Archived: Rosemary Care Home

Rosemary Care Home is a residential care home providing personal and nursing care for up to 24 older people. At the time of the inspection, the service was supporting 22 people across three floors. The upper floor was dedicated to accommodation while the other two floors housed accommodation, lounges and dining areas.

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

Medicines were not always safely managed in accordance with best practice. Risks associated with the building were not always managed safely. The service was in breach of regulation regarding Safe Care and Treatment.

Quality assurances processes had not been effective in identifying and rectifying concerns found during this inspection. We made a recommendation regarding this.

Systems and processes were in place to safeguard people from the risk of abuse. Individual risks to people were assessed. There were enough staff to meet people's care needs. Arrangements were in place to keep premises clean and hygienic to protect people from the risk of infections. Additional measures had been introduced to reduce risk associated with COVID-19 (Coronavirus). However, areas of the building and the grounds needed refurbishment and some furniture needed replacing.

Notifications to the Care Quality Commission (CQC) had been submitted as required. The service had a positive learning culture where people were supported to reflect on performance and improve practice. The provider regularly engaged people using the service, their relatives and staff through meetings and informal discussions. People said communication with the registered manager was good.

People were given a good choice of nutritious food and drinks in accordance with their needs and preferences. Their healthcare needs were met through effective working with a range of healthcare professionals. The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). 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.

Staff treated people with kindness, compassion and respect. People’s faith and cultural needs were recorded and understood by staff. People were encouraged to be as independent as possible. Staff understood the need to protect people’s privacy and dignity when providing care.

Care records were personalised for each individual. Care plans were reviewed regularly to ensure they remained accurate and reflected people’s needs. Staff adapted the way in which they communicated with people to engage them and to ensure important information was shared. People were supported to engage in a range of activities and to maintain important relationships. However, recent changes in personnel meant activities hadn’t always taken place as planned. People’s end of life wishes were considered as part of the assessment and care planning process.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

The provider has acted to reduce the risk posed by the issues we identified during this inspection.

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 (published 24 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the management of medicines and the safety of the environment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Rating at last inspection:

At the last inspection, in April 2016, the service was rated Good. At this inspection, we found the service remained Good.

Why the service is rated Good:

People continued to have their health needs met. People had access to a range of healthcare professionals, when required. Changes in people's health and wellbeing were responded to.

People, relatives and staff continued to be positive about the registered manager and the running of the home. Staff felt motivated and valued in their roles.

People continued to enjoy positive and respectful relationships with staff. People's independence was promoted, as much as possible. People's privacy was respected.

People were able to express their views and make suggestions, and these were acted on. Complaints were investigated, responded to and used to improve practice.

There were enough staff on duty to meet people's needs. People received their medicines safely.

Further information is in the detailed findings below.

This was an unannounced inspection carried out on the 21 and 28 April 2015. At the time of our inspection there were 20 people living at the service.

The home had a manager who 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.

We had previously inspected the home in March 2015. We found the provider was in breach of four regulations in relation to good governance, staffing, recruitment and systems to safeguard people. The provider sent us an action plan, which showed what action they had taken.

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

The management and administration of people’s medicines was not safe and did not ensure people received their medicines as prescribed.

Potential risks to people’s health and wellbeing had not always been assessed to help protect them from harm or injury.

We have made a recommendation that the provider considers a formal process for identifying and deploying appropriate staffing levels to meet the individual needs of people.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

Staff were able to demonstrate their knowledge and understanding about the safeguarding procedures and what action they would need to take to keep people safe. We were aware of issues which had been reported to the local authority. The registered manager was working in cooperation with the local authority to address any issues.

People and their visitors were complimentary about the staff and the care and support offered to their family member. Staff were seen to be polite and respectful towards people, offering assistance when needed.

Opportunities for staff training and development were provided. Staff spoken with confirmed they had completed some training and felt supported by the manager.

People told us they felt safe and received the care they needed. During our inspection we observed staff to be kind and caring towards people and responded to people’s requests.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Relevant information and checks were completed when recruiting new staff. This helps to protect people who use the service by ensuring that the people they employ are fit to do their job.

A programme of redecoration and refurbishment was taking place to enhance the standard of accommodation and facilities provided for people. Hygiene standards were maintained to help minimise the risks of cross infection and checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe.

Suitable arrangements were in place to ensure hygiene standards were maintained. The premises and equipment were adequately maintained so that people were kept safe.

Care files contained sufficient information to guide staff in the delivery of people’s care. Information about people was easily accessible to staff and held securely so that confidentiality was maintained.

Opportunities for people to participate in activities in and outside the home were being provided. The registered manager was exploring other opportunities to enhance this further to promote people’s well-being and independence.

Suitable arrangements were in place for reporting and responding to any complaints or concerns. People felt they would be listened to.

Due to unforeseen circumstances the manager was not available to assist with the inspection. Therefore, confirmation of an updated fire risk assessment and gas safety certificate could not be provided.

We found that adequate systems were in place with regards to the safe administration of medication. However we found that not all staff responsible for medicines understood their responsibilities in the safe storage of items so that people were not placed at risk.

We saw that information about the individual needs and wishes of people had been clearly detailed in the new care plans. Information provided staff with details of people's routines, preferences, likes and dislikes, as well as how they wished to be cared for. Plans had sufficient information to guide staff in the delivery of people's care and support.

Care records did not provide detailed information about the individual needs and wishes of people, to clearly direct staff in the safe delivery of people's care and support.

Suitable arrangements were in place to ensure people's nutritional needs were met.

Improvements were needed in relation to the safe storage and administration of medication so that people were not place at risk of harm.

Work to improve the standard of accommodation had been identified and planned for. This will ensure that people are provided with a good standard of accommodation in which to live.

Relevant checks had been carried out to show that new staff had been safely recruited. Some records were not completed in full detailing when and by whom decisions were made about their suitability.

Arrangements for on-going staff training and development were in place so that staff had the knowledge and skills needed to meet the varying needs of people living at the home.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service.