Archived: Rosewell

Updated 20 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 1 March 2016 and was unannounced. The inspection was undertaken by three inspectors.

We reviewed the information that we had about the service including statutory notifications. Notifications are information about specific important events the service is legally required to send to us.

We spoke with eight people that used the service, four relatives and thirteen members of staff. We also spoke with the business support manager, a consultant and the regional manager. We also spoke with two health professionals who were visiting the service on their weekly round.

We reviewed the care plans and associated records of seven people who used the service. We also reviewed documents in relation to the quality and safety of the service, staff recruitment, training and supervision.

Updated 20 April 2016

This inspection took place on 1 March 2016 and was unannounced. The last full inspection took place on 20 July 2015 and, at that time, five breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to staffing, premises and equipment, meeting nutritional and hydration needs, safe care and treatment and good governance. These breaches were followed up as part of our inspection.

Rosewell is registered to provide personal care and nursing care for up to 96 people. Three areas of the home named Rose, Sunflower and Bluebell accommodated people with personal care and nursing needs. The Farmhouse area accommodated people with personal care needs only. At the time of our inspection there were 57 people living in the service.

There has been no registered manager in place for over a year. 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. The business support manager has been in post for approximately six months. They told us that they would submit their registered manager’s application form.

In July 2015 people were not cared for in a safe, clean and hygienic environment. At this inspection the provider had not made sufficient improvements.

In July 2015 we found systems were not being operated effectively to assess and monitor the quality and safety of the service provided. At this inspection the provider had not made sufficient improvements.

Medicines were not consistently managed safely. We found two medication errors during the inspection and neither of these had been reported by the nursing staff and neither had been identified through the provider’s own audits and checks that were being undertaken.

In some areas of the building the premises were not suitable for the purpose for which they were meant to be used. Some bathrooms were not fully operational and there was a lack of adequate storage facilities throughout the service.

Care plans were person centred and provided details on people’s preferences, but there was not always enough detail provided for staff on how to promote people’s choices.

People’s nutrition and hydration needs were not met. People’s food and fluid intake was not managed effectively because food and fluid charts were not being monitored.

In July 2015 the lunchtime service was not organised which resulted in food not being consistently served at an appropriate temperature. At this inspection we found inconsistencies at the lunch time service and this required further development.

In July 2015 staff were not consistently supported through an effective training and supervision programme. At this inspection the provider had made sufficient improvements.

In July 2015 we found staffing levels were not sufficient to support people. At this inspection the provider had made sufficient improvements.

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. Care documentation demonstrated consideration of the Mental Capacity Act. The provider in some cases adopted a blanket approach to the mental capacity assessments. Some assessments of capacity were not decision specific.

The current Deprivation of Liberty Safeguards (DoLS) arrangements showed that the service followed a procedure to ensure they had an appropriate agreement to restrict people's rights.

Records showed a range of checks had been carried out on staff to determine their suitability for the work. For example, references had been obtained and information received from the Disclosure and Barring Service (DBS).

Staff we spoke with demonstrated a good understanding of how to recognise and report abuse. All staff gave good examples of what they needed to report and how they would report concerns.

People were treated with kindness and compassion. Staff knew people well, understood their support needs and were familiar with people’s personal preferences.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found four 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.