About the service:

Roseland Care is a care home that provides care for a maximum of 55 adults. At the time of this inspection there were 32 people living at the service. The service comprises of two separate

buildings, Roseland Care (nursing) and Lowen House (residential). Roseland Care is a purpose built care service with two floors, one for general nursing and one for dementia nursing. Each floor has a shared lounge and dining room and access to private garden areas. Lowen House is part of an older house situated a short distance from the main building.

What life is like for people using this service:

• People told us they were happy living at the service. However, two people raised concerns to us about not being able to access staff assistance when needed. The acting manager spoke with these people and was actively resolving their concerns.

• Staff were not always provided with accurate and up to date information relating to people’s needs in some care plans.

• Risks to people had been identified and assessed in care plans, but the assessments did not always provide staff with clear guidance and direction on how to reduce those risks. For example, where a falls risk and specific situations when the person would stand unaided had been identified in a risk assessment, it did not then provide guidance for staff on how to mitigate that risk. However, we found staff were supporting this person in bed currently, so the person could not fall. When they were out in the chair staff ensured their chair was reclined and they kept a close watch on them.

• We were able to evidence from the daily monitoring records that staff were providing suitable care to people despite the lack in some cases of accurate care plan records.

• People received care from staff who had not always completed mandatory training as required. The provider was aware of this and was putting together a comprehensive plan to address this concern.

• People did not always have their legal rights protected as the service did not know which people had Deprivation of Liberty Safeguards authorisations in place, and could not therefore effectively uphold any conditions that had been put in place in the authorisation. The provider had not notified the Care Quality Commission about the authorisations as they are legally required to do.

• People had experience low staffing levels for a period of time before this inspection. This had impacted on their experience of care provided. An additional nurse had recently been added to the day shift by the provider, following concerns by the local authority safeguarding unit.

• Staff were kind and caring but morale was low they reported being very tired, stressed and did not feel valued and well supported. Supervision had not been regularly provided to all staff.

• Quality assurance processes were not effective and did not pick up the concerns identified at this inspection.

• People had completed a survey in 2018 giving their views and experiences of living at Roseland Court, the responses were mainly positive at that time.

• The premises were in good condition and provided a spacious, warm and relaxed environment for people.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 18/09/2018)

Why we inspected: We bought this inspection forward due to the high number of concerns raised to the Care Quality Commission (CQC) by the local authority safeguarding unit, the clinical commissioning group and whistle-blowers. Concerns had been raised about low staffing levels which had led to poor care provision for people. There were concerns raised about poor personal care, dirty bed linen, some people did not have call bells available to them. Some people had pressure damage to their skin and this had not been appropriately escalated and referred to external professionals for advice. One person had lost a considerable amount of weight but the care plan had not been reviewed to address this conc

We carried out an unannounced inspection of Roseland Care on 21 and 22 August 2018. Roseland Care is a ‘care home’ that provides care for a maximum of 55 adults. 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. At the time of the inspection there were 39 people living at the service, 30 in the nursing unit and nine in the residential unit. Some of these people were living with dementia.

The service is situated in a retirement village complex with access to communal facilities such as a restaurant, swimming pool, gym and extensive landscaped grounds. The service comprises of two separate buildings, Roseland Care (nursing) and Lowen House (residential). Roseland Care is a purpose built care service with two floors, one for general nursing and one for dementia nursing. Each floor has a shared lounge and dining room and access to private garden areas as well as the communal garden areas within the complex. There are stairs and lifts to access each floor. All bedrooms have ensuite facilities with wet rooms and there are shared bathrooms with assisted baths. Lowen House is part of an older house situated a short distance from the main building. All bedrooms have ensuite facilities and there are shared bathrooms and living areas as well as access to outside spaces.

This was the first inspection for the service since it re-registered as a new legal entity in August 2017.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

During the inspection we spent time in the shared living areas across the service to observe staff interaction with people and how people responded to the care and support provided. We observed that people were relaxed and comfortable with staff, and had no hesitation in asking for help from them. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff are so compassionate, they make me feel safe and looked after", "They look after us so well, there is nothing to worry about" and "It’s just a lovely atmosphere that makes me feel safe."

Care records were personalised to the individual and detailed how people wished to be supported. They contained accurate and up to date information to enable staff to provide the agreed care and support for people. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risks in relation people’s skin care and nutrition were being effectively monitored.

Management and staff had developed good working relationships with healthcare professionals to help ensure people had timely access to services to meet their health care needs. These services included tissue viability nurses, physiotherapists, GPs and speech and language therapists (SALT).

People were supported to eat a healthy and varied diet. Comments from people about their meals included, "They make me lovely bacon and egg for breakfast", "You can always have something else if you don't fancy what's on the menu" and "All the food tastes lovely and fresh."

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for D