Abbey Grange

Updated 26 March 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Rockley Dene Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not available on the day of the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, including Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We spoke with two deputy managers, an agency nurse, an agency care assistant, an admin worker, the maintenance worker and the laundry assistant.

We reviewed a range of records. This included three people’s care records in full and six others in part as well as multiple medication records. We looked at a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke and met with external stakeholders and other regulatory bodies.

Updated 26 March 2022

About the service

Rockley Dene Nursing Home is a residential care home providing personal and nursing care for up to 34 people in one adapted building over two floors. Seventeen people were living at the home at the time of inspection.

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

We found systems and processes used to ensure the service was running safely were not effective. We observed a lack of leadership, direction and oversight.

People’s safety and welfare was compromised and there was a lack of understanding of the risks and issues and the impact on people using the service. Quality assurance systems were ineffective and unreliable in identifying shortfalls, and where improvement was needed.

We identified significant shortfalls with how the provider and management team were responding to the COVID-19 pandemic. People's health and safety was at risk due to shortcomings in infection prevention and control. The building was not hygienic. This put people at risk of infection.

Risks associated with people's behaviours were not managed safely. Risks had not always been assessed and there was a lack of guidance about how to manage some people's behaviours. Incidents and accidents were not effectively reviewed to ensure lessons were learnt to drive improvements.

Staff were not always deployed effectively to ensure people's needs were met and the staffing levels meant people did not always receive a dignified service. Systems in place to safeguard people from abuse were not effectively implemented. Following the inspection we shared our concerns with the local authority.

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 requires improvement (published 26 August 2021) and there was three breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The overall rating of the service has changed from requires improvement to inadequate based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about areas of concern such as infection control and staffing. A decision was made for us to inspect and examine those risks.

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 the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to fire safety, infection control, risk, environment, staffing, staff training, dignity and respect, personalisation, leadership, management and governance.

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

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 continue to monitor information we receive about the service. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

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.