access to people’s care plans and had a handover at the beginning of each shift to share information about people’s daily well-being.

The provider’s processes failed to identify shortfalls in the assessment of people’s needs. Care plan audits were in place, but these had not identified and therefore not addressed the lack of clarity around people’s medical, mental health and other needs. They also failed to identify that staff had had little information on people’s clinical risks and the monitoring they required.

The processes in place to ensure people received safe and effective care, were not properly followed by staff. For example, where clinical or daily monitoring was required, this was not always completed accurately or consistently by staff, to enable people’s progress to be monitored. Daily records maintained in relation to some people’s care and well-being, for example diet and fluid charts, repositioning, and bowel records, showed gaps and inconsistencies that suggested people were not in receipt of the care they needed. There was little evidence manager or leaders routinely reviewed these records to ensure people’s needs were being met and their health and welfare protected.

People told us they felt their needs, or the needs of their loved one were met by the service. We found however that the assessment and management of people’s medical or clinical needs and the delivery of care in respect of those needs was not in line with legislation and current evidence based good practice recommended by National Institute of Health and Care Excellence (NICE), or other associated guidance. For example, we found some people’s diabetic care plans failed to adhere to best practice guidance. We also found that appropriate action was not always taken when people’s blood sugars were outside of a safe range.

Records in relation to PEG management and were not maintained appropriately in line with clinical guidelines to enable the manager and nursing team to be assured people’s PEG care was safe. People’s nutritional care did not always adhere to NHS guidance given by dieticians or SALT teams, or the standards specified in the Index of International Dysphagia Diet Standardisation Initiative (IDDIS). People's experience of medicines did not follow good practice guidelines issues by the Royal Pharmaceutical Society, NICE or CQC.

The use of restrictive interventions to manage people’s behaviours of concern were not assessed, planned and approved in accordance with the Mental Capacity Act or Deprivation of Liberty Safeguarding Legislation. This meant people’s human rights were not protected at all times.

Support for people with communication needs was not always provided in accordance with the Accessible Information Standard.

Manager and leaders were unable to explain why concerns with care and treatment, medicines management and the safeguarding of people’s human rights had not been identified and addressed. Nursing staff also lacked clear insight into the concerns identified relating to people’s risk assessments and care planning.

The provider’s audits and processes had not identified the shortfalls in care planning, clinical care, medicines management, PEG management, diabetes care or the inappropriate and unauthorised use of restrictive interventions.

The processes had not identified and ensured people who required additional support with their communication needs had communication aids in place. In some cases, the aids specified in people’s care plans as supportive of their mental health, such as access to the use of therapy dolls were also not in place.

During our visit, we observed that care staff worked well together and co-ordinated people’s day to day support.

There were shortfalls in nursing care in respect of the oversight of medicines and some medical conditions which resulted in staff not having all of the information they required to care for people and effectively liaise with other health and social care professionals.

The manager told us there was a line management system in place to staff were adequately supported in their role. Teams were directed by nursing staff and senior carers who supervised care staff in the delivery of people’s care.

Staff told us that they enjoyed working in the home and felt they worked well together as a team. One staff member said, “They encourage us, and I believe we are a family, they don’t let us struggle, we are trained properly and respected and we put service users first”.

Partners gave no feedback on how staff worked together.

Staff had access to regular supervision from their line manager in support of their duties. Daily meetings took place to keep everyone up to date on any changes to people’s wellbeing. Regular staff meeting took place to enable staff to be given updates on service performance and to share their views.

Good team work and individual contributions were recognised via the Exemplar work app and on noticeboards were appropriate. This fostered positive working relationships between staff and teams and create a good working culture.

People did not always experience care that maximised positive outcomes in their health and wellbeing. Some people also experienced increased checks and restrictions on their day to day lives which had not been appropriately assessed and decided upon as necessary or in the person’s best interests.

People had access to a GP and other health and social care professionals as required in support of their health and well-being. For instance, dieticians, speech and language therapy, physiotherapy, mental health teams.

Staff made referrals to other health and social care professionals in support of people’s needs when appropriate.

There were processes in place to enable referrals to be made in support of people’s health and wellbeing needs and to respond to signs of ill-health. Some improvements were needed with regards to clear identification and management of risks and how to support people to prevent deterioration, as information regarding this was not always clear.

People’s care was not adequately monitored to ensure it was safe and effective in promoting positive outcomes. Records in relation to both people’s day to day care and clinical care showed gaps and inconsistencies, which suggested people were not in receipt of the care they needed. For example, records in respect of people’s PEG nutrition and management were not always accurate or clear. They did not show person’s PEG nutrition had been given at the correct time.

Records made in relation to diabetes monitoring were not always completed appropriately or contemporaneously. For example, one person’s care plan outlined tests to be undertaken if blood sugars were high. Records showed there were several occasions where the person’s blood sugars were high with no records of any other tests being undertaken. People blood sugar testing records were not recorded at the time they were taken. Staff recorded the test result at the time they documented it on the care record system. On some occasions no records of blood sugar readings were made at all.

Daily records were not always kept to monitor people’s bowel habits for people at risk of constipation. This meant it was difficult for nursing staff to be assured were not at risk of constipation and discomfort. Continence records regarding toileting or pad changes showed significant gaps. It was impossible to know if this was a recording issue or if people were being placed at risk neglect.

Managers and leaders were unable to explain why the gap and inconsistencies in the care people received had not been identified and addressed.

There was no effective process to gain a clear oversight of people’s care. The gaps and inconsistencies in people’s care records had not been followed up to determine if the anomalies were record keeping failures as opposed to shortfalls in the delivery of care.

Care plan audits were in place but these failed to be effective in driving up improvements in care planning, care delivery and positive outcomes. Medication audits were in place, but these also failed to identify the serious concerns with medicines management found at this inspection.

The process in place to ensure nursing practice was safe such as clinical meetings and clinical supervision were not effective. They had not identified that clinical care (PEG, Diabetes, Mental Health) did not align with safe or best practice.

People told us staff sought their consent prior to providing support. Where there were concerns about a person’s ability to understand and consent to decisions about their care, there was evidence some decisions had been made on their behalf in accordance with the MCA.

Where people had communication difficulties however, there was a lack of appropriate communication aids, for example picture cards and assistive technology to enable them to participate in discussions and decisions made about their care.

The majority of assessments were in the format of verbal questions and conversations with people, some of whom struggled to communicate and concentrate in this way. The way in which mental capacity assessments were undertaken therefore required review to ensure everyone had equitable support to be able to express their views and wishes. This did not show people were always actively supported in decision making at all times.

Staff told us they had completed training in the MCA. During discussions with the manager and nursing staff we were not assured that they had a sufficient understanding of MCA and DOLs legislation. They were unable to explain for example, why increased restrictions on people’s lives, for example enhanced checks and the sanctioned use of physical restraint (as a last resort) had been put in place without seeking approval from the Local Authority Deprivation of Liberty Safeguarding Team that this was necessary, proportionate and in the person’s best interests.

Processes were in place to assess people’s capacity to make decisions. This included processes to ensure best interest decision making took place.

These processes however were not always used appropriately at all times to ensure that the MCA and DOLs legislation was appropriately applied.