About the service: Rockley Dene Nursing Home provides care and support for people with residential needs. The home is registered to accommodate a maximum of 34 people. On both days of our inspection, 14 people were living in the home. Some people who used the service were living with dementia.

Rating at last inspection: Inadequate (report published November 2018). We placed the service in special measures as breaches of the regulation were found in relation to person-centred care, need for consent, safe care and treatment, good governance and staffing.

Following the last inspection, we met with the registered provider to discuss their action plan which showed what they would do and by when to improve the ratings in respect of our key questions. At this inspection we found improvements had been made in most areas. However, concerns remained regarding systems of governance to demonstrate clear management oversight.

People’s experience of using this service: Action was needed in response to the January 2019 fire risk assessment as issues identified had not been followed up. These actions were completed during and following this inspection. All of the registered provider’s policies and procedures had been reviewed on the same day which was not a robust check to ensure they were still valid. Actions from various audits had not demonstrated these tasks were always completed.

Legal requirements relating to the displaying of the last rating we allocated this home and reporting two notifiable events to the Care Quality Commission had not been fulfilled.

Staffing levels to meet people’s needs were calculated, although records relating to staffing were not robust.

People’s privacy and dignity was not always upheld as two people were weighed in the lounge in view of others in this area. People were satisfied living at this home and relatives we spoke with gave more positive feedback. Staff were seen to be kind and attentive.

People felt safe and staff were trained in how to identify abuse. Recruitment procedures were checked and found to be safe. The storage, administration and disposal of medicines was managed safely. Risks to individuals had been assessed and reviewed.

The home was clean, although some areas looked worn. We asked the management team to review storage of linen as there was an unpleasant smell in this cupboard. The registered provider was taking steps to make the living environment more dementia friendly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Discussions to promote people’s equality, diversity and human rights had started.

Staff received regular formal support through training and ongoing supervision. People received access to healthcare and visiting professionals told us staff followed their guidance.

People were supported to maintain a healthy weight and largely had a positive mealtime experience. We discussed concerns with the management team about two people who needed additional support with their meals.

The procedures for making complaints was transparent and a single complaint received was dealt with appropriately. The activities programme met people’s needs, although people told us there were no trips out.

Care plans were difficult to use due to the volume of information and key details about people’s needs was not immediately obvious. The registered manager has since addressed this.

A system of audits was in place and the registered provider had oversight of the home. Regular meetings with people, relatives and staff were taking place. Satisfaction surveys captured their feedback.

Why we inspected: To follow up on enforcement action we took at our last inspection and to review whether the action plan the registered provider submitted to us had been acted on.

Enforcement: We have taken enforcement action in relation to the governance

This inspection took place on 29 August 2018 and continued on 6 September 2018. The first day of our inspection was unannounced. The second day was announced to give the registered provider an opportunity to attend feedback.

We had previously inspected the home in January 2018 and rated it overall as requires improvement. Our key question ‘safe’ was rated as inadequate and other key questions were all rated as requires improvement. We found breaches of the regulations concerning dignity and respect, need for consent and staffing. We took enforcement action in relation to safe care and treatment and good governance. The registered provider sent us an action plan dated March 2018 which we followed up at this inspection.

Rockley Dene Nursing Home is a 'care home'. 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. Rockley Dene Nursing Home provides care and support for people with nursing and residential needs. The home has a maximum occupancy of 34 people. On both days of our inspection, 15 people were living in the home and the local authority had taken the decision to suspend new placements at this home. Due to their concerns, the local authority was visiting on a daily basis to check on the care provided and to ensure shifts were fully staffed.

At the time of our inspection a manager was still registered with the Care Quality Commission. However, the week before our inspection, they left the home and were no longer in day-to-day control. 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 home did not have a deputy manager in post, although by day two of our inspection, a clinical lead had been temporarily appointed to manage the home. The registered provider was in the process of appointing a permanent new home manager.

The majority of nursing staff were agency workers which meant consistency of care was difficult to provide. During our inspection, the registered provider made us aware they would de-register from nursing care and run the home providing residential care only.

We found a continued breach of the regulations as staff training gaps were identified in first aid, fire safety, dementia care and safeguarding. Limited supervision had taken place since our last inspection and there were no staff appraisals.

The storage of medicines was not well managed and staff were not using body maps or topical medication administration records. Individual risks to people had not been properly assessed. Concerns regarding fire safety seen at the last inspection were still evident at this inspection.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Deprivation of Liberty Safeguard (DoLS) authorisations had not been appropriately managed. Capacity and consent was not consistently recorded. Staff understanding of DoLS was poor.

Some gaps in the recruitment processes followed for two staff members were identified. Complaints were recorded, although evidence of responses was not always evident.

The home was generally clean and free from odours. Technology was used in the home to assist people in their day-to-day lives.

Dignity and privacy was seen to be improved. People and relatives spoke positively about the staff. People were consistently offered choice during our inspection, although people’s preferences regarding waking times had not been respected.

Staffing levels were insufficient to meet people’s need

The inspection of Rockley Dene Nursing Home took place on 9 and 11 January 2018. This was the services first inspection since their registration with the Care Quality Commission in February 2016.

Rockley Dene Nursing Home is a ‘care home’. 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. Rockley Dene Nursing Home provides care and support for people with nursing and residential needs. The home has a maximum occupancy of 34 people. On the day of our inspection, 24 people were resident at the home.

At the time of our inspection a registered manager was 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.

People told us they felt safe, but during the course of the inspection we found aspects of the service were not safe. Risk assessments did not include adequate detail to reduce the risk of harm to people or staff. People were not adequately protected from the risk of fire as staff had not received sufficient training, people’s personal emergency evacuation plans were not fit for purpose and we could not evidence a recent fire risk assessment had been completed. The registered manager was not able to evidence checks on lifting equipment had taken place in line with Lifting Operations and Lifting Equipment Regulations 1998 (LOLER).

People told us there were not always sufficient numbers of staff on duty to meet their needs and some staff felt they had recently had to work excessive hours, however, this was in part due to a recent outbreak of sickness in the home.

Procedures for the recruitment of staff was not always robust. Checks on nurse’s registration had not been kept up to date and there was insufficient information in the personnel file for one nurse to evidence pre-employment checks had been robust.

Records relating to some people’s medicines needed to be improved. We could not evidence nursing staff had received regular medicines training and competency assessments.

Policies were not reflective of current good practice guidance.

New staff with no previous experience in providing care to people, they were not enabled to complete the Care Certificate. We were unable to evidence staff had received practical moving and handling training.

Feedback regarding the meals at the home was mixed. We saw meals were plated up in the kitchen and then served to people, on the second day of the inspection we saw the serving of the lunchtime meal was more person centred. People were not always encouraged to eat their meals and records of people’s diet and fluid intake were not always accurate. We have made a recommendation regarding meeting peoples nutrition and hydration needs.

Peoples weight and nutritional risk was monitored and action was taken where concerns were raised.

People were not supported to have maximum choice and control of their lives, we found records in peoples care plans did not evidence the home was compliant with the requirements of the Mental Capacity Act 2005.

People told us staff were caring and kind, but we saw a number of examples where staff did not treat people with dignity and respect. This included staff not explaining to a person what they were doing and where they were taking them and not offering people a choice in regard to the drink they were given.

There was a programme of activities, but some people felt they were not suited to the people who lived at the home.

Information in people’s care files was recorded consistently throughout the document and the content was person centred, although some care plans lacked detail. P