About the service:

• Rotherlea is situated in Petworth, West Sussex and is one of a group of homes owned by a national provider Shaw Healthcare Limited. It is a residential ‘care home’ registered for up to 70 older people who are living with dementia or frailty. At the time of the inspection there were 61 people living in the home. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• There were serious concerns about the care people had sometimes received and the provider’s lack of oversight to ensure that appropriate improvements were made.

• Risk were not well-managed and there were concerns about people’s safety.

• One person had not always had access to prescribed medicines to manage their health condition.

• Risks had not been considered for people. One person had experienced a serious scald.

• Staff sometimes lacked understanding about potential risks and about gaining people’s consent.

• People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. The policies and procedures in the home did not support this practice.

• The management of the home had changed since the previous inspection. They showed commitment and enthusiasm to implement the changes needed to improve the care people received.

• People were protected from abuse.

• People were protected by infection prevention and control.

• There were sufficient staff to meet people’s needs.

• People told us that they were happy living at the home, that they felt well-cared for and safe.

• Staff were observed engaging and interacting with people in a kind and compassionate way.

• More information can be found within the full report.

Rating at last inspection:

• At the last inspection the home was rated as Requires Improvement. (Published on 27 November 2018). This home had been rated as Requires Improvement in the last three consecutive inspections. At this inspection on 29 January 2019, we continued to have concerns.

Why we inspected:

• This was an unannounced focused inspection to look at the key questions of Safe, Effective and Well-led. This was because at our last inspection, on 27 September 2018, the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action against the provider and gave them a date to meet the Regulations by. This inspection took place to check that improvements had been made and that they were now meeting the Regulations.

Enforcement:

• The provider had not met the Warning notices that had been issued following the previous inspection on 27 September 2018.

• We continued to have concerns.

• The overall rating for this home is ‘Inadequate’ and the home is therefore in special measures.

• Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

• If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

• For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

• Full information about CQC’s regulatory response to

This unannounced inspection took place on 27 September 2018. Rotherlea is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rotherlea is situated in Petworth in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Rotherlea is registered to accommodate 70 people. At the time of the inspection there were 60 people accommodated in one adapted building, over two floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people and those living with dementia.

The management of the home had been through a period of transition. The home had a registered manager who had been on long-term leave from work. A registered manager is a ‘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 home is run. The management team consisted of team leaders and two deputy managers, one of whom was also on long-term leave from work. A manager from one of the provider’s other homes had been managing Rotherlea, alongside their own service. An operations manager also regularly visited and supported the management team.

At the last inspection on 14 and 15 September 2017, the home received a rating of ‘Requires Improvement’. The provider was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, the provider completed an action plan to inform us of what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. This was because there were concerns about staff’s understanding and use of the Mental Capacity Act 2005 (MCA). The provider had not always complied with the Deprivation of Liberty Safeguards (DoLS). Staff were not always provided with consistent guidance about people’s specific healthcare needs. Records to document the actions of staff were not always maintained. Areas identified as needing improvement related to following advice that had been provided by external health care professionals.

At this inspection, we found some improvements, in relation to MCA, the maintenance of some records and implementing healthcare guidance, had been made since the previous inspection. However, people were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible. The policies and systems in the home did not always support this practice. This was an area of concern.

One person’s needs had been assessed before they moved into the home. This had shown that they had a history of falls. The provider had failed to ensure that these risks were identified and managed to assure the person’s safety. The person had fallen and sustained a significant injury. This was an area of concern.

There were continued concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Not all concerns that had been identified at the previous inspection on 14 and 15 September 2017, had been addressed. Areas that were identified as part of this inspection had not always been picked-up and acted-upon by the provider’s own quality assurance audits.

Records, to document people’s specific healthcare conditions did not always contain sufficient guidance to inform staff’s practice. It was not always evident how people or their relatives had been involved in contributing or reviewing their care.

We made a recommendation about people’s access to meaningful activities, interaction and stimulation.

People were cared for by su

The inspection took place on 14 and 15 September 2017. The first day of the inspection was unannounced, however the second day of the inspection was announced and the registered manager, staff and people knew to expect us.

Rotherlea is a residential service providing accommodation for up to 70 older people, some of whom are living with dementia and who may require support with their personal care needs. On the day of the inspection there were 56 people living at the home.

Rotherlea is situated in Petworth, West Sussex and is one of a group of services owned by a National provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are also communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, one unit manager and team leaders.

We previously carried out an unannounced comprehensive inspection on 26 and 27 July 2016. Breaches of legal requirements were found in relation to safe care and treatment, the need for consent, sufficiency, support and training of staff and governance. The home was rated as ‘Requires Improvement’.

At this inspection it was evident that improvements had been made. Staff received training and appropriate support and guidance within their roles and quality monitoring systems, to enable the management team to have an oversight of the service that was provided, had improved. Risk assessments had been completed that identified the hazards and measures had been put in place to monitor and mitigate risk. As a result the registered manager was no longer in breach of these associated regulations. Although improved and therefore not in breach, an area in need of improvement related to the implementation of guidance in relation to peoples' healthcare needs. There was a new concern with regards to the lack of records to provide guidance to staff in relation to peoples’ specific healthcare needs and to document staff’s actions. There were continued breaches in relation to MCA and DoLS. Staff lacked understanding and the registered manager had not always ensured that peoples’ capacity was assessed in relation to specific decisions. In addition, applications had not always been made to the local authority to ensure that people were not being deprived of their liberty unlawfully.

People were protected from harm and abuse as they were cared for by staff that knew how to recognise the signs of abuse and what to do if there were ever any concerns. Risks to people were assessed, monitored and mitigated and peoples’ freedom was supported and respected according to their needs. Staff were adequately supported within their roles and had access to training to enable them to deliver safe care to people. People told us that they were happy with the food and drink that was provided. Comments included, “Food good, given too much” and “Food much better, better selection than other home”.

Staff were aware of peoples’ needs and could recognise when people were unwell. People had access to external healthcare professionals to support them to maintain good health. Staff were kind and caring and people and relatives told us that they were happy with the support they received from staff and they were treated with dignity and respect. One person told us, “Staff ask in a nice way, all very good”. Another person told us, “Staff very good, no complaints”. A comment within a recent relatives’ survey echoed these views, it stated, “I cannot fault t

The inspection took place on 26 and 27 July 2016 and was an unannounced inspection.

Rotherlea provides accommodation and care for up to 70 older people, some of whom are living with dementia. At the time of our visit, there were 61 people in residence (27 in the three downstairs units and 34 in the four units upstairs).

The service has 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.

There were not enough staff employed by the service. Although the registered manager had mostly maintained the staffing numbers by using temporary staff, this was having an impact on the care that people received. Staff were under pressure and had little time to engage with people socially or to support them to pursue their individual interests. Staff were ‘borrowed’ from the domestic and activities staff teams to provide care to people. This had a knock on effect on the cleanliness of the home, the ordering of supplies to the kitchen and the provision of activities. Due to staff changes and staff moving between the units of the home, people did not have the continuity of the same keyworker to ensure their wellbeing.

Risks to people’s safety had not been managed effectively. We could not be sure that people received appropriate support at all times to minimise any impact on their health.

Medicines were not managed safely. A new electronic recording system for the administration of medicines had been introduced but some staff had not received training to use it effectively. Stocks of medicines did not tally and staff did not always follow the provider’s policies in how to store, administer and dispose of medicines.

The Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider was not meeting the requirements of DoLS because the registered manager had not applied to authorise the deprivation of liberty for some people using the service. Staff had a variable understanding of the Mental Capacity Act 2005 (MCA). Records did not demonstrate that people’s rights had been protected when they were deemed to lack capacity to make decisions regarding their care and treatment.

Staff did not feel supported by management or that their contribution was valued. Staff had not always received appropriate training, support and supervision to enable them to carry out their duties effectively.

The registered manager had not carried out regular audits to monitor the quality of the service and to make improvements. She told us that she had been working hard behind the scenes to implement an action plan agreed with the provider. We saw that the score resulting from audits by the provider had improved during 2016.

People’s care had been planned but the monitoring in place did not demonstrate that people’s planned support had been consistently delivered. People were referred to healthcare professionals to promote good health. Visiting professionals told us that staff generally made appropriate referrals and followed their recommendations.

People enjoyed the food and were offered a choice of meals. Staff did not use any visual prompts to support people living with dementia to understand the choices available to them. We have made a recommendation regarding adaptations to better meet the needs of people living with dementia.

People spoke highly of the regular staff team that supported them. They told us that they were very kind and that they worked extremely hard. They told us that staff treated them with respect and were mindful of their privacy. Some people were actively involved in planning their care, others told us that they would like to have more of a say.

People felt safe

At our previous inspection in November 2013, we found the service was not meeting minimum standards in three areas. We carried out this inspection to check the necessary actions had been taken to achieve compliance in these areas. We also inspected other areas as part of our routine inspection programme to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led?

The inspection team consisted of an inspector and an expert by experience. At the time of our inspection there were 68 people using the service. We spoke with six of them and relatives of another four in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with a unit manager and eight members of staff.

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe and comfortable in the home. One person said, “Yes, I’m very happy, I am well looked after and I feel very safe here.” All the visiting relatives we spoke with said their family member was well cared for. They told us they felt assured their family members were safe.

We found the service carried out the necessary checks before staff started work and there was a robust recruitment process in place. There were sufficient staff to look after people safely. Processes were followed to ensure medicines were administered safely. We observed care workers helping people to move about the home safely using wheelchairs, frames and other equipment.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person’s relative said, “Very good. 10/10.”

We found people’s care and support were based on thorough assessments and detailed and personalised support plans. The environment people lived in had been adapted and decorated in a way that helped people to live well with dementia. Systems were in place to ensure care was delivered according to people’s plans.

Is the service caring?

Relatives of people using the service told us support was provided in a caring way. One said, “Yes, it’s brilliant. They know me, they know mum. Mum has been here two years. I can come in, make myself a cup of tea. I love it. It makes me want to come in.” Another said “Quite nice, the people are friendly”. People using the service told us they got on well with their care workers and had a good relationship with them. One person said, “I’m very happy; the people are very kind and look after us well."

Staff we spoke with were motivated to provide high quality care. They had a thorough knowledge of people’s needs and how they preferred to have their care delivered. One member of staff said “I love working with the residents, I treat them like I would my mum, my dad, my grandparents.”

Is the service responsive?

The service responded to changes in people’s needs or circumstances. People told us staff responded promptly when they needed assistance.

We found the service assessed people’s risks and adapted their care plans accordingly. Staff were aware of people’s preferences, backgrounds and interests.

Is the service well-led?

Systems were in place to regularly assess and monitor the quality of service provided. There were processes in place to review and learn from incidents and accidents. People who used the service and their families were able to contribute their views about the service they received.

We spoke with 13 people during our visit. Most people told us that they were very satisfied with the service. One said, “You can’t beat this place”. Another told us, “The carers we have are really lovely”.

We spoke with five relatives. They had mixed experiences of the service. One said, “The whole place is just very nice. The atmosphere is good, the carers are very helpful, caring and approachable”. Another told us, “They’re lovely but I don’t think they’ve got time to care”.

We spoke with eight carers, three team leaders and the manager. Staff told us that they enjoyed working in the home. One said, “I love it, it’s the best job ever”. Many told us, however, that they were finding it increasingly difficult to meet people’s needs with the number of staff they had on shift.

We found that people were happy in the home. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. People told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

We found, however, that there were not enough staff in all parts of the home to ensure people’s safety and welfare at all times. Where risks had been identified support plans were not always in place or followed. We observed some dangerous moving and handling practice and found that prescribed creams were not properly managed.

We spoke with five people who lived in the home. They told us that they enjoyed life in the home and that they had choices in daily activities of living. One person told us, “I love it here.” Another told us, “I like to get up around nine.”

We were told that there were plenty of activities such as music, singers and trips out. One person told us, “I love the trips out.”

We looked at completed surveys from people and relatives and they also expressed satisfaction with the activities but some people pointed out that there was not much on offer for people who did not like groups or could not go out on trips.

People told us they were happy with the care they received and that they were treated with respect.

We spoke with one relative who was happy with the care in the home and who confirmed that the meals were very good.

We spoke with professionals from West Sussex County Council, with the district nursing team and with the Primary Care Trust Mental Health team who were, in the main, happy with the care in the home. We were told that the home learned from any incident or investigation, that staff were caring but that “sometimes staff are very thin on the ground” We were told that the majority of staff were enthusiastic about some recent dementia workshops.