Roscarrack House

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