Archived: Rose Brae Nursing and Residential Home

This was an unannounced inspection carried out on 10 and 11 September 2015. Rosebrae Nursing and Residential Home provides accommodation with nursing and personal care for up to 30 older adults.

The home is a converted three storey mature house situated in the residential area of Spital, Bebington. It is within walking distance of local shops and public transport. Accommodation consists of 29 single bedrooms and one shared bedroom. A passenger lift enables access to all floors for people with mobility problems. On the ground floor, there is a communal lounge/ dining room for people to use.

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.’

People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives and friends also told us they felt people were safe. During our visit, however we identified concerns with the safety and quality of the service.

We found breaches in relation to Regulations 9, 10, 11, 12, 13, 15, 16, 17 and 18 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.

The provider had a safeguarding policy in place and staff we spoke with were knowledge about types of abuse and the action to take if an allegation of abuse was made. The manager had no records relating to any potential safeguarding incidents at the home. We saw that two complaints of a safeguarding nature had been made which the manager had responded to as a complaint. We found evidence of one safeguarding incident during our visit that had not been appropriately identified as safeguarding by the staff team. The manager told us they were unaware the incident had occurred. We saw that there were gaps in the training of some staff members in safeguarding. This meant there was risk staff would not know what to do in the event of an allegation of abuse being made.

People’s feedback on whether the number of staff on duty was sufficient was mixed. The manager had no formal mechanism for determining whether staffing levels were sufficient to meet people’s needs. We found that that the deployment of staff required improvement.

Staff recruitment records were poor. Criminal conviction checks had been undertaken but staff references in the majority were not verified to ensure staff had the necessary skills and experience to do the job role prior to employment. There was also insufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. This meant there was a risk that staff lacked the required skills and knowledge to care for people safely.

Parts of the premises were unsafe and not consistently well maintained. Parts of the home had been refurbished and the manager told us communal areas where due to be redecorated in the coming weeks. External contractors were employed to inspect and maintain the home’s electrical and gas systems and equipment in use at the home. For example, moving and handling equipment and fire extinguishers. We found however that some bedrooms had trailing electrical wires which posed a trip hazard, unsafe windows and a lack of hot water. The home had a pleasant garden but it was not secure enabling unauthorised entry and exit.

Infection control standards at the home required improvement and standards were not monitored and managed. The home’s infection control standards had been rated as requiring improvement by a recent NHS infection control audit. There was little evidence that appropriate processes and systems had been put in place to maintain infection control standards following this visit. This placed people at risk from infection.

Medicines were not always stored safely or dispensed to people who were self- administering safely. This placed people at risk of harm. Oxygen storage was unsafe and medicines received by the home were not always properly accounted for. This meant the management of medications was unsafe.

We reviewed nine care records. Care plans did not accurately reflect people’s needs and wishes and were not person centred. Dementia care planning was poor and support for people’s behavioural and emotional needs inadequate. The majority of risk assessments were poor and failed to provide staff with any guidance on how to manage people’s risk and care for them safely. This placed people at risk of harm.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. People’s capacity to make their own specific decisions had not been assessed and there was no evidence that any best interest meetings had taken place or least restrictive options explored for any decisions about their care. This included decisions to deprive people of their liberty. There was no evidence that staff were trained to support people with these needs.

People we spoke with said they had no complaints. Two people we spoke with told us they had previously raised concerns with the manager and that they had been responded to, to their satisfaction. We reviewed the manager’s complaints policy and records. We found a number of concerns with complaints management at the home.

People said they were happy with their care and everyone we spoke with gave positive feedback about the staff. We observed that staff were patient with people and supported them at their own pace when they needed support. We found however that staff were not always observant to people’s general care, welfare and dignity needs for example, one person initiated a conversation with a staff member but was not responded to, one person was asked a question by a member of staff but was not listened to and one person requested assistance but did not receive the assistance they required. Two people shared a room but there was little evidence that care was delivered in a way that promoted their dignity at all times.

The service was not well led. There were no adequate systems in place to ensure the service was safe, effective, caring, responsive and well led. There were no effective infection control audits, care plan audits or adequate accident and incident monitoring in place to ensure people were safe and well cared for. There was limited evidence that some of the provider’s policies and procedures were followed and some policies in relation to legislative requirements were not in place. For example, a mental capacity policy. At the end of our visit, we discussed the concerns we had about the service with the manager. They were unable to provide a satisfactory explanation as to why the issues we identified during our inspection had not been picked up and addressed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.