Rodney House Care Home

Rodney House Care Home is a residential care home providing accommodation and personal care for up to 57 people in one adapted building. Rodney House predominantly cares for people who require support with their mental health and or have a physical disability. At the time of our inspection 47 people were living at the home.

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

The provider had failed to ensure a safety monitoring and management approach had been effective across the whole service.

We had previously highlighted concerns with the management of people’s medicines at the home and these concerns remained. We had also raised concerns regarding the home’s environment, including cleanliness and hygiene in certain areas, and some of these concerns also remained.

The provider and home manager were responsive to our concerns raised during this inspection. They took appropriate action and put plans in place to quickly resolve the concerns highlighted.

Since our last inspection, there was an ongoing program in place to help ensure that all staff had the required skills and competencies to support people well and safely.

We made a recommendation regarding the scope of the training provided.

People spoke positively about the home; one person told us “I’m really happy with this place.” Another person said. “It’s all good here.” People described staff as “kind” and “respectful”; one person told us, “The staff are really decent people, they make me forget I’m in a care home.” Staff spoke positively about people and supporting them to achieve good outcomes.

Assessing and managing risk in relation to people’s care planning was improved. There was a new care planning system in place. The new care planning system focused on people’s decisions, preferences and what they are able to do for themselves; along with identifying the areas of their lives in which they need some support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff deployed at the home to meet people’s needs within a reasonable time.

Steps had been taken to help protect people from the risk of abuse.

A number of other audits had been effective at the home, and these had contributed to areas of improvement that we had seen. For example, audits on response to safeguarding concerns and the use of as required (PRN) medication.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 07 December 2022) and there were breaches of regulation.

At this inspection we found the provider remained in breach of regulations. This service remains in Special Measures and has been in Special Measures since December 2022.

Why we inspected

We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to safe care and treatment; the ongoing assessment of risks, safe management of medicines, maintaining a safe environment and effective governance of the home.

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 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 ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rodney house is a care home providing accommodation and personal care for up to 57 people At the time of our inspection 55 people were using the service.

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

Risk was not assessed, safely monitored and managed placing people’s health, safety and welfare at risk. There was lack of information to guide staff on how to manage and monitor risk. The cleanliness, hygiene and condition of the premises and equipment were poorly maintained increasing the risk of the spread of infection. There were multiple fire doors across the service with defects and a smoking room on the ground floor was unsafe. Information required about candidates was not confirmed to ensure they were fit and suitable for the job before they were appointed. There were insufficient numbers of suitably skilled and experience staff deployed across the service to meet people’s needs and keep them safe.

The service lacked clear leadership and governance. Managers were unclear about their roles and responsibilities and lacked understanding of regulatory requirements. The systems and processes used to assess, monitor and improve the quality and safety of the service were not used effectively. Audits and checks carried out at the service were unreliable and ineffective, they failed to identify risk and bring about improvements. There was a lack of provider and management oversight of the quality and safety of the service. Notifications about incidents which occurred at the service were not always submitted as required to The Care Quality Commission (CQC). The failure to identify and mitigate risk and bring about improvements to the service led to people not always receiving person-centred care with good outcomes.

Rating at last inspection and update

The last rating for this service was good (published 19 December 2017).

At this inspection we found the provider was in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s safety. This inspection examined 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.

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 and well-led sections of this full 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 Rodney House Care Home on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, staffing, recruitment and the governance and leadership of the service.

Follow up

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 varying the conditions of 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.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice:

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks and a negative lateral flow test.

Staff used personal protective equipment (PPE) and followed good guidance and practices. There was ample PPE available to the people living at the home and staff.

Staff were trained on how to manage the spread of COVID-19. People were encouraged to maintain social distancing and use face masks in the community where required.

Staff supported people to access healthcare services.

We found the following issue needed improvement:

Daily cleaning schedules were implemented by the care staff. However, we found the laundry floor was badly worn and damaged and may present as a risk of cross infection.

Rodney House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The building is a large Georgian style building with a more recent extension over five floors in a city centre location. The home had 57 rooms all for single occupancy; nine of the rooms were en-suite. For people living at the home there were three lounge areas and smaller sitting areas on different floors. There were also two dining areas, two smoking rooms, bathrooms and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 57 people. At the time of our visit 55 people were living at the home. Rodney House supports people who may have a physical disability or require support with their mental health.

The home required and had a registered manager. 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.

During our previous inspection in December 2016 we had found breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service was ‘requires improvement’ and the key question ‘Is the service safe?’ was rated inadequate. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; ‘Is the service safe?’ ‘Is the service responsive?’ and ‘Is the service well-led?’ To at least a rating of good. After our previous inspection the owner and registered manager quickly took steps to make improvements. These improvements meant that all of the breaches we identified in December 2016 had been addressed. At this inspection, the service was compliant with all of the health and social care regulations.

As the domain of safe was rated inadequate at our last inspection, we were unable to rate it any higher than requires improvement at this inspection. This was because the provider needs to show that they can sustain these improvements over time. We will therefore check this at our next inspection. The domains of ‘responsive’ and ‘well-led’ were rated 'requires improvement' at the last inspection and were found to be good at this inspection. The overall rating is now ‘good’.

During our previous inspection we saw that a number of people living at the home were smoking in their bedrooms, this was unsafe and against the home’s smoking policy. There was a designated smoking room within the building that the home’s policy highlighted was the only safe place to smoke within the building. The registered manager and owner had taken some steps to keep people safe. However these had not been adequate as the home did not have the systems, staffing capacity or equipment to ensure people were kept safe.

After our previous inspection the owner and registered manager quickly took steps to ensure people were safe. The registered manager and the owner set up an additional smoking room on the ground floor and installed a system which was sensitive to cigarette smoke in people’s rooms that alerted staff at reception rather than setting off an alarm. Staff went to people’s rooms to remind them to use the smoking areas provided and asked them to extinguish the cigarette. This encouraged an increase in people using the designated smoking areas. During our inspection we saw that this system was operational and we observed staff using it to keep people safe.

During our previous inspection we saw that the environment was not safe for vulnerable adults as access to the loft, a high balcony, the laundry, cleaning chemical stores and other storage areas had not been secured. On this inspection we saw that these areas had been made safe and were now secured with key code locks. There had been improvements made in how food was stored in the kitchen areas and the food storage areas have been renovated. Previously some of the checks and audits of the home in regard to safety, the environment and reviews of people’s care plans had not been effective and they had not addressed the concerns highlighted during our previous inspection. Risk assessments had not always been effective in assessing and mitigating risks.

On this inspection we saw that the registered manager had made changes to the audits in these areas. There was an audit calendar in place checking the quality of many different aspects of the service provided to people. There was evidence that these had been thorough and that there had been improvements made in the delivery and checking of the service provided in these areas. We also saw that there was a new risk assessment process in place which highlighted risks and provided an agreed plan to mitigate these risks.

People told us that they felt safe living at Rodney House. One person told us, “Once I’m inside and through the door I feel safe.” Another person told us that in previous homes they had at times felt unsafe; but the “calm and quiet atmosphere” at Rodney House made them feel safe. People also told us that they were happy with the staff at Rodney House and spoke positively about their approach and the relationships they had with them. Themes in people’s feedback was that the staff were friendly, kind, helpful, listened to people and if they were able acted on any concerns or worries they had. One person told us, “The staff help in every way they can and will always listen to my concerns.”

We observed the interactions between people and staff; we saw that there was a relaxed, calm and comfortable atmosphere at the home. It was clear that people found staff approachable. One visiting health professional told us that they had observed, “Staff greet people respectfully and treat people at all times with respect. You can see from the interactions between people and staff that people are happy.”

We saw that support was planned and provided in a manner that was respectful and promoted people’s autonomy and decision making. There was a respect for people’s freedom and individual choices. We saw examples of people who had benefitted from this approach. The registered manager told us that the aim was, “To provide safe care whilst balancing people’s right to make choices.” One social worker told us that the registered manager, “Attempted to instil a culture of sensitive yet realistic care and support to some very hard to reach service users, which in a lot of cases has paid dividends.”

We saw that the registered manager had a presence at the home; they were approachable and communicated well with people and staff members. The registered manager and the owner of the home who was the nominated individual; had a clear and well communicated vision of how high quality and respectful care should be delivered at Rodney House. We met with them and they told us, “We aim to equip people with skills. We are not here to lay down the law, we are here to show people respect and to not judge.”

Rodney House is a large Georgian style building with a more recent extension over five floors in a city centre location. The home had 57 rooms all for single occupancy; nine of the rooms were en suite. For people living at the home there were three lounge areas and smaller sitting areas on different floors. There were also two dining areas, a smoking room and toilets, bathrooms and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 57 people. At the time of our visit 57 people were living at the home. Rodney House supports people who may have a physical disability or require support with their mental health.

The home required and had a registered manager. 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.

During our inspection we found breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

It became clear during our inspection that at least 14 people living at the home were smoking in their bedrooms, this was against the home’s smoking policy. There was a designated smoking room within the building that the home’s policy highlighted was the only safe place to smoke within the building.

There was another specific fire risk that had not been adequately risk assessed and the risk had not been sufficiently reduced. Also we found that people’s personal emergency evacuation plans (PEEP) did not contain sufficient detail.

There were aspects of the home’s environment that were unsafe. A number of doors with signs on them saying ‘keep locked’ were open. These provided access to bulk storage of cleaning chemicals, personal documents and the home’s loft space. These are areas that contained risks for people living at the home. French doors opening onto a balcony between the first and second floors were not secured and were accessible to people at the home. In the kitchen, food was not being stored safely. During our visit the registered manager addressed these concerns with regard to the environment. They had also started to address the issue of people not keeping to the smoking policy.

Some of the checks and audits of the home and its environment and reviews of people’s care plans had not been effective. They had not addressed the concerns highlighted during our inspection.

We found the home to have a pleasant and relaxed atmosphere. We saw people being supported with kindness and respect during difficult times. The registered manager told us that “People who come here may have had very chaotic lives. We offer support that is non-judgemental in a family atmosphere”. Many people we spoke with who lived at the home told us they were happy living there. One person said, “It’s beautiful. It’s the only place where I’ve settled”. People told us that they were happy with the care staff. Visitors to the home told us they had seen good care. One visitor said, “The staff are always patient with people, never seen anyone be short”.

We found that the service operated within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguard (DoLS) applications had been made for some people who would benefit from them. We saw that this had been done thoughtfully for specific reasons after the person’s capacity to contribute to the decisions had been assessed. People’s consent to care and treatment at the home was sought and if they wished people were involved in planning their care.

Feedback from people who lived at the home, staff and visitors about staff numbers was mixed. We saw times when care staff were very busy responding to call bells and caring for people. We fed this information back to the registered manager.

We saw, and visiting health professionals told us, that people’s health needs were responded to and people were supported to access services as necessary.

We saw that staff received support to be effective in their role. This support included training, initial induction, supervision meetings, staff meetings and appraisals. Staff went to the manager or an assistant manager if they needed support. Staff told us they felt comfortable doing this.

Incidents that occurred at the home were dealt with and people were kept safe with appropriate support. We saw that the records relating to incidents had been reviewed at management team meetings and strategies and responses analysed. Staff told us they though this had led to a decrease in incidents at the home. Records showed that people were supported during incidents with respect and dignity and it wasn’t the practice to restrain people if there was a physical incident.

We considered our inspection finding to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that improvements were needed to the management of infection control procedures around the building. This was because during our visit we found that appropriate actions had not taken place to help ensure that adequate standards were maintained in and around the building.

Is the service effective?

We saw that improvements were needed to ensure that people received the care and support they required. This was because people had not always received their planned care. For example, one person's care plan stated that they required support with maintaining the cleaning of their bedroom and changing their bed linen. We saw that this support was not being delivered.

Is the service caring?

People who used the service told us that they liked the staff. We spoke with a number of staff who worked directly with people who used the service and they demonstrated an awareness of the people they supported.

Is the service responsive?

We saw that systems were in place to monitor the service delivered at the home. However, we saw that improvements were needed in relation as to how the service responded when areas of improvement had been identified. For example, we saw that an infection control audit had taken place in February 2014 which identified areas of improvements needed, however no action had been taken in response to the improvements that were needed.

Is the service well led?

We saw that improvements were needed to the management of quality assurance systems around the home. This was because the current systems in place had failed to identify the need for improvements in relation to the environment and cleanliness around the home. Once they had been made aware of the concerns identified around the service they took action immediately.

One person told us they were not happy and they wanted to leave. We spoke to the manager about this and reviewed the person's care records. We saw that a meeting had taken place and the person had agreed to remain at the home until an alternative could be found. This showed that people were listened to and the home worked with other professionals to obtain the best outcome for the person concerned.

We saw that other health and social care professionals were often consulted because of the nature of people's support packages. People spoken with told us they were assisted to dental and GP appointments and staff said that specialists and district nurses came to the home to provide treatment to the people who lived there.

Comments from people we spoke with about the home included :

"This is a good place".

'On a good day I'm really happy".

'I'm very happy here, the staff are great' and

'I don't really like it, but they support me and look after me".

We reviewed the environment and found carpets were well fitted, radiators were covered and upstairs windows were restricted from opening too wide. Regular maintenance of equipment was carried out by the maintenance person and fire checks were undertaken weekly. This meant that people were protected from risks around the environment they lived in because measures were in place to prevent them.

We reviewed eight staff files to make sure that appropriate checks were made on staff prior to them being employed by the service. In all files reviewed we saw that necessary pre-employment checks had been carried out and appropriate training had been provided.

There was a complaints policy in place and it was evident that complaints were listened to, acted upon and learned from.

People told us that they had accessed the community and joined in activities arranged at the home. People commented that they enjoyed activities and events which had taken place at the home over the Christmas period.

People using the service told us they knew how to complain and would do if they were unhappy about any aspect of their care and support. They also told us they were confident that staff would listen to any concerns they had and that they would sort them out. People said they felt safe using the service and would tell someone if they had been mistreated or thought somebody else had. We saw that people had been given the opportunity to put forward their views about how the home is run and that they had made suggestions about change.