This inspection was completed on 14 and 15 March 2017 and was unannounced. City Health Care Limited has been the new registered providers of Rossmore Nursing Home since September 2016. This is their first inspection since registration and was brought forward from the planned date due to a notification of an incident that raised concerns.Rossmore Nursing Home is registered to provide personal and nursing care for up to 56 people. The service is accommodated in a series of converted, large, terraced houses in a residential area of Hull, close to amenities and public transport; there is on street parking available. The service has 17 placements for people who have had a stroke and who require therapy input to assist their rehabilitation; an adjoining house has been purchased next door to extend the stroke unit. The day therapy activity is currently provided by Humber NHS Foundation Trust in a separate building in the grounds of Rossmore Nursing Home. There are also eight step-down placements for people who require an interim service following discharge from hospital until a package of care can be arranged for them in the community. The remaining 31 placements are for people who require on-going residential and nursing care. There is a large sitting room, a small seated area and a dining room on the ground floor. There is a mixture of single and shared occupancy bedrooms on the ground and first floors; the upper floors are accessed by a passenger lift, a stair lift and stairs. There are bathroom and shower facilities on both floors.
The service had a registered manager in post as required by a condition of their registration. 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.
Due to concerns found during the inspection, 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.
Following the inspection, we met with the registered provider and have received an interim action plan. We also requested and have received weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the back of the full version of the report.
We found concerns with how the service was governed. The support system for the registered manager had shortfalls which meant they were managing the four distinct areas of the service as one, without effective clinical guidance and support. The registered provider told us directors, and a senior nurse employed within the company, were available to support the registered manager. The CQC had not always received notifications of incidents which affected the welfare of people who used the service. Communication and documentation was poor in some areas which meant the registered manager had not been informed of important incidents to enable them to take action. There were discrepancies and inaccuracies regarding the records of some people who used the service which made it difficult to check if the correct care and treatment had been delivered. There were different systems of recording in the service which added to the confusion. For example, therapists in the stroke unit recorded their care plans and treatment records on a computerised system but the nursing and care staff did not have access yet so were unable to see the information.
The quality monitoring system was very new and had not been fully developed; the registered provider had concentrated on external structural work, had completed a full infection control audit and a full medicines audit. However, there was a range of internal issues that had not been addressed effectively. These included cleanliness, documentation, medicines management, nurse staffing arrangements, inconsistent application of mental capacity legislation, safeguarding reporting, safe care and treatment, risk management, assessments and care planning. We found accidents had been logged, which highlighted specific issues but lacked analysis to ensure lessons were learned to prevent reoccurrence.
We found the arrangements for nurse cover during the day and night had led to shortfalls on occasions and an over-reliance on agency nurses on others. This meant there had been an inconsistency of care and treatment, poor communication in sections of the service and people’s care needs being overlooked.
Some people had not received their medicines as prescribed due to stock control issues and errors in administration. There were occasions when people’s health care needs were not met in a timely way and there were concerns about how the staff team worked with other health professionals when people’s care and treatment was shared between them.
There was a lack of robust risk assessment and management; staff had not always followed policies and procedures, guidance from health professionals and outcomes from risk assessments. Areas of the environment were cluttered with equipment and rooms such as sluices were constantly accessible to people which made them unsafe. These issues had placed people who used the service at risk of harm and injury.
Not all staff had received safeguarding training and there had been occasions when incidents had not been reported properly to the local safeguarding team so they could review how they were being managed.
Not everyone who used the service had a care plan and there were significant gaps in care planning for other people. Also care plans were not always updated when people’s needs changed. This meant staff did not have up to date information about people’s individual needs and important person-centred care could be missed.
We found there was an inconsistent application of mental capacity legislation. Some people had assessments to determine their capacity to consent to specific restrictions such as bed rails but others did not. Documentation that showed best interest decision-making had not been completed appropriately. There was also one person whom we felt should have been assessed to see if they met the criteria for a deprivation of liberty safeguard; they were agitated, confused and wanting to leave the service.
There were concerns with the management of infection prevention and control as some areas of the service and equipment required cleaning. Refurbishment was underway; at present this was the exterior of the building but there were also plans to upgrade the interior in the near future.
Staff had access to training and those spoken with confirmed this had improved since the new registered provider took over. There were gaps in training but these had been identified and plans put in place to address them. We made a recommendation that the registered provider follows through with the training plan and we will assess this at the next inspection. New staff supervision support meetings had just started and the registered manager had plans to ensure senior staff were suitably trained to enable them to carry out formal supervision. Staff told us they felt supported by the registered manager.
People told us the staff approach was kind and caring and they felt able to raise issues with them. We observed positive interactions between staff and people who used the service although improvements could be made in some areas to ensure privacy and dignity was enhanced.
We found people’s nutritional needs were met. There was a varied menu which provided people with choices and alternatives. People told us they liked the meals provided to them.
There was a range of activities and therapies for people to participate in; some people were supported to attend a local social club and enjoyed outings when possible.
Staff were recruited safely and employment checks were carried out before new people started work in the service.
There was a policy and procedure to guide staff in how to manage complaints and a record was held of investigations and outcomes. The new registered provider’s complain