Archived: Rosewood Court

Our last inspection took place on 11 July 2017 and included information received from the local authority on 1 August 2017. We rated the service as requires improvement with three breaches of regulations.

This unannounced inspection took place on 12 and 13 September 2017. We also received information by email from the provider on 20 September 2017. There were 19 people receiving care, and one person in hospital, at that time.

Prior to this inspection we received further concerns from the local authority and Clinical Commissioning Group in relation to the management of the service and the care people received.

Before this inspection the provider's representative told us they planned to temporarily stop providing nursing care in order for them to focus on making the necessary improvements to the service.

During our inspection visit on 12 September 2017 the provider's representative told us they had decided to close the service. They engaged a consultancy company to assist senior managers with the closure.

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 service had not had a registered manager since January 2017. Since that time the provider had appointed five managers. The current manager took up post on 6 September 2017. However, they were not present during our inspection and senior managers told us the new manager was unlikely to return to work. The compliance manager was managing the service during our inspection. The lack of stable management had negatively impacted on the service, causing confusion and low staff morale.

The provider had failed to follow the required process to notify CQC of changes in the service’s managers.

Systems to continually assess, monitor and improve the quality and safety of care provided at the service were lacking and remained ineffective.

There were opportunities for people and their relatives to provide feedback to the provider. However, these were not always communicated to them and that little had changed as a result of their comments. Relatives were not always informed of changes in their family member’s well-being. We therefore concluded that complaints were not always thoroughly investigated and complainants were not always kept informed of the progress of their complaints.

Not all staff received sufficient training and support to carry out their roles.

Staff had not always supported people with decision making. The provider told us this would be addressed by 20 September 2017.

People’s nutritional needs were met. However, people’s health care needs were not always effectively monitored or met and people did not always receive their prescribed medicines.

Potential risks to people had not always been assessed and were not always well managed.

There was not always enough sufficiently skilled and experienced staff on duty to make sure people’s needs were fully met and people were kept safe. Staff knew how to recognise incidents of potential harm but did not always know how to, or feel confident in, reporting these.

Some people were happy with the care they received. However, staff did not always follow people’s care plans and people did not always receive the care they needed. However, we were aware the provider was in the process of reviewing people’s care plans.

People received care from staff who were kind, respectful and supported their independence. Staff treated people with dignity and respect. However, care was not always person-centred and people were not always involved in every day decisions about their care.

There were opportunities for people to develop and maintain interests and hobbies.

At our previous inspection on 11 July and 1 August 2017 we found two breaches of the Health and Social Care Act (Registration) Regulations 2014 and one breach of the Health and Social Care Act (Regulated Activities) Regulations. We were waiting for the provider’s action plan detailing the improvements they planned to make. During this inspection on 12, 13 and 20 September 2017 we found a further five of the Health and Social Care Act (Regulated Activities) Regulations 2014 had been breached, in addition to the breaches identified at our previous inspection. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Rosewood Court provides accommodation for up to 66 people who require nursing and personal care. They care for older people who may have a physical disability as well as those who may be living with dementia. The service is split over three floors, with only the ground and first floor currently occupied. Each floor had individual en suite bedrooms and several communal areas, such as lounges and dining rooms. On the day of our inspection, 25 people were living at the service.

At our last inspection on 15 November 2016, the service was rated requires improvement. At that inspection we asked the provider to make improvements as we found that staff members at the service were not always deployed in such a way as to make sure that people's needs were being met. During this inspection we found that they had made improvements in this area.

Before and during this inspection we spoke with the local authority about the service. They had a number of concerns about the service, including risk management, staffing levels, lack of stimulation for people and concerns relating to the management of the service.

The service did not have 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. There was a new manager appointed and they were in the process of applying to the CQC to register with us.

There were not effective system in place to ensure the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were being implemented. MCA assessments had not been completed and DoLS authorisations were not always effectively managed. There was some evidence of consent being sought, however; this was not across the board.

The culture at the service was not always positive. There had been a number of changes in management at the service, which had impacted on people and members of staff. The new manager had identified this and was working to improve morale and confidence in the leadership at the service. People's complaints and concerns were not always dealt with in a robust or satisfactory manner.

Quality assurance procedures had not always been effective in identifying areas for development, however; these had recently been improved and were starting to have a positive impact on the service. People and their families were aware of who the new manager was and meetings were held with people, relatives and staff to keep them up-to-date of developments at the service.

People felt safe living at the service. Staff members received training in abuse and safeguarding and were aware of the action they should take if they suspected people had been abused. Accidents and incidents were recorded and reported and risk assessments were in place to help prevent people coming to harm. However; those risk assessments were not always followed to ensure that people received care which minimised risks to them.

Staffing levels were sufficient to meet people's needs. There had been some reliance on agency staffing, however; recruitment was underway to try to reduce this needs. Staff members had been robustly recruited with background checks being completed to ensure they were of good character. Trained staff supported people to take their medicines. There were suitable systems in place for the storage and recording of people's medication. These systems were not always effective and some errors had taken place.

Staff members were provided with the training and support they needed to develop in their roles and to meet people's needs. New staff received inductions and all staff had periodic supervisions. People enjoyed the food and drink provided by the service and were given plenty of choice and healthy options. People's health needs were being met and the service supported them to have regular access to healthcare professionals, such as their GP.

Staff members treated people with kindness and compassion. They worked hard to develop positive relationships with people and their family members and were committed to providing them with the care they needed. We saw that people and their families were involved in care planning and were provided with the information they needed about the service. People's privacy was upheld at all times and staff treated people with dignity and respect.

Care plans were in place however; they were not always reviewed and updated on a regular basis. All the care plans in the service had, or soon would be, reviewed and rewritten to ensure they were as person-centred as possible. Some activities were available at the service however; they were not always effective in ensuring people were kept busy and stimulated.

We identified breaches of legal regulations during the inspection, you can see what action we told the provider to take at the back of the full version of the report.

Rosewood Court is a newly built three storey home. It is well appointed with single rooms, all of which have en-suite wet rooms. It was registered with CQC in April 2016 to provide accommodation for up to 66 people who require nursing or personal care. At the time of our inspection, 27 people were living at the home, some of whom had dementia and some who required 'end of life' care.

There was a registered manager in post. 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.

People were safe at the home and we found the management to be supportive and approachable. There were mixed opinions about the food and drink that people received and promised changes to the menu had been delayed. However, people received sufficient food and drink to maintain their health and well-being. People were engaged with the activities that had been arranged and had discussed improvements to these at regular resident meetings.

The home had developed policies, systems and processes to enable the needs of people to be assessed and for care plans to be developed to meet those needs. However, people's care plans were not always personalised to reflect the individual’s preferences. Management plans had also been developed to minimise the risks associated with the individual’s care needs.

The number of staff required to support people had been determined using the dependency levels of the individuals who lived at the home but they were not always deployed in such a way that people's needs were met in a timely manner. This was a breach of Regulation 18 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 the report.

The recruitment process for new staff was robust. Staff received an induction programme and on-going training. They were supported to gain relevant qualifications in Health and Social Care and were supported by way of regular supervisions. This meant that people were cared for and supported by staff who had the necessary skills and knowledge to do so safely and effectively. Although staff had an understanding of the requirements of the Mental Capacity Act 2005 they were unaware that authorisations had been received to deprive some people of their liberty for their own safety under the associated Deprivation of Liberty Safeguards. They were unaware of the conditions of the authorisations and people may have had their rights infringed.

Staff were caring and friendly. They knew the people they cared for and supported well. They protected people’s dignity, treated them with respect and encouraged them to maintain their independence. Staff understood the need for confidentiality.

There were systems and processes in place to monitor the quality and effectiveness of the service. The provider was actively involved with it and received twice monthly reports on the quality and development of the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rosewood Court is a newly built three storey home. It is well appointed with single rooms, all of which have en-suite wet rooms. It was registered with CQC in April 2016 to provide accommodation for up to 66 people who require nursing or personal care. At the time of our inspection, 35 people were living at the home, some of whom had dementia and some who required ‘end of life’ care.

Although the accommodation was modern, well-appointed, clean and tidy it did not have a homely atmosphere. The décor was not helpful to people who were living with dementia as all doors to rooms looked the same. The provider had failed to acquire and provide the equipment needed before people had been admitted to the home.

People had been admitted to the home before appropriate systems and documentation was in place to provide safe and effective care. Care records had not been developed for some people so that staff understood their care needs. Risks arising from people’s care and treatment had not been identified or assessed appropriately to mitigate them as far as was possible. There were no effective complaints or quality monitoring systems in place. People had been admitted at a rate that was unsafe and staff were not able to identify them as neither their care records nor their medicines administration record bore their photograph.

Staffing levels had been determined with no reference to people’s dependency levels or needs. Staff were not given appropriate induction or training before they provided care and treatment to people. There was no supervision of staff at which they could discuss their performance, concerns, training needs or suggestions for improvements to the service. There were no checks carried out to determine the effectiveness of the training staff had received or that they were competent to carry out their duties.

Although there were some group activities arranged, there was nothing for people who could not join in with these. People were bored and felt isolated. The home was in the process of developing links with local churches.

During this inspection we identified that there were a significant number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to level of our concerns we have taken enforcement action that required the provider to make improvements to the service and has prevented any new people from using the service since 21 July 2016. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.