Rose Cottage Nursing Home

Rose Cottage is a residential care home providing accommodation for persons who require nursing and personal care for to up to 21 people. The care home accommodates 21 people in one adapted building. At the time of our inspection there were 18 people using the service.

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

People were not always protected from the risk of harm. Records did not always evidence action taken to keep people safe. Staff were not always provided with detailed guidance to follow when supporting people with complex needs.

Medicines were not always managed safely. The provider had an auditing system which included auditing medicines; however, shortfalls found during inspection were not always picked up by these audits.

Staff we spoke with understood their responsibilities to report concerns. There were enough staff to meet people's needs. Staff told us they felt they had the skills, time and support they needed to meet people's needs.

When incidents or accidents occurred, it was not always clear these were investigated, and if lessons were learnt. There were systems in place to monitor the safety and quality of the service. However, these monitoring systems were not always effective in identifying quality concerns and had not identified the concerns we found at this inspection.

People and their families gave positive feedback about being involved in the planning of their care and the care they received from staff at Rose Cottage Nursing Home.

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; however we saw that documentation around best interest decision was not always completed in full as it did not involve professionals in decision making. We were assured by the provider that this would be implemented immediately.

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 good (23 January 2019).

At our last inspection we recommended that the service seeks guidance from a reputable source in relation to effective quality assurances systems to identify and manage potential risks to people. At this inspection we found that although regular audits were being carried out, these were not always effective at driving improvement or identifying concerns found on inspection.

Why we inspected

The inspection was prompted as we received concerns in relation to people’s safety, nursing care needs, management of the service and staff competency. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led relevant sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

• Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow device test result, proof of vaccination against COVID-19, temperature checks, hand sanitisation and wearing personal protective equipment (PPE).

•The home was clean, tidy and smelled fresh. Rigorous cleaning schedules ensured the home was maintained to a safe and hygienic standard.

•The provider participated in the Covid-19 regular testing programme for both people and staff.

• There was a comprehensive contingency plan of what to do in case of an outbreak. The management team completed risk assessments to assess and mitigate risks in relation to COVID-19.

•We were assured the service were following safe infection prevention and control procedures to keep people safe.

People’s experience of using this service:

• At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good. However, we have made a recommendation about the effectiveness of the quality assurance systems being used to monitor the quality of care being delivered. This was because the quality auditing tools being used to monitor the service had not always been effective in identifying potential risks to people. This had no impact on people as they were supported by an established staff team who knew people well and how they should be supported.

• Feedback from people and their relatives about the care people received was positive. They complimented the caring nature of staff and felt that the service was well-led.

• People praised the approach of staff and stated that they felt their relatives were safe living at Rose Cottage Nursing Home.

• People’s needs had been assessed and their support requirements were recorded in detail to provide staff with the guidance they needed to support people.

• People were supported to have maximum choice and control of their lives.

• Effective systems were in place to manage people’s medicines so that they received them safely and on time.

• People were supported to access health care services and to maintain a healthy lifestyle.

• Sufficient numbers of staff were available to ensure people’s safety and well-being. New staff were suitably vetted and trained before they supported people.

• Staff had a good understanding of people’s needs and had been trained to carry out their role. They understood their responsibility to report concerns and poor practices.

• The registered manager worked alongside staff which enabled them to have a good understanding of people’s current needs.

The service met the characteristics of Good in four of the five key questions and an overall rating of Good. More information is in ‘Detailed Findings’ below.

Rating at last inspection: Good (Last report was published on 24 June 2016).

Why we inspected: This was a planned inspection based on the previous rating at the last inspection.

Follow up: The rating of this inspection and the information and intelligence that we receive about the service will determine the timeframe of our next inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 felt safe living at Rose Cottage. People’s individual risks were assessed and management plans how to reduce these risks were in place. People received their medicines safely and as prescribed. Appropriate records were kept when medicines were administered to people. There were enough staff on duty to meet people’s needs. Staff were clear about their responsibilities to identify abuse and to report any concerns to protect people who lived at the service.

Staff received regular training appropriate to their roles. Staff told us they felt valued and well supported by the management and their colleagues. The registered manager followed safe recruitment processes.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. DoLS provides legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.

People were provided with a choice of food and drink that met their nutritional needs. People told us they were happy with the food and confirmed they were able to choose what they wanted to eat. People were supported to meet their health care needs. This included proactive referrals to various specialist services and professionals to source further advice if required.

Staff supported people in a caring and friendly manner. People were happy with how care was provided. They made positive comments about the staff and the support received. People had access to an in-house activities programme. People told us they enjoyed the activities but could choose not to participate if they preferred.

People’s needs were assessed prior to admission to ensure their needs could be met by the service. Care records were detailed and contained details of people’s personal histories, health issues, their likes, dislikes and preferences. Care plans and risk assessments had been reviewed on a regular basis to ensure the planned care was working, or if changes needed to be made.

People we spoke with said they had no complaints, but would feel comfortable speaking to staff if needed. We saw that when concerns had been raised these had been logged, investigated and resolved promptly .The registered manager sought people’s opinions through a yearly satisfaction survey and regular meetings.

The registered manager conducted regular audits to monitor the quality of service. There was an open and transparent culture and staff spoke positively about the management and the team. Accidents and incidents were recorded, investigated and the records confirmed appropriate action was taken when people had been involved in an accident or incident.

Staff showed that they were aware of the needs of the people in their care and the level of support that each person required. People and their relatives made positive comments about the dedication and quality of care provided by staff. One person said, 'The quality of nursing is very good. When I first came here I only weighed four stones and now I'm back up to nine. They look after me so well.' A relative told us, 'I can't praise the staff enough. Mum had been in hospital for nine weeks and had gone down hill fast. We feared the worst but they have coaxed and nursed her back to health. It's amazing.'

The home effectively managed medicines and ensured that people received them at the times they needed them in a safe and dignified way.

The provider had effective recruitment and selection procedures. This meant that people were safe and their health and welfare needs were met by staff who were fit, appropriately qualified and able to do their job.

The home had an effective complaints procedure which demonstrated a commitment to recording, investigating and resolving complaints to the satisfaction of the person who used the service.