Rosevilla Residential Home

Rosevilla Residential Home provides accommodation and personal care to older people, including people living with dementia. At the time of our inspection, there were 40 people living in the home.

People's experience of using the service and what we found

Governance systems failed to identify issues and drive necessary improvements to the quality and safety of the service. Issues we identified during the inspection had occurred partly due to a lack of understanding around the requirement for some actions and records that needed to be implemented in order to keep people safe.

People's prescribed medicines were not always managed safely. Risks associated with fluid thickening powder had not been considered and acted upon to ensure people were kept safe. Records required to show where and how topical medications such as creams and pain patches should be applied were not in place to evidence staff were following prescriber guidance. Advice had not been sought from a pharmacist to ensure that covert medicines (hidden in food or drink) were being given in a safe way. Staff had failed to follow prescriber guidance when administering medicines required to be taken separately to other prescribed medicines.

Risks to people's health safety and wellbeing had not always been assessed or documented in people's care plans to help staff support people safely. Risks associated with taking blood thinner medication and falls had not been considered as part of the care planning process. Staff did not have access to guidance around how to identify and respond to people who may experience low or high blood glucose levels.

Accidents and incidents were not subject to review or analysis to help identify patterns and trends. This meant there were missed opportunities to implement necessary changes to help prevent incidents occurring in the future. There were not always enough staff deployed across the service to support people safely.

Safeguarding concerns were recorded and acted upon appropriately. However, we could not always be certain they were reported to relevant agencies, including CQC, in a timely manner. We have made a recommendation regarding this.

Assessments were completed to determine people’s capacity to make specific decisions. However, there was no evidence to show that best interests processes were being followed in line with the principles of the MCA. We have made a recommendation regarding this.

Whilst people were supported to have maximum choice and control of their lives and supported by staff in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation regarding capacity assessments and best interests processes.

The layout of the building was suitable to meet the needs of people who needed mobility equipment. However, we identified some issues regarding the atmosphere and the impact this could have on people living with dementia and those with increased anxiety and distress. We have made a recommendation regarding this.

Whilst people's needs had been assessed, we could not be certain care was being delivered in line with best practice. This was due to a lack of detailed and person-centred information in people's care plans and some monitoring charts not providing evidence that people had received their meals in line with their assessed needs.

People and family members spoke positively about the care provided by staff and told us staff were kind and caring and knew people well. Observations completed during the inspection further evidenced this.

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 8 January 2022).

Why we inspected

We received concerns in relation to risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection activity, we identified further concerns relating to MCA. As a result we included the key question of effective.

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 sections of this report

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 Rosevilla Residential Home on our website at www.cqc.org.uk

Enforcement and recommendations

We have identified breaches in relation to medicines management, risk management, staffing and governance at this inspection.

We have made recommendations in relation to safeguarding incidents, MCA and the environment.

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.

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.

Rosevilla Residential Home is a 'care home' providing accommodation for persons who require nursing or personal care for up to 43 older people; some of whom lived with dementia. At the time of the inspection 41 people were living at the home.

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

People were not fully protected from the spread of infection and COVID testing was not managed in line with government guidelines. The provider acted immediately to make improvements. We have made a recommendation about the management of infection prevention and control measures.

People told us they were happy with the care they received and said they felt safe living at the home. One person said, "Its great here and we have fun." People living at the home were comfortable with staff. Staff were attentive and caring with people and supporting them when they became distressed.

People were protected from abuse because staff understood what was meant by abuse and the correct procedures to follow if they had any concerns about people’s safety. People received their medicines as they preferred and prescribed. Staff were knowledgeable about people's health needs and the provider had sought advise from other health professionals as appropriate to support people's needs.

People were kept safe. Risks were well managed, and the provider learned from previous accidents and incidents to reduce future risks. Risks, such as falls, were fully assessed, monitored and reviewed. Key information in people’s care records about the management of risk was accurate with daily notes completed and accurate.

Staffing levels were appropriate to match the needs of people at the home. The home used very low numbers of agency staff. The provider assured us that they were continuously working to recruit more permanent staff. Staff received training and support to enable them to effectively meet the needs of the people they supported.

Rating at last inspection

The last rating for this service was good (published 10 October 2017).

Why we inspected

We carried out an unannounced focused inspection of this service on 16 December 2021 following a number of concerns relating to infection prevention and control measures and intelligence gathered through various sources and our system. This report only covers our findings in relation to the Key Questions of Safe and Well-led.

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.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the caring, effective and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosevilla Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The service accessed COVID-19 testing in accordance with the relevant guidance.

Managers worked effectively with other staff to ensure they followed correct infection prevention and control (IPC) procedures and were provided with current IPC guidance. Staff completed IPC training.

Well stocked and clearly signed personal protective equipment (PPE) stations were located around the service. Staff were observed using correct PPE equipment when carrying out their duties. Staff were observed social distancing whilst supporting people.

People were supported with their wellbeing through regular one-to-one contact with staff and support to contact family and friends. The provider had recently purchased a large interactive television with an additional camera to help support family to exchange messages and videos whenever they wished to.

Further information is in the detailed findings below.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the home.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support or, where appropriate, their relatives were involved in decisions and consented to their care.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

People received adequate nutrition and hydration. Their nutritional needs were assessed and appropriate diets were provided, such as diabetic diets and mashable diets.

We found people had access to healthcare professionals and their healthcare needs were met.

People were encouraged to participate in a range of activities that had been organised.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff and resident/relatives surveys to seek the views of people about the quality of care being provided.

The home provides personal care, support and accommodation for up to 35 older people who may also have dementia. Accommodation is provided on two floors, with lounges and dining rooms available on the ground floor. A passenger lift and stairs provide access to upstairs. At the time of the inspection there were 25 people residing in the home and another resident was in hospital.

There was a registered manager in post. 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 this inspection we identified one breach of the relevant regulations in respect of the secure storage and recording of controlled drugs . You can see what action we told the provider to take at the back of the full version of the report.

We found that whilst the administration, storage and disposal of other medications were safe, the provider did not have the correct systems in place for the storage and recording of controlled drugs. This meant that they were not stored securely and there wasn’t a clear audit trail for all controlled drugs received into the home. However, this had no impact on the people who used the service. This had had no impact on the people who used the service, but posed a risk that errors could be made because controlled drugs couldn’t properly be accounted for.

The experiences of people who lived at the home were positive.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People’s needs were assessed and plans were developed to identify what care and support people required to maintain their health and wellbeing and foster their independence where possible.

People were protected from abuse. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed.

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People’s health care needs were met and their medicines were administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Staff received suitable induction and training to meet the needs of people living at the home. Staff were well supported by the manager. This meant people were being cared for by suitably qualified, supported and trained staff.

There were systems and processes in place to monitor the quality of the service. Audits were carried out and where shortfalls were identified the management were using the information to improve the service. This demonstrated that it was a learning organisation.

During this inspection we spoke with six people, including those with dementia, three relative's and three staff members including senior managers of the service. Comment cards were received from three people who offered their opinions about the service.

As part of this thematic inspection we also looked at how the service managed record keeping. We reviewed this outcome because we issued a compliance action at our last inspection due to concerns around record keeping at the service. We found that the provider had a detailed action plan in place to improve the standard of recording and that records were very person centred to the needs of people living at the service.

We saw that people with dementia were treated with care and compassion and were treated with dignity and respect. People living at Rosevilla and their relative's were overall positive about the service and their experiences of the care provided. Comments included:

"Our relative is a lot happier now with having company here"; "Our relative is really looked after and that's very reassuring for us"; " We've no complaints but could always raise issues with the manager's" and "I like it here, it's champion."

Care records for people with dementia showed that staff were responsive to changes in their needs. We saw that health and social care professionals were consulted with, and that staff worked with other providers to ensure that people received the right care suitable to their changing needs.

Various quality assurance checks on the service helped to show systems were in place to ensure that the service was effectively managed. There was evidence of promoted good practices especially in identified risks for people with dementia who were at risk of falls.

Staff were positive about working for the service and felt they were well supported with their training needs to be able to meet the individual needs of the people living at Rosevilla. Staff received training in dementia which enabled them to provide safe and professional care.

Visiting relatives also told us positive things about the staff team. These comments included 'staff are always available and to hand' and 'we can't fault the staff.'

We saw that improvements had been made since our last visit in relation to staff training and the systems in place to gather people's views on the service they receive.

During this visit we found that improvements were needed in relation to the management of records.

Comments received included: 'I am treated well'; 'The staff are quite good' and 'The standard of care seems reasonable to me.'

Likewise, comments received from the representatives of people living at Rosevilla included: 'I have no concerns whatsoever'; 'They provide excellent care. I have no complaints or concerns' and 'We are invited to social functions from time-to-time and are always made to feel welcome.'

Some people living at Rosevilla and their representatives highlighted that the environment was in need of refurbishment. For example, one relative reported: 'It would be nice if the people living here had a return for the fees they pay. The building is in need of investment.'

The people living at Rosevilla were observed to be relaxed in their home environment and in the company of the staff team. No concerns, complaints or allegations were brought to our attention during the visit.