Archived: Rogers House

Rogers House is a residential care home providing personal care to up to a maximum of 43 people. The service provides support to people who have care needs, such as, diabetes, epilepsy, Parkinson’s disease. Some people were living with dementia or had deteriorating mobility. At the time of our inspection there were 23 people using the service.

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

Although improvements had been made to the identification and mitigation of individual risk and to the safe management of people’s medicines, further improvement was ongoing to ensure people’s safety.

Although there were improvements to how people were supported to make decisions and choices, people were still not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although improvements had been made to the recording of peoples’ assessed needs, care plans were still a work in progress to capture people’s needs, and were not always reviewed and updated to reflect changes.

The provider’s governance systems were still a work in progress. Monitoring systems introduced since the last inspection were not always kept up to date to make sure people received safe and good quality care.

People were now kept safer by staff who knew their responsibilities to safeguard them and who felt more confident to raise concerns. Staffing levels had improved, and safer staff recruitment practices were now in place. The levels of agency staff had reduced and the agency staff supporting people now were regular agency staff who were treated as part of the team. The management of fire safety had improved, people’s evacuation plans were kept up to date and staff had completed fire evacuation drills.

Staff uptake of training updates had improved, and they felt better supported. People received better care with their health needs and the advice of healthcare staff was now followed. People were happy with the food provided and their meals and told us they could choose other options if they wished.

Staff said the culture had changed and they felt positive that there would be further improvements, Staff said they felt listened to and were more able to speak up if they needed to. Staff had only positive things to say about the manager and were happy with the changes being made. The provider had engaged with people, relatives and staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 16 December 2022) and there were breaches of regulation. We took urgent enforcement action against the provider. The provider also completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of some regulations, however improvements had been made.

This service has been in Special Measures since 8 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 inadequate to requires improvement. This is based on the findings at this inspection.

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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rogers House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the assessment of risk and medicines management, mental capacity, record keeping and governance 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rogers House is a residential care home providing accommodation and personal care for to up to 43 people. The service provides support to older people, some of who were living with dementia. At the time of our inspection there were 41 people using the service.

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

Although people we spoke with told us they were happy, we found people were not safe living at Rogers House. Risks had not been identified and mitigated by staff and as a result people had been placed at risk. There was a lack of comprehensive guidance in place to inform staff how best to support people with their health needs including wound care, diabetes, supporting them when transferring and the risk of falls. There was no effective system to learn from accidents and incidents and no system in place to reduce the risk of the incident reoccurring. Incidents of potential abuse had been identified by staff, but not reported or investigated sufficiently.

Medicines management was poor and ineffective. Audits had not been completed and therefore issues with medicines administration had not been identified. These included medicines not being counted to ensure people had received their medicines and ensuring the relevant guidance was in place for staff.

There were not sufficient numbers of staff to meet people’s needs and keep them safe. We observed people waiting for support to use the toilet, and there was a high volume of unwitnessed falls. Staff had not been recruited using safe recruitment processes, and staff had not received the training, and competency checks to complete their roles.

People’s needs had not been consistently assessed when they were living at Rogers house. When people’s needs changed, risk assessments and care plans were not reviewed and there was not an effective system in place to share information with staff. For example, when staff were told to check on a person every 30 minutes by healthcare professionals due to the risk of falls, they were not always doing this. People were not always referred to the relevant healthcare professionals for support.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had made decisions for people and had not always included them in the decision-making process. For example, where people ate their breakfast and having access to personal belongings. Dementia friendly equipment did not work, and in the main area people liked to relax in, the television was broken and therefore people could not watch it.

The culture of the service was not empowering to focus on the needs of people. Staff meeting minutes showed staff did not always speak about people in a positive way. We received mixed feedback from healthcare professionals regarding the implementation of advice and directions for staff.

There was a lack of effective leadership and oversight. Checks and audits were poor and did not identify significant risks highlighted within our inspection. Statutory notifications had not always been submitted.

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 18 August 2017).

Why we inspected

We received concerns in relation to staffing and wound care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led key questions. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rogers House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, staff deployment, staff recruitment, abuse, training, mental capacity, person centred care, and effective checks and audits at this inspection.

Following the inspection, we took immediate action to impose conditions on the provider’s registration in relation to risk management, staffing and oversight.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care 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.

Abbeyfield – Rogers House is a care home providing accommodation and personal care for up to 41 older people. Abbeyfield – Rogers House also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 38 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection in October 2016, we asked the provider to take action to make improvements in care planning, the management of medicines, quality assurance processes and recruitment procedures. The breaches of Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 19 Fit and proper persons employed were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan in December 2016 which stated that they would comply with all Health and Social Care Act 2008(Regulated Activities) Regulations 2014 by February 2017.

At this inspection on 14 and 15 June 2017, improvements had been made in all areas but there remained some concerns around people’s safety. We made a recommendation with regards to reviewing current equipment checks and cleaning practices to ensure people's safety.

Staff received training in how to give medicines safely and their competency was checked. However, staff did not always accurately record when people had been given their medicines.

Assessments of individual risks to people’s safety and welfare had been carried out. However, cleaning trolleys were left unattended which posed the risk of people living with dementia who may mistake cleaning fluid for a harmless drink.

Accidents and incidents were recorded and the appropriate action taken to reduce the likelihood of them happening again.

Staff knew how to follow the service’s safeguarding policy in order to help people keep safe. Checks were carried out on all staff to ensure that they were fit and suitable for their role.

Staffing levels ensured that staff were available to meet people’s needs.

Regular checks were made of the environment, services and equipment to make sure they were in good working order.

The service was clean and staff knew what action to take to minimise the spread of any infection.

People had their health needs assessed and monitored. They were offered a choice at mealtimes and support was provided in an individual manner when people needed it.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications for everyone to ensure that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members. The service had received a number of compliments about the caring nature of the staff team.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important to them. We received positive feedback on how staff supported people at the end of their lives, but their specific wishes and choices at this time had not be recorded to ensure they were acted on.

People were offered a range of activities on a daily basis. Special events were celebrated which involved people, their family members, friends and staff.

There were systems in place to monitor the quality of the service, which included gaining the views of people and their relatives. People felt confident to raise a concern or complaint.

Abbeyfield – Rogers House is a care home providing accommodation and personal care for up to 41 older people. Abbeyfield – Rogers House also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 39 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

At our previous inspection on 28 October 2015 and 02 November 2015 we found breaches of Regulation 12, Regulation 13, Regulation 15, Regulation 17, Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We asked the provider to take action to meet the regulations.

The provider sent us an action plan in February 2016 which stated that they would comply with the regulations. They told us that they had already met four of the regulations and the final date to meet one of the regulations was 01 May 2016.

At this inspection we found there had been some improvements to the service. However there were still issues in a number of areas and some new breaches of Regulations. People and their relatives were positive about the service they received. People told us they felt safe and well looked after.

The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in employment history had not been explored to check staff suitability for their role.

Medicines had not always been administered as they should be. Staff administering tablets and creams had been trained to do so and did this in a safe way. However staff had been administering Insulin injections which they had not been trained to do. Medicines records were not always complete and accurate. Records relating to topical creams and some pain relief were not always completed to evidence people had received their medicines as prescribed.

Staff had been given training in essential areas. Staff had not always been given training relating to people’s individual health needs. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had submitted Deprivation of Liberty Safeguards (DoLS) applications for some people, but had failed to reapply for these in a timely manner when these had expired and had failed to meet conditions within these. We made a recommendation about this.

Action taken when people had lost significant amounts of weight was not always timely. One person’s had low sodium levels, information in their care file detailed that they required additional salt to be added to their diet. This had not been communicated to the kitchen staff which meant this person was at risk of receiving meals that did not meet their assessed needs.

People’s care plans detailed what staff needed to do for a person. The care plans did not always include information about their life history and were not person centred. Some care plans had not been updated in a timely manner when people’s needs had changed.

Records relating to care and support provided were not accurate and complete. Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not always picked up the concerns about staff recruitment records, medicines administration, fire safety, dependency assessments, DoLS applications, person centred care and records and action to address issues identified in audits was not always timely.

There were suitable numbers of staff on shift to meet people’s needs. The provider had a dependency tool in place to check that staffing levels were appropriate to meet people’s needs. However, some people’s dependency levels had not been reassessed and checked regularly. We made a recommendation about this.

The home was clean and smelt fresh. Appropriate checks had been carried out on equipment. Fire drills had not taken place regularly. Some staff did not know what to do in the event of a fire. We made a recommendation about this.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity. Actions taken after accidents and incidents did not always follow the provider’s policy. Post falls assessments had not taken place. We made a recommendation about this.

The registered manager sent us an action plan on 19 October 2016 to detail how they planned to address the issues we had found during this inspection.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

Improvements had been made to the environment which meant the ground floor of the home met the needs of people living with dementia, further improvements to the decoration of the upper floors were planned to ensure the environment meets everyone’s needs.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People were given information about how to complain and how to make compliments. Complaints had been dealt with appropriately. People’s views and experiences were sought through review meetings and through surveys.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Staff had received regular support and supervision from their line manager.

We found 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.

We found that the home had a relaxed and comfortable atmosphere, and people said they were happy living in the home. People's comments included: 'It is faultless here, everything is brilliant and I have a beautiful bedroom'; 'It is A1 here, it is excellent'; and 'I am very happy with everything, and the staff are brilliant.'

We saw that people were provided with plenty of activities for those who wished to take part in them.

The care plans showed that people's health needs were being met.

People said that the food was 'Very good', and we saw that there was a good variety to provide people with a nutritious diet.

The home had suitable procedures in place for the safe administration of medicines.

We found that the service had robust staff recruitment and induction procedures.

The home took account of people's views and used these towards ongoing improvements.

People felt able to raise any concerns or complaints without the fear of being victimised.

One person said 'I am very happy here, its really lovely, the staff are good and they're always willing to have a chat with you'.

A relative of a person that used the service told us 'They will do anthing for my mum, it is an excellent home, I can't fault them'. They also said 'I'm very happy with the home and I have recommended the home to other people'.

A healthcare professional we spoke with told us 'I think this is a lovely care home and the carers really care which is really important'.