Rosslyn Residential Care provides accommodation for up to thirty older people some of whom may live with dementia. There were twenty-eight people living in the home at the time of the inspection.

The inspection was unannounced took place on 5 and 10 December 2018.

There was a registered manager in place. 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We have written this inspection report in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service and were protected from potential harm or abuse. Risk assessments were in place and had been regularly reviewed. Staff were aware of the measures in place to reduce risks to people. Recruitment checks were completed to ensure staff were suitable to work in this type of service. Staffing levels were good which ensured that people’s needs were met in a timely way. People received their medication as prescribed. Accidents and incidents were monitored to help prevent a reoccurrence. Infection control measure were in place to reduce the risk and spread of infection.

People continued to receive an effective service. Staff received an induction, training and support which gave them the skills and knowledge they required to support people effectively. Staff supported people to eat and drink sufficient amounts to help maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and were asked to consent to their care. People were supported to access healthcare professionals when required.

People continued to receive care and support from staff who were kind, caring and compassionate. Staff respected people’s privacy and dignity and knew people well. People were supported to remain as independent as possible. People’s relatives and visitors were welcomed at all times, including social events held at the service. People could access the services of an independent advocate if required.

People continued to receive a service that was responsive to their changing needs. People and their relatives were fully involved in the development, planning and ongoing review of their care and support. Support plans were personalised and included information about people’s life histories, and family involvement. People choose what activities they wanted to participate in and how they spent their time. People and their families knew how to raise any concerns and were confident they would be dealt with appropriately. Many compliments had also been received.

The service continued to be well-led, by a registered manager who led by example, and was open, transparent and inclusive. The culture of the service was ‘people first’ and they were at the centre of everything that happened at the service. There were a range of quality assurance systems and processes in place to monitor the service. People’s views were sought and these were taken into account when considering the development or improvement of the service. The service worked in partnership with other organisations which included the local authority and GP’s which helped provide people with holistic care.

Further information is in the detailed findings below.

The inspection took place on 19 & 26 February 2016 and was unannounced. At our last inspection on 24 April 2014, the service was found to be meeting the required standards in the areas we looked at. At this inspection we found that they had continued to meet the standards.

Rosslyn Residential Care provides accommodation and personal care for up to 28 older people. At the time of our inspection 27 people lived at the home. Some people at the home were unable to verbally communicate with us so we observed how care and support was provided in communal areas such as the lounge and dining area.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us that they felt safe, happy and well looked after at the home. Staff received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to help ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made efforts to ascertain people’s wishes and obtain their verbal consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders were complimentary about the manager and staff on how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

During this inspection we set out to answer our five key questions; Is the service caring, responsive, safe, effective and well led?

We checked to see if improvements had been made in the areas that were previously found to be non-compliant.

Below is a summary of our findings.

Is the service safe?

Staff were able to demonstrate they knew how to support people safely and minimise risk. We saw from records we looked at that some of the staff had received training in relation to protecting people from harm. Staff we spoke with demonstrated their awareness of types of abuse, and explained the process they followed to raise any concerns appropriately.

Is the service effective?

We reviewed the care records for the three people who lived at Rosslyn residential care home. We found that they contained person centred information. These covered the various aspects of people's lives.

Is the service caring?

People were supported by staff who knew them well and were able to care for them in a personalised way. We saw that the support workers showed positive interaction with people who used the service. Care plans were pesonalised and gave staff clear guidance on how to deliver appropriate care that met people’s individual needs.

Is the service responsive?

We observed the staff to be responsive. Throughout our inspection we observed that staff were aware of people's needs and responded appropriately when people required assistance.

Is the service well-led?

Since our last inspection, there had been some changes to the management team and these were still being implemented at the time of our inspection. We could not assess the impact of these changes as they had not been fully implemented.

You can see our judgements on the front page of this report.

We had received concerns relating to the effectiveness of the pre-employment checks carried out by the home. An inspection was undertaken to explore this further and to check compliance with other standards which could also be impacted.

We found that there were gaps in the recruitment and selection process and pre and post employment checks.

We also found that people’s care plans were incomplete. There were multiple versions of the care plan in each of the five files we reviewed, so it was difficult to know which version was current.

We reviewed information relating to the safeguarding of vulnerable adults and found that there had been gaps in the training and found staff were not able to describe their responsibilities under the safeguarding policy.

We looked at quality monitoring procedures relating to all aspects of the service and found that they were ineffective and, although some information had been collected, it had not been acted on in a timely way. This meant that people may have been put at risk of receiving unsafe care and treatment.

We spoke with a large group of people who lived at the home and relatives as well as the staff on shift. We were told by one relative that the home had been chosen because it was homely. We were told by a person who had lived in the house for some time that a lot of people smile and laugh.The people we saw at breakfast time and then throughout the day expressed their satisfaction with the home. We saw and we were told that the food is good and the staff are good. We were told that the staff are happy and do everything we want doing although some said food can be a bit boring.

We were told that the house is still in need of some modernisation and an improvement plan is in place. Decoration had already been completed and people were pleased with the outcome.

A person we spoke with concerning the night staff commented, “Night staff are very polite. They are not noisy. They come into my room quietly. Sometimes I don’t even know that it’s been done: they are so quiet.” Another person said, “All the staff are very, very pleasant and helpful. No complaints whatsoever.” These complimentary comments were echoed by another person who said, “The service is absolutely brilliant. They look after us. Nothing is too much trouble for them. Very caring staff. I love it here.”

Relatives we spoke with commented, “Staff are marvellous. The care is out of this world.” Another relative said, “Excellent service. We were very lucky to find this home. Couldn’t praise them enough for the care they gave my relative.”

People confirmed that they have choices. A person commented, “We do get a choice of menu. The staff will ask me which dish I would like to have.” This was echoed by another person who said, “I think the food is very good too. There are choices and plenty to eat. I am one very satisfied customer.”

When asked about social activities, a person said, “There are quiz games and guitar music and I love the food.” Another person commented, “We have exercise and bingo. The music and exercise are very good.”

We carried out a follow up inspection over three half days at Rosslyn court to check that the provider had made the required improvements following concerns we had raised with them as part of a previous inspection. We observed during our initial walk around of the premises that there were some concerns regarding the maintenance of the building and concerns about the safety, availability, and suitability of equipment in Rosslyn court. We noted that in various parts of the home there were mal odours and poor infection control arrangements.

We observed that various items had been used to prop open fire doors, these included a hoover, walking stick and slipper. We spoke to the manager about this and some other concerns that we observed relating to the risk of fire. We undertook a separate visit with a representative from the fire service; this resulted in urgent action being required by the provider. We returned on a separate day, we found some action had been taken and other required actions were in progress.

We found gaps in record keeping, the lack of accurate recording, and records that were inaccurate or contradictory. We also identified concerns about data protection and the security of confidential records.

There were marginal improvements in some of the areas which were found to be non-compliant at the previous visit in July 2013. However, because of the other shortcomings and deterioration in other areas we reviewed an additional four standards as part of the follow up inspection.