Archived: Rosemary Retirement Home

About the service

Rosemary Retirement Home is a residential care home providing personal care for up to 23 people over the age of 65, including those living with dementia. At the time of the inspection, 19 people were living at the home.

The accommodation comprised a communal ground floor lounge and dining area. Some bedrooms were located on the ground floor with additional bedrooms on the first floor. There was a smaller lounge area on the lower ground floor along with additional bedrooms.

People’s experience of using this service and what we found

Relatives and people we spoke with gave positive feedback about the staff and the home. However, we found significant shortfalls throughout the inspection which impacted on the safety and quality of care for people.

We were not assured the provider had taken effective action to make sure government guidance was being followed after a recent COVID-19 outbreak. Due to the issues identified at the inspection, the local authority provided additional care staff to support the service to ensure people received the right levels of care and support.

Infection prevention control measures that were in place, were not safe and put people and staff at risk of contracting the virus.

The quality assurance checks in place to drive improvement were not robust. They had not ensured the safety of care was sufficiently monitored. The poor management of the COVID-19 outbreak did not protect people and staff from the ongoing risk of harm.

Risks associated with people’s health had been identified however there was no guidance for staff to follow if a person with diabetes were to become unwell.

Some medicines were administered safely, although staff did not have the required protocols in place to administer ‘as required’ medicines.

People were not always treated with dignity and respect. Staff did not always treat people with compassion. We observed some kind and caring interactions, however we also observed people were left for long time periods with little stimulation or staff engagement.

At our last two inspections we have had concerns the governance systems were not effective to ensure the quality of the service. This has continued to be a concern at this inspection and the provider had not taken enough action to make improvements.

Care plans had not been consistently reviewed to ensure all the information reflected people's needs. However, the new home manager had started to review all care plans and make referrals to health care agencies for some people to have their needs reassessed.

The overall dining experience for people required improvement. People’s dietary needs were appropriately assessed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were processes in place to safeguard people from abuse. Appropriate recruitment procedures ensured new staff were assessed as suitable to work in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 14 May 2021) and there were multiple breaches of regulation. The provider has submitted monthly action plans following the last inspection to show what they have done to improve the service. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns about infection control. A decision was made for us to inspect safe and well-led and examine those risks.

Following the first day of the inspection on the 05 August 2021 and our concerns, urgent action was taken by the CQC. We imposed urgent additional conditions on the provider’s registration to address the issues identified around the provider’s management of the COVID-19 outbreak. The provider met those urgent conditions and submitted the requested, additional action plans of all the actions needed to mitigate future risk of harm.

We continued the inspection on the 12 August 2021 and due to the continued concerns identified at the 05 August 2021 inspection, it was agreed to inspect against the remaining key questions, effective, caring and responsive.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosemary Retirement Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold the provider to account where it is necessary for us to do so.

We have identified continued breaches in relation to the safe management of COVID-19, treating people with dignity and respect, staffing and governance of the service at this inspection.

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 they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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.

Rosemary Retirement Home is a residential care home providing personal care for up to 23 people, including older people and people who may be living with dementia. At the time of our inspection 22 people were living at the service.

The accommodation had a communal lounge and bedrooms on the ground and first floor with some bedrooms having ensuite facilities.

People’s experience of using this service and what we found

At our last inspection we found there were not enough staff to meet people’s needs to ensure safe and quality care. At this inspection the staffing levels had improved but we had concerns about the skills and knowledge of staff and relevant training had not been provided.

The provider did not have effective systems to ensure people always received safe care and that medicines were managed safely. We found concerns regarding the storage and administration of medicines and the management of risks in relation to distressed behaviours, malnutrition and sore skin. There were inefficient systems to ensure monitoring records were accurate and completed in line with people's assessed needs.

People were not always treated with dignity and respect, staff did not always treat people with compassion and choices were not always respected. At our last inspection we had concerns that the governance systems were not effective to ensure the quality of the service. This continued to be a concern and the provider had not taken enough action to ensure improvement.

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 and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not been completed for some key decisions when people lacked capacity.

There had been no adaption to the environment to support people living with dementia and we have made a recommendation that the provider refers to best practice guidance to make improvements. People told us the food was good and a they had a choice although further consideration was required to support people living with dementia to make a choice. Staff knew how to recognise and report concerns about people’s safety and people told us they felt safe. People and relatives felt able to raise concerns with the management team and were generally positive about the care they received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 November 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We used our transitional monitoring approach to review information about the service. This focuses on looking at information about safety, how effectively a service is led and how easily people can access the service.

Following this we had concerns in relation to the assessment of risk and staff training and competency. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same, requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosemary Retirement Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to regulation 10 dignity and respect, regulation 12 safe care and treatment, regulation 17 governance of the service and regulation 18 staffing, at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosemary Retirement Home is a residential care home providing accommodation and personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 23 people.

People’s experience of using this service and what we found

The support people received was not always safe. There were not sufficient staff to ensure any potential risks to people could be managed safely. People could not always decide what they had to eat and drink

People were not consistently supported to have maximum choice and control of their lives. The characteristics of the Equality Act 2010 was not consistently being identified in how people’s needs were assessed. However, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were not always caring and kind as people were sometimes given cold meals. We found since our last inspection people’s privacy, dignity and independence was being promoted.

Reviews were carried out but did not identify who was present and the discussion that took place.

There was a constant odour within the environment of the home, which did not demonstrate a well led service. While the provider did not conduct spot checks, we found the registered manager did carry out these checks and audits. These checks were not always clear as to actions taken as a result of concerns identified. Questionnaires were not consistently used to gather views from people and their relatives. Not all staff were aware of the provider’s whistle blowing policy and its purpose.

Assessments and care plans while basic were completed. People could access healthcare when needed. The provider had a complaints process in place which people used to share any concerns they had.

Staff received training and knew how to keep people safe and were appropriately recruited. Staff went through an induction process, so they would know how to support people appropriately. Medicines were administered as it was prescribed. Infection control processes were in place and staff could access personal protective equipment when needed. When an accidents or incidents took place, they were logged and the registered manager ensured trends were monitored.

Rating at last inspection:

The last rating for this service was Good (published 16/02/2017)

Why we inspected

This was a planned inspection based on the previous rating. However, concerns were identified because of a serious injury and this inspection examined those risks.

Follow up

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rosemary Retirement Home provides accommodation and personal care for up to 23 older people. At the time of the inspection there were 23 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.

At the last inspection on 15 and 17 September 2015 we asked the provider to take action to make improvements (regarding the audits in place to assess, monitor and drive improvement in quality and safety of the services provided and to seek and act on feedback from people using the service). We saw that these actions had been completed.

People’s dignity was not always respected when receiving care and support. People described staff as kind and caring and supported them to make their own decisions on the support they received. People were supported to retain their independence, where possible.

People were supported by staff who had received training in how to recognise signs of abuse and what actions to take should they suspect someone was at risk of harm. Staff were aware of the risks to people on a daily basis and how to manage those risks.

Staffing levels were based on people’s dependency levels and were reviewed on a regular basis. People were supported by staff who had been safely recruited. There were systems in place to ensure people received their medicines safely.

People were supported by staff who received an induction that prepared them for their role and were provided with the training they needed to meet people’s needs.

Staff understood the importance of obtaining people’s consent prior to supporting them and ensured they offered people choices throughout the day in line with their personal preferences.

People were supported to have sufficient amounts to eat and drink and their dietary needs were adhered to.

People’s healthcare needs were met and they were supported to access a variety of healthcare professionals to ensure their health and wellbeing.

Efforts were made to obtain more information about people’s interests in order to introduce activities that were of interest to them. People had requested for more activities and plans were in place to extend the number and variety of activities on offer. People were involved in the planning of their care and were regularly asked for feedback on the service.

People were aware of how to make complaints and were confident that if they did raise a concern it would be dealt with to their satisfaction

The registered manager had a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. On the day of the inspection there were 23 people living at the home but they were not all able to verbally express their views so we observed how they were supported. We were only able to speak with one person. We also spoke with two members of staff who supported people, two relatives, the manager and the provider who was supporting the inspection process and a district nurse. We looked at three people's care records.

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

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. Staff we spoke with were able to explain how these types of events would be managed.

Records showed that there were systems in place to identify potential risks to how people were supported. We found that these risks were being reviewed along with the care and support people were given, there was no evidence that people or their relatives were involved in the process. One person said, "No I have not been part of any reviews". This meant that the review process did not allow for people or their representatives to be involved.

We observed people throughout the inspection being offered drinks by staff on a regular basis. This ensured that people would not be at risk of dehydration. Relatives we spoke with told us they felt people were well looked after and safe.

The concerns identified with the management of medicines previously had not been fully rectified and evidence showed that the provider was not meeting the regulation for this standard. Medicines were not being audited on a regular basis and there was not a protocol in place to consistently advise staff when they were administering 'as required' medicines.

No applications for the Deprivation of Liberty Safeguards had been submitted by the provider. Staff we spoke with knew how to keep people safe from abuse but had limited knowledge of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff told us they had received training in both areas, but records we saw only confirmed that training was available in the MCA. This meant that staff were able to keep safe, but further training was needed in DoLS.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

We found that people were being supported appropriately and the records being used were not always consistent. People's care records were not all in one place so staff could access records easily. Appropriate documentation was being used to support people, but records were not always signed and dated. There were instances of blank paperwork on people's care records. This could lead to staff not having the appropriate information they needed to support people because paperwork had not been completed.

We found that checks were not regularly being carried out to ensure the quality of the service being provided. One person said, "I am happy with the service, staff support me when I need it". This meant without regular audits being done people could not be sure about the quality of the service.

The provider was required to action some concerns found from the previous inspection, however we found that some of this had not been carried out. For example, we found that people's care records all had diabetic forms on even if people were not diabetic.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

Staff we spoke with were able to explain people's needs. Our observations were that staff were very caring and supportive to people. We carried out a Short Observation Framework for Inspections (SOFI) assessment and found that people had little if any interaction on a regular basis. Activities which allow for stimulation were very limited and we saw no plans on display. One person we spoke to told us that they were able to take part in activities some of which they liked. This meant that people were able to get some stimulation but this needed to be more regular.

We saw staff asking people if they were okay and getting their consent before supporting them to mobilise for afternoon tea or for particular personal care tasks. We saw staff reminding people the time of the day or what they had decided to have for tea. This showed that staff had an understanding of how people needed to be supported.

Where people needed their medication before or after a meal, we saw that this was now being carried out appropriately.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found from our previous inspection that the provider had taken some action to improve the service to people. We found that there were still areas to be improved that had not been identified on their action plan or had just not been carried out. The manager and the provider told us that where there were still areas of concern they would be actioned immediately.

Relatives we spoke with told us that when they had concerns they would speak to the manager or the provider. One person we spoke with said, "People used to come in my room and I spoke to the manager who arranged for a lock to be put on my door". This meant that the service respond to concerns brought to their attention.

A relative told us that they had completed a questionnaire about the service. Records showed that the provider had a process to gather people's views to help improve the service.

The provider had a complaints process in place so people could share any concerns they had. We found there was not a process in place for logging complaints so they could be monitored.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive.

Is the service well-led?

The service was led by a registered manager, who was closely supported by the provider who were both present at the time of our inspection and assisted us with any information we needed.

We found that care records had not improved sufficiently since our last inspection. Concerns we had about the lack of record being archived when they were no longer relevant had not been actioned appropriately. People's care records were still in a number of different places and were not easily found. This could potentially lead to staff confusion when trying to find people's care notes.

We found that people received care and support which met their needs. We observed staff supporting people appropriately. One person said, 'This is a lovely place, the staff are so caring.'

Arrangements were not in place to ensure appropriate storage, recording and safe handling of medicines.

Processes were in place to support staff to carry out their role. People and relatives we spoke with were complimentary about staff. One staff member told us, 'They support me really well.'

We found that some systems were in place to monitor the quality of the service. One person said, 'I have no complaints at all.'

We found that people's care records were not always accurate and fit for purpose. This could increase the risk of people receiving inconsistent care.

People were happy with the service they received and how their needs were met. One person said, 'The staff are very nice, they do anything I want'. The visiting health professional described the care given by the home as, 'Excellent'.

People's dietary needs were being met. One person said of the food, "It's been pretty good but there is not much choice'. Another described the food as being, 'Good quality'.

All of the staff had been trained in safeguarding and the policy and procedure were readily accessible. They all knew what they should do in respect of reporting safeguarding matters.

People were being cared for, or supported by, suitably qualified, skilled and experienced staff.

All of the people we spoke with had no complaints about the service but told us they knew how to make a complaint should the need arise. The people we spoke with told us that they felt confident to raise any complaint either directly with their care worker or with the management of the service.