Archived: Rosemount

The last inspection of the service was carried out on 21 and 22 November 2017 and published on 15 February 2018. At that time the service was rated as good.

Rosemount 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.

Rosemount is registered to care for older people, some of whom were living with dementia. Rosemount accommodates 20 older people in one adapted building. On the days of the inspection there were 16 people living at the home.

The service has a registered manager, who is also the registered provider. 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.

Before the inspection we had received concerns relating to the health and welfare of people living at the home. On 4 June 2018, a multi-agency safeguarding meeting was held. As part of that a plan was agreed with the registered manager, health and social care professionals, to protect people's safety and wellbeing. This included health professionals visiting the home every day as part of a support and protection role. The local authority quality improvement team and community nursing team were working with the home to help support improvement. We shared our findings and concerns with the registered manager and with the safeguarding and commissioning teams during and after the inspection.

During this inspection on 5, 6 and 7 June 2018 we highlighted a number of issues that required improvement and identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On this inspection we found there was a lack of effective leadership and governance which impacted on people's safety, the quality of care and support people received. People did not receive safe and effective care because there were insufficient systems in place to ensure this. The checks the provider had in place to monitor the quality and consistency of the service, were not effective in identifying shortfalls and driving the required improvements.

People were not safe and were placed at risk of harm. The registered manager had failed to ensure fire safety equipment was in satisfactory order. We saw a number of fire doors were defective as they had holes in them and two powder fire extinguishers located in high risk areas, were out of date. Emergency arrangements for actions to be taken in the event of a fire or other emergency situation placed people at risk.Since the inspection actions have been taken to address these risks.

Risks to people had not always been assessed and managed appropriately. Risk assessments were not always in place or contain enough information for staff to manage or mitigate the risk and provide safe effective care. Care plans were not always in place, completed fully or up-to-date. This meant staff did not have information on how to meet people's needs. This meant people were at risk of receiving inconsistent care and not receiving the care and support they needed.

People were not protected from the risk of harm as they were living in an environment that was not always safe. For instance, frayed carpets posed a trip hazard and people were at risk from falling from windows that did not comply with Health and Safety Executive guidance. We brought these concerns to the attention of the registered manager and they immediately arranged for them to be addressed.

People did not benefit from a clean environment. The premises were not free from offensive odours. Some carpets were stained and dirty and the home did not have adequate house-keeping arrangements.

The way the home was managed did not promote a caring ethos. People were not always treated with dignity and respect. We observed on occasions, staff would walk into a room and not acknowledge the people there. Some staff spoke in a disrespectful manner about the people they supported. For example, one staff member referred to people needing support to eat as "feeders". We observed continence products left in people's rooms which showed a lack of respect for people's dignity.

We did however see other instances of staff supporting people in a caring way. Some staff were patient with people and encouraged them to retain their independence. People were relaxed and happy in staffs' presence. Staff showed care and compassion to people and spoke about them with affection.

People did not benefit from activities or engagement that had been designed to address issues such as preventing isolation, helping to maintain the person's identity, and helping the person feel valued, helpful and involved. We saw people appeared withdrawn and disengaged with the environment. People were sat in the lounge or alone in their rooms for long periods of time just looking around or falling asleep.

People were not protected from the risks associated with the employment of staff who may be unsuitable to work with people requiring help with their care needs. This was because there was not a robust recruitment system in operation. Staff files we saw contained an incomplete employment history which had not been explored and did not always contain satisfactory evidence of conduct in previous employment, such as references.

We observed there were insufficient numbers of staff to meet the physical and social needs of people living at the home. Our observations showed there were a number of times when communal areas were left unsupervised. We saw interaction between staff and people often only happened when they needed support with a physical care task. In addition to supporting people with their physical care needs, staff were expected to prepare, cook and serve all of the food, do the laundry and attend to some cleaning around the home. This meant staff did not have time to support people in a person centred way.

People did not always receive support from staff with the knowledge and skills they needed to carry out all aspects of their roles. The registered manager had not followed their own policies to ensure staff had the necessary training to meet people’s health needs.

Staff received some training which the registered manager considered essential to their roles such as, manual handling, fire safety awareness and infection control. Staff were supported by regular supervision and appraisal. Staff said they could approach the management team at any time for support and guidance.

People were not always protected from the safe management of medicines. During the inspection we observed staff administering medicine in ways that did not follow safe practice or the home’s policy. Other aspects of medicine management, was safe. Medicines were stored correctly to help ensure they were safe and effective to use. Records showed medicines were given to people at the correct times.

People were seen by GPs who visited the home regularly. However, staff did not always make timely referrals to other healthcare professionals to ensure people's care and treatment remained safe or act on recommendations or instructions. Since the safeguarding process started, all relevant healthcare professionals have been involved in monitoring people's care to ensure their safety.

The home was complying with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The overall rating for this service is 'Inadequate' and the service 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of registration.

For adult social 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.

Following the inspection in March 2017 we asked the provider to complete an action plan to show what they would do and by when to meet the breaches of Regulations 9, 12, 15 and 19. We expected the service to improve the key questions Safe, Effective, Responsive and Well-led to at least good. We also issued a Warning Notice in respect of Regulation 17. At the inspection in November 2017 we found that improvements had been made in all key questions and the requirements of the Warning Notice had been met. However, insufficient time had passed since the last inspection to ensure the improvements would be sustained.

Rosemount 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. Rosemount is registered to care for older people, some of whom may have memory problems. The service accommodates 20 older people in one adapted building. On the day of inspection there were 16 people living at the service.

The service has a registered manager, who is also the registered provider. 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.

Improvements had been made to the quality assurance processes which had led to an improvement in the environment and risks to people’s safety being minimised. The staff recruitment process had been improved and people were receiving person centred care that was responsive to their needs.

All providers of NHS and publicly funded adult social care must follow the Accessible Information Standard. The Accessible Information Standard applies to people who have information or communication needs relating to a disability, impairment or sensory loss. CQC have committed to look at the Accessible Information Standard at inspections of all services from 01 November 2017. We found people’s communication needs were being met. However, people did not have a specific communication plan.

People’s needs were met by kind and caring staff. One visitor told us everything was “Brilliant” at the service. People told us “They [staff] treat you like we’re one big happy family. Wouldn’t want to go anywhere else thank you!” People’s privacy and dignity was respected and all personal care was provided in private.

The registered manager was open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager and said they felt well supported. They were confident any issues they raised would be dealt with. People also knew the registered manager well and we saw positive interactions between them.

Staff told us they thought there was an open and honest culture in the home. They felt there was a clear vision for the service which was to provide good quality care to people. Staff had been involved in ensuring the service improved and the requirements from the Warning Notice had been met.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Discussions with the registered manager indicated that where necessary people’s capacity to make decisions had been assessed and decisions taken in their best interests.

People’s medicines were stored and managed safely. Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. Care plans and risk assessments were updated following any accidents or incidents.

People’s needs were met by ensuring there were sufficient staff on duty. People, visitors and staff told us they felt there were enough staff available to meet people’s needs. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

Staff confirmed they received sufficient training and support to ensure they met people’s needs in a safe manner. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse.

People received person centred care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

People and their relatives were supported to be involved in planning and reviewing their care if they wished. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Not everyone living at Rosemount was able to tell us about their experiences. Therefore we spent some time in the lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Staff took time to ensure people received any assistance they needed.

People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals.

There were regular activities available for people to participate in. These included crafts, pamper sessions and outside entertainers. We saw people enjoying craft and pamper sessions.

We have made a recommendation in relation the Accessible Information Standard and the quality assurance systems.

Rosemount is a residential care home providing personal care for up to 20 people. The service supports older people, some of whom may have memory problems. On the day of inspection there were 14 people living at the service.

A manager, who was also the owner of the service, was registered with the Care Quality Commission. 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.

During this inspection in March 2017 we highlighted a number of issues that required improvement and identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not benefit from having social activity plans based on their life histories. This meant they did not receive person centred care. People’s daily records did not indicate any social interaction between staff and people. People’s dignity was not always respected. People were not protected by robust recruitment procedures that ensured only staff suitable to work with people needing help with their care were employed. One person had not received their medicines as prescribed. Staff did not receive appraisals and had not received training in the Mental Capacity Act 2005. Infection control procedures were poor and many parts of the environment were in need of attention and upgrading. For example, the lounge and dining area was poorly lit and some areas were in need of cleaning. Risks to people were not always well managed. Fire doors had needed attention and the carpet in the doorway to the lounge was badly frayed and presented a trip hazard. Following the inspection the registered manager sent us a detailed plan for addressing the environmental issues. The registered manager could not be assured people received correct pressure area care as records were incomplete. Improvements were also needed to complaints records. One person did not know how to make a complaint should they wish to do so. The lack of effective quality assurance systems had meant these issues had not been identified and addressed.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), although they had not received training in this area. Staff were trained and knowledgeable in how to support people’s personal care needs.

Although we found many areas that required improvement staff, visitors and people were happy with the standard of care being provided.

People’s personal care needs were met all personal care was provided in private. People and their relatives could be involved in making decisions about their care if they wished. People’s care plans contained details of how their personal care needs were to be met and were reviewed regularly. People we spoke with expressed satisfaction with the care they received at the service. We asked one person who had lived at the home for 10 years if they were happy with the care they received. They replied “yes thank you”. Another person was asked if they felt they received good care. They told us “Oh yes, yes we get on very well with them [staff].” They went on to say “they [staff] are very kind, marvellous, they are very kind to us.” Another person said “yes quite happy, I seem to have a lot of friends.”

People’s personal care needs were met by ensuring there were sufficient staff on duty. However, we saw that staffing levels had been reduced between 3pm and 9pm. The registered manager told us this was because the people living at the service had lower care needs than those that had lived there at our last inspection. They said they would increase staffing levels if numbers and the needs of people increased. People we spoke with told us they did not have to wait for their needs to be met. During the inspection we saw people did not have to wait for attention from staff.

People were protected from the risks of abuse. Staff knew how to recognise and report abuse. We asked people if they felt safe at the service. One person said “Oh yes definitely,” others said “oh yes very lucky really” and “yes I do feel safe.”

People were supported to maintain a healthy balanced diet and to maintain good health. We spoke with a visiting community nurse who told us that the home was very good at contacting them when required. They said staff always acted on any advice given and were confident people’s healthcare needs were being met.

We have made recommendations in relation to medicine management, staff support and training in the MCA, respecting people’s dignity and monitoring staffing levels.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

In May 2016 we received concerns in relation to low staffing levels. As a result we undertook a focused inspection on 29 June 2016 to look into those concerns. Two social care inspectors arrived at the service at 3pm and left at 9pm.The inspectors looked at the staffing levels in the home to determine if the service was safe This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosemount on our website at www.cqc.org.uk.

The service had 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

People’s health, safety and welfare were put at risk because there were not always sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times. During the day people had their care needs met in a timely way. However, after three pm the rota showed staffing levels reduced to two members of care staff, who were responsible for providing all care to the 15 people living at the home. Some people had dementia and could become agitated and some people needed two members of staff to support them with their personal care needs. These care staff also had responsibility for preparing, delivering and supporting one person to eat supper. They were also responsible for any other housekeeping jobs needed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was carried out by an adult social care inspector. During the inspection we looked at the evidence to answer the question:

Is the service safe?

Rosemount is a care home for up to twenty older people, many but not all of whom were living with dementia or mental health needs. On the inspection we spoke with three people who lived at the home about their experiences there. We also spoke with two members of staff and the provider, who is also the Registered Manager. We toured the accommodation and looked at records relating to the management of the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that improvements had been made to the safety of the service since our last inspection. We saw that the environment of the home had been improved for people, including covering of radiators and hot surfaces, improvements to the fire safety at the home, clearer risk assessments and improved cleanliness and odour control. We saw that substantial work had occurred and was still occurring on the premises to make them a more attractive and safe place to live in. This included both inside and outside of the building.

People told us they felt safe at the home. One person told us 'They look after me well. I am happy. If I wasn't I would talk with (deputy manager) and she would deal with it. I feel quite safe here and have all the things that I want from my home with me'.

We saw that the home had made appropriate arrangements to ensure people were safeguarded from abuse and abusive practices. A staff member we spoke with told us the provider 'was very approachable' and that they would have 'no worries about going to her or the deputy if I was worried about anything'. Staff had access to appropriate policies and procedures including whistleblowing to help raise concerns outside of the home's management if necessary.

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People all had an individual care plan which set out their care needs. We saw that the plans had been rewritten and information gathered together to make it easy to see current information on people. Risk assessments had been completed for the person and for their environment. We saw these had helped to reduce risks to people. For example we saw the home had fitted new radiator covers to protect people from coming into contact with hot surfaces.

We also saw that the provider had begun auditing falls and accidents to reduce the potential for harm and see if there was any pattern that could be used to reduce them happening.

Is the service effective?

We saw the changes the provider had made had led to improvements in people's care. We were told for example that the new care plans had been successful in that they had helped the staff identify trends and risks to people who lived at the home. This had resulted in them taking action to refer one person for specialist support.

We saw that staff knew people well and understood their needs and anxieties about their care. We saw this in the way the home's staff supported one person using a hoist.

Is the service caring?

We saw staff on the inspection supporting people kindly and well with good humour. We saw one person being supported and encouraged to eat successfully and independently. We saw another person being supported to eat by staff. This was done with good eye and verbal contact and at an appropriate pace. We saw another lady being taken out to go to the hairdressers, and pleasure being taken in her return.

We saw the new care plans had been written to take account of the individual and the life they had lived before moving into the home where this information was available. Plans had been written not just to reflect the skills people had lost but also those they had retained. This gave a positive focus and helped staff see the person as an individual.

Is the service responsive?

We saw that the home had responded well to the last inspection report and had made significant changes as a result. We saw that staff training for example had been increased and that the majority of staff had now undertaken both core training and training in specific areas as a response to changes in the needs of people who lived at the home. We saw that staff had received or were receiving training in care of people with diabetes or dementia which was reflected in the needs of the people who lived at the home.

Is the service well-led?

We saw that the provider of the home had made significant improvements since the last inspection. New systems had been put in place for care planning and risk assessment. There had also been substantial improvements to the building. New auditing systems were in place for example for accidents and incidents that would help to identify any trends or identify risks in future.

The provider had taken a robust stance on staff training to ensure the planned programme was completed including reasonable adjustments for staff where appropriate. Supervision and appraisal systems were working well. The provider had also identified where they needed additional support and had requested the district nursing team leader visit the home and discuss with them some of the assessments in the new care planning systems to ensure they were being completed correctly. This told us the provider was reflecting on their practice and developing positive strategies for improving the service.

In April 2013 we identified there had been improvements. However the home was still non-compliant with outcomes on supporting workers and we found new concerns over records management. Prior to this inspection we contacted the provider who told us that they felt they were now compliant and had completed the actions from their last inspection.

On this inspection we looked to see what improvements had been made. We found that some improvements had been made with staff support systems, but that we still had concerns over records management, training and the management of risks.

We saw that care workers had received supervision to ensure they worked consistently and to their full potential to support people. We saw a care worker supported one person to eat their lunch. We saw this was done at an appropriate pace for the person. The care worker told us that the person really enjoyed their food which made it so rewarding helping them to eat.

Following the inspection we referred some concerns to the fire authority and the local safeguarding team for their specialist investigation and action.

People who lived in the home had dementia and when we spoke with them they were not always able to tell us about their experiences. During our visit we observed good interactions between care workers and people who lived in the home. We spoke with care staff who were able to tell us how they met people's care needs.

People who lived in the home told us they felt safe and staff knew what to do to meet their needs. Staff knew how to report concerns to ensure people were protected from the risk of harm. We found staff had not completed some areas of training to keep them up to date with current best practice. Staff told us they felt well supported in their job role.

The home was developing its quality assurance system to assess and monitor the quality of the service. People told us 'I've got no concerns' and 'there's nothing to worry about'.

Records were not always maintained to evidence what was happening in the home. Care plans did not contain accurate information. The plans were not written in enough detail to ensure that care staff could follow the instructions.