About the service:

Rosewood Care Home is a care home that provides care and accommodation to mainly older people some of whom may be living with dementia. It can accommodate up to 43 people.

Rating at last inspection: May 2017 Requires Improvement (Report published July 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found concerns with the service provided, including breaches of the Health and Social Care Act, and rated the service as ‘requires improvement.’

People’s experience of using this service:

People did not always receive safe care and support. Safeguarding procedures had not always been adhered to. Individuals did not have comprehensive risk assessments that reflected their needs. Relatives and people told us that they could not recall being involved in reviews of their care. The care and support plans in place did not always reflect people’s current or changing needs. The registered manager advised us of plans to introduce a new care planning system which they hoped would address these issues.

We received some mixed views from people, relatives and staff regarding staffing arrangements. The provider’s representative agreed to review the way they determined staffing. People received their medicines as it was prescribed but guidance to staff about when people should be administered ‘as needed’ medicines needed improvement. Staff followed infection control guidance and had access to personal protective equipment.

People did not always receive effective care. People were not consistently supported by staff with the right training to provide safe care. We found where people lacked capacity and were being deprived of their human rights that the appropriate authorisations were in place and being reviewed by the local authority. People told us they were supported to have enough to eat and drink. People accessed health care when needed. Records in relation to hydration, nutrition, pressure area care monitoring and healthcare needed improvement.

We received positive feedback from people about the caring attitude and behaviours of individual staff. However, we also found that the providers systems did not always support the service to be fully caring.

People did not always receive responsive care. Where people needed support on end of life care, information was not being gathered sufficiently to ensure people’s wishes could be met. People's needs were not always assessed and planned for. The registered manager was unable to show how the service involved people in reviews about the support they received. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaint process which people and relatives were aware of.

The service not consistently well led. The registered manager carried out quality assurance checks however they were not effective. They agreed to reflect and develop their systems further. The registered manager and provider did not understand the responsibilities of their registration with us. The registered manager and provider failed to make notifications to the care quality commission. The registered manager was known and made themselves available. People’s relatives shared their views by completing a provider questionnaire about the service.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will

make changes to ensure the provider improves the rating of the service to at least Good. We will re-inspect Rosewood House within our published timescales to see what improvements have been made.

The inspection took place on 4 and 5 May 2017 and was unannounced.

Rosewood Care Home is registered to provide accommodation and nursing support for up to 43 people with a variety of health conditions including dementia. On the day of our inspection there were 29 people living in the home.

There was a registered manager 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.

At our last inspection in March 2016 we found that the provider ‘required improvement’ overall. We found that arrangements in place to check that people received care and support that met their needs and preferences, including medicines were not always effective. We also found that people were unable to take part in activities of their choice. At this inspection we found that some improvements had been made but further improvements were required.

An assessment and care planning process was in place, which people were involved in as part of making decisions about their support needs. We found that records in relation to care plan reviews were not being kept. The provider had systems in place to ensure the activities people took part in reflected their preferences.

People were safe. Staff knew how to keep people safe and there were sufficient staff available to meet people’s support needs. People’s medicines were being administered as they were prescribed.

Staff were able to access support from the registered manager when needed to meet people’s needs, however they did not receive training on a consistent basis to ensure they had the skills and knowledge required to support people effectively. Whilst the provider ensured people’s human rights were not being restricted unlawfully, not all staff were receiving the training required to ensure they understood the principles of the Mental Capacity Act (2005). People were able to make choices as to what they had to eat and drink and were able to access healthcare as needed.

Staff were kind and caring. People were able to make decisions as to how they were supported and where an advocate was required they were able to access this support.

The provider had a complaints process in place which people were aware of and knew how to use to share their views.

Records were not consistently being kept up to date or accurate. Audits and checks were taking place to ensure the quality of the service people received. People were able to share their views by completing a quality assurance questionnaires. The information gathered was analysed by the provider to make improvements to the service people received.

The inspection took place on the 15 and 16 March 2016 and was unannounced. At our last inspection on the 9 and 12 January 2015 the provider failed to ensure there were sufficient staff to support people and that an effective system was in place to prevent people being unnecessarily deprived of their liberty. This was a breach of Regulation 22 and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to send us an action plan outlining how they would make improvements and we considered this when carrying out this inspection.

Rosewood Care Home is registered to provide accommodation and support for 43 older adults who may have dementia. On the day of our inspection there were 34 people living at the home. There was a registered manager 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.

We found that the provider had taken the actions they told us they would and there were sufficient staff to keep people safe. Care staff knew how to keep people safe and when people needed their medicines this was being administered.

We found that care staff were able to access relevant support to ensure they had the appropriate skills and knowledge to meet people’s needs. The atmosphere within the home was warm, welcoming and staff consistently demonstrated that they were kind and caring.

People’s consent was sought before they were supported. The provider had the appropriate systems in place to ensure people’s human rights would be protected and staff had access to training to ensure people would not be deprived of their liberty.

People were encouraged to live independently and their privacy and dignity was respected. They were also able to make choices as to when and what they had to eat and drink. We found that people were able to access support from health care professionals when needed.

We found that care plans and assessments were in place to identify people’s needs and how they would be met. However reviews were not being carried out consistently and people were not involved in the process.

The provider had a complaints process in place and people in the service knew who to complain to. The provider had a system in place so people were able to share their views.

The provider had no written process in place to show how the service quality was being audited and checked and where improvements were required how they would be actioned.

The standard and quality of the provider’s care records and retention processes needed to be improved to ensure they were accurate and clear for staff to follow.

We carried out an inspection to help us answer five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their representatives, the staff supporting them, a visiting professional and from looking at records. We spoke with eight people and representatives, three members of staff and the manager. We looked at four people’s care records.

There were 28 people staying at the service at the time of our inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe and comfortable staying at the service. One representative said they had, “Peace of mind” with their relative living at the service.

Systems were in place to make sure that managers and staff learned from events such as complaints, and accidents and incidents. This helped the service to improve.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service, but the manager showed good knowledge about how they should protect people’s rights. Staff, through practical examples, showed they knew how to protect people’s rights to make decisions.

There were not always enough staff to support people safely. The manager gave assurances that they would look at staff numbers and reassess them in light of people’s needs. Records showed that management addressed issues through appropriate disciplinary procedures with staff, when required.

Is the service effective?

People told us that the care they were provided with helped them to improve. One person told us that staff had helped them to get better from an illness.

A visiting professional told us that staff were cooperative in assisting their work in supporting one of their patients. They told us, “They always have time to discuss people’s care”. This meant that staff cooperated with external professionals to promote people’s wellbeing.

Is the service caring?

We observed staff interacting with people and saw that these interactions were positive, patient and caring. One person told us, “Staff are magnificent”. One person’s representative said, “I like all the staff. They’re all pleasant”.

Is the service responsive?

We found that staff responded to people’s choices and respected these. We saw that staff used communication in the way people preferred so that they could understand their choices.

The provider carried out a number of themed questionnaires to understand what was good about the service and what could be developed. We saw that action was taken to improve areas of improvement raised by people.

Is the service well-led?

The service was led by a registered manager, who was present at the time of our inspection. They assisted us in obtaining the information we required during our visit.

We saw that a number of audits were carried out in order to assess the quality of care provided. The provider reacted positively to areas we identified for improvement, including the purchasing of additional equipment to help keep people safe. Falls were fully recorded and analysed to assess what action was required to increase people’s safety.

The inspection took place on the 9 and 12 January 2015 and was unannounced. At our last inspection on the 17 April 2014 the provider was not fully compliant with the regulations inspected.

Rosewood Care Home is registered to provide accommodation and support for 43 older people with dementia. The manager present had recently been appointed and was currently going through the process to become a registered manager. 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.

We last inspected the service on the 17 April 2014 and at this inspection we found the service was not meeting the regulations we inspected. We found that there were not enough staff to keep meet people’s care needs safely. We asked the provider to send us an action plan outlining how they would make improvements and we considered this when carrying out this inspection.

We found that the provider had not addressed the concerns from our previous inspection in April 2014. The provider had increased the staffing levels on the morning and afternoon shifts but they were using the staff to work in the kitchen rather than providing care. This meant that there was still not enough staff caring for people to keep them safe. Our observations were that people were being left in the lounge area with no staff to support or monitor them and as a result people were arguing amongst themselves or not being responded to in a timely manner when assistance was needed.

We found that staff were not being deployed appropriately to ensure people could be supported safely.

We found that the levels of agency staff being used in the home to manage the shortfall in staffing was impacting on the quality of care people were receiving. This led to an agency staff member being asked to leave the home by the manager due to their behaviour on the day of our inspection.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We found that people’s rights were not being protected in line with the legislation. Staff we spoke with had not had any training and where people who lacked capacity were unable to give consent or their liberty was being restricted the appropriate actions had not been taken. Staff did not have the appropriate skills and knowledge to ensure the MCA was being adhered to.

We found that people were relaxed amongst staff and did not show any anxiety when being cared for by staff. People we spoke with told us the staff were good, and that they were able to make choices in how they were cared for. Our observations were that staff knew how to care for people, on occasions agency staff we observed were not so caring with their approach to people. This meant that people could not always be sure as to how staff would interact with them.

We found on one occasion the service was not as responsive as it should be. One person who was poorly and in their bedroom was calling for staff support as the alarm cord was out of their reach. It was unclear as to how long they had been calling for help. This meant that when the person needed assistance they were unable to get it.

We found that people’s preferences and interests were generally recorded, but staff were not consistently ensuring they were met. The staff provided activities as a way of stimulation but they were not being provided often enough and were not what people had identified as their preferences.

We found that there was no system in place so people and their relatives could share their views on the service they received so the provider was able to make improvements where required.

The provider had systems in place so people could make a complaint if they wanted too. People we spoke with told us they were not all aware of the process and relatives said they would speak to the manager if they had a complaint. We found that the provider also sent out a questionnaire to gather people’s view, but the information gathered was not being analysed in order to improve the service.

We found that the service was not well led because the provider and the manager did not have a proper reliable and consistent auditing system in place to monitor the quality of the service to ensure it was being delivered safely and how people wanted it. We found that records were not accurate, consistent and in some cases there were non-existent. This meant we were not always able to verify what was being done.

There was no effective system in place to ensure that the service was meeting people’s needs and be compliant with the law.

You can see what action we told the provider to take at the back of the full version of the report.