This unannounced comprehensive inspection took place on 5 June 2018. The service was rated Good in all areas following a focused inspection in March 2017. At this inspection we found improvements identified in the previous inspection had been sustained and the service remains good in all areas.

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.

Roscarrack House is a detached historic house in its own grounds situated on the outskirts of Falmouth. The service provides single room accommodation for up to nineteen predominantly elderly people who need assistance with personal care. At the time of the inspection there were nineteen people using the service.

The service is situated over two floors which are served by a stair lift. Five rooms have en-suite bathrooms with twelve with en-suite toilets. Two rooms have no en-suite facilities. There are additional toilets and two assistive bathrooms to support people with personal care.

There is a large lounge on the ground floor with a separate dining room. There are garden areas around the service with an accessible decking area leading from the dining room. There are a range of aids and adaptations to support people with limited mobility.

A registered manager was in place. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The atmosphere in the service on the day of the inspection was relaxing, friendly and calm. Staff responded promptly when people asked for help and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness. People told us they felt safe and comfortable living at Roscarrack House. Comments included, “I used to worry about being safe in my flat but I don’t worry any more, I haven’t a care in the world now,” “The staff are amazing, I couldn’t be happier” and “I can talk to anyone about anything.”

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were identified. Care plans had been updated so staff knew how to manage those risks.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely.

Care plans contained information about the person and what their individual needs were and how they would be met. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff responsible for peoples care.

Staff were sufficiently skilled to meet people needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedures in place to manage infection control risks.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. Capacity assessments were in place to justify restrictions in order

We carried out a comprehensive inspection on 8 March 2016. A breach of the legal requirements was found. This was because risk assessments did not always provide staff with enough information to know how to support people safely. There were some gaps in medicine records meaning staff did not have an accurate account of how much medicine had been given. Audits carried out by the service had not identified these omissions. Some staff were concerned that due to the increased dependency levels of people using the service they did not always have the time to carry out care in a timely way, potentially putting people at risk. Following the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the13 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the question ‘is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosecarrack House on our website at www.cqc.org.uk

Roscarrack House is a family run residential home that can accommodate up to 19 older people. On the day of the inspection 19 people were using the service. Roscarrack House is required to have 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.

The service had taken action to improve risk assessments so the directive was clear and all staff had access to the information. Risk assessments identified potential risks to people and provided instructions for staff members as to how to manage and minimise individual risk.

The registered manager and deputy manager had reviewed the way medicines were managed. Regular audits were taking place with evidence of any errors being recorded and responded to through staff training. Medicine records seen were accurate and showed medicines had been administered as prescribed at the time prescribed.

Staffing levels had fluctuated in recent months; however a full staff team were now in place with an additional member of staff covering the busiest times of the day. Staff told us it was busy but there were enough of them to support people safely.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

We inspected Roscarrack House on 14 March 2016, the inspection was unannounced.The service was last inspected in May 2013; we had no concerns at that time.

Roscarrack House is a family run residential home that can accommodate up to 19 older people. On the day of our inspection 17 people were living at the service. Roscarrack House is required to have 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.

Care plans contained risk assessments which identified when people were at risk, for example from falls. However, the guidance for staff lacked detail or information on the action staff could take to minimise the risk.

Gaps in Medicine Administration Records (MAR) meant it was not always possible to establish how much medicine people were receiving or whether the amount of medicine in stock tallied with the amounts recorded.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. They were supported by a head of care and an administrative worker. Team leaders had day to day oversight of the team of care workers. In addition the staff team included kitchen staff, cleaning staff, a maintenance worker and a gardener. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people’s needs. The registered manager was aware people’s needs were increasing and was employing an additional care worker as a result. The new employee would also be able to cover for any staff absence.

People and relatives told us they considered Roscarrack House to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service in terms of its ‘family’ feel. Terms such as ‘homely’ and ‘friendly’ were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people’s needs.

Applications for DoLS authorisations had been made to the local authority appropriately. Training for the MCA and DoLS was included in the induction process and in the list of training requiring updating regularly. The registered manager and staff demonstrated an understanding of the principles underpinning the legislation. For example, staff ensured people consented before giving personal care. Mental capacity assessments had not been completed as required. The registered manager assured us this would be addressed immediately.

The premises were clean and odour free. People were able to use a shared lounge or stay in their rooms as they chose. Improvements to parts of the building were planned. There was a large decking area immediately outside the dining room where people could eat during warmer weather. Staff told us this was well used.

There were two part-time activity co-ordinators employed and people were supported and encouraged to take part in a range of activities organised in the service. Visitors were made to feel welcome at the service and staff recognised the value of these relationships to people.

We identified a breach of the regulations. You can see what action we have asked the provider to take at the back of this report.

We spoke to four people who lived at Roscarrack House, and spent time observing people and staff during the day. We saw people’s privacy and dignity was respected. We saw people chatted with staff when they were receiving support in the lounge and dining areas.

We witnessed staff interactions with people which were positive. One person told us the staff were always “top notch” and “if I ask for assistance staff come as quick as they can, normally very good, it’s a great comfort”. Another person told us the “Food is very good, if you don’t like it there are alternatives, they always offer a choice”.

One person told us their room “does not have a toilet I share with a male, he turns the tap too tight”.

We saw that people had been offered a choice of whether they would like to have a lock on their bedroom doors.

We heard staff discussing with people what they would like spend time doing in future planned activities at Roscarrack House.

We found that appropriate action had been taken to keep people safe from abuse.

We saw that steps had been taken to ensure a training schedule was in place for all staff, and this was monitored and reviewed.

We found people who used the service benefited from safe quality care, treatment and support due to effective decision making and the management of risks. This was done through quality monitoring and surveys of the people who lived at Roscarrack House the families and carers, and the staff.