27 and 30 January 2015
During a routine inspection
This inspection was carried out on 27 and 30 January 2015.
Rosehurst Care Home provides accommodation for up to 22 people who need support with their personal care. The service provides support for older people and people living with dementia. The service is a large, converted domestic property. Accommodation is arranged over two floors. A stair lift is available to assist people to get to the upper floor. The service has 16 single bedrooms and three double rooms, which two people can choose to share. There were 13 people living at the service at the time of our inspection.
The registered manager was not working at the service at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We received concerns about the care received by people living at Rosehurst Care Home from whistle blowers and the local authority safeguarding team, so we inspected the service to make sure people were receiving safe, responsive and effective care and support.
We last inspected Rosehurst Care Home in October 2013. At that inspection we found the provider had taken action to meet the regulations that they were not meeting at our inspection in May 2013. The regulations related to the care and welfare of people who use services, safety and suitability of premises, and assessing and monitoring the quality of service.
Staff knew the possible signs of abuse; however some staff did not know how to report possible abuse. New staff had not completed safeguarding and whistleblowing training. Guidance was not provided to staff about how to identify and respond to safeguarding concerns. The provider did not know if they had put safeguarding or whistleblowing systems in place.
The provider did not have a system to ensure the service was provided by sufficient staff with the right skills and experience. Staff did not have time to spend with people and several people in the lounge and dining room received little interaction from staff during the day. At times staff were providing care to one or two people and were not available to keep the remaining 12 people safe. Cover for staff holidays, sickness and vacancies were provided by other staff members. Staff completed management tasks in their own time. Some staff told us they were tired because of the number of hours they were working each week.
Emergency plans such as emergency evacuation plans were not in place. Action had not been taken to minimise the risks to people from the environment. People were not able to call staff from communal areas such as the lounge. The environment had not been designed to support people to remain as independent as possible.
Some staff giving people their medicines had not received training. People were not always given their medicines at the time they required them. Systems were in place to ordered medicines but there were sometimes delays in obtaining new medicines. Guidelines for ‘when required’ (PRN) medicines were not accurate.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider was unaware of their responsibilities under Deprivation of Liberty Safeguards (DoLS). The provider did not have arrangements in place, as the managing authority, to check if people were at risk of being deprived of their liberty and apply for DoLS authorisations. The provider did not have a system to assess people’s ability to make specific decisions where they may lack the ability to do so. Staff did not know who was able to make specific decisions for people when the person was not able to do so. Staff assumed that people were able to make decisions for themselves and supported them to do this.
Staff recruitment systems did not protect people from staff who were not safe to work in a care service. The provider had not obtained detailed information about staff’s previous employment. Disclosure and Barring Service (DBS) criminal records checks had been completed.
The provider did not have a system in place to support staff to provide care safely and to an appropriate standard. Staff did not receive an induction to get to know the people and the care they needed when they first started working at the service. The provider did not have a system to ensure staff completed training to provide safe and appropriate care to people. People could not be confident that staff had developed the skills and knowledge to provide their care safely and effectively.
Care had not been planned to ensure that people remained well. Changes in the care that people needed were not recorded in people’s plans of care and there was a risk care would not be provided as prescribed by the doctor or nurse.
People said they liked the food provided at the service. Meals included fresh vegetables and some homemade foods. Food was not prepared to meet people’s specialist dietary needs. Staff did not know what each person preferred to eat and drink, their favourite food or foods they disliked. People had not always been referred to appropriate health care professionals when they lost weight. Care recommended by healthcare professionals was not always planned and delivered to people to help them stay healthy. No system was in place to ensure people were offered drinks and snacks regularly during the day. People who needed pureed food were not able to taste the flavours of each food as it was pureed together. No choices were offered to people who required fortified, low calorie or pureed foods.
People were not always offered choices or were not offered choices in ways that they understood. Staff did not always respond to what people told them, and people did not always get the information they wanted. Staff did not always speak to people respectfully and did not always respect people’s privacy.
People and their relatives had not been asked for information about their life before they moved into the service. When people were able to tell staff how they preferred their care provided, staff provided care as people wished. There was a risk that people who were not able to tell staff what they wanted would not have their needs met in the way they preferred.
Assessments of people’s needs had been completed but changes were not been identified. Detailed guidance was not provided to staff about how to provide people’s care and support. Staff did not always deliver care in the way it was planned.
People were at risk of isolation. Some people stayed in their rooms and had limited interaction with staff. Other people were isolated because of their communication difficulties. People were not supported to continue with interests and hobbies they enjoyed before moving into the service. A programme of activities was on display but this was out of date and most of the activities no longer happened.
People were happy to raise any concerns they had with the staff. People’s relatives told us they had made complaints and the service had been slow to respond to their concerns. Information about how to make a complaint was displayed; however, this was not written in a way that people could easily understand.
The staff did not know what the aims and objectives of the service were. Care and support was not provided in the way described in the provider’s statement of purpose including respecting people’s privacy and dignity, encouraging people to be independent and making sure people received a good quality service.
The provider was not aware of the shortfalls in the quality of the service and staff practice we found at the inspection. Systems were in place to check the safety of the service but checks had not been completed on the quality of the care people received. Checks on the quality of the service had not identified shortfalls in the management or delivery of the service. The provider had not obtained information from people, their relatives and staff about their experiences of the care.
Action had not been taken to monitor and challenge staff practice to make sure people received a good standard of care. A manager with the skills and knowledge to lead the staff effectively was not working at the service. Staff were not given responsibilities and were not accountable for the care they provided. Staff were not supported to keep up to date with changes in the law and recognised guidance.
Records were kept about the care people received and about the day to day running of the service. Some records could not be found easily whilst other records could not be found at all. Systems were not in place to make sure that records were kept securely and could be located promptly when they were required.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.