Background to this inspection
Updated
17 December 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team comprised an inspector and assistant inspector on the first day and one inspector for the second day of the inspection site visit.
Service and service type
Rosemary Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We checked for feedback on the Healthwatch website. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service and a healthcare professional on the 12 August 2021. We spoke with three members of staff, the home manager and a representative for the nominated individual. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at a variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We spoke with three relatives and four staff members. We looked at information for two staff files in relation to recruitment. We looked at training data. We continued to seek clarification from the provider to validate evidence found.
Updated
17 December 2021
About the service
Rosemary Retirement Home is a residential care home providing personal care for up to 23 people over the age of 65, including those living with dementia. At the time of the inspection, 19 people were living at the home.
The accommodation comprised a communal ground floor lounge and dining area. Some bedrooms were located on the ground floor with additional bedrooms on the first floor. There was a smaller lounge area on the lower ground floor along with additional bedrooms.
People’s experience of using this service and what we found
Relatives and people we spoke with gave positive feedback about the staff and the home. However, we found significant shortfalls throughout the inspection which impacted on the safety and quality of care for people.
We were not assured the provider had taken effective action to make sure government guidance was being followed after a recent COVID-19 outbreak. Due to the issues identified at the inspection, the local authority provided additional care staff to support the service to ensure people received the right levels of care and support.
Infection prevention control measures that were in place, were not safe and put people and staff at risk of contracting the virus.
The quality assurance checks in place to drive improvement were not robust. They had not ensured the safety of care was sufficiently monitored. The poor management of the COVID-19 outbreak did not protect people and staff from the ongoing risk of harm.
Risks associated with people’s health had been identified however there was no guidance for staff to follow if a person with diabetes were to become unwell.
Some medicines were administered safely, although staff did not have the required protocols in place to administer ‘as required’ medicines.
People were not always treated with dignity and respect. Staff did not always treat people with compassion. We observed some kind and caring interactions, however we also observed people were left for long time periods with little stimulation or staff engagement.
At our last two inspections we have had concerns the governance systems were not effective to ensure the quality of the service. This has continued to be a concern at this inspection and the provider had not taken enough action to make improvements.
Care plans had not been consistently reviewed to ensure all the information reflected people's needs. However, the new home manager had started to review all care plans and make referrals to health care agencies for some people to have their needs reassessed.
The overall dining experience for people required improvement. People’s dietary needs were appropriately assessed.
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 processes in place to safeguard people from abuse. Appropriate recruitment procedures ensured new staff were assessed as suitable to work in the home.
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 requires improvement (published 14 May 2021) and there were multiple breaches of regulation. The provider has submitted monthly action plans following the last inspection to show what they have done to improve the service. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns about infection control. A decision was made for us to inspect safe and well-led and examine those risks.
Following the first day of the inspection on the 05 August 2021 and our concerns, urgent action was taken by the CQC. We imposed urgent additional conditions on the provider’s registration to address the issues identified around the provider’s management of the COVID-19 outbreak. The provider met those urgent conditions and submitted the requested, additional action plans of all the actions needed to mitigate future risk of harm.
We continued the inspection on the 12 August 2021 and due to the continued concerns identified at the 05 August 2021 inspection, it was agreed to inspect against the remaining key questions, effective, caring and responsive.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and Well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosemary Retirement 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 to keep people safe and to hold the provider to account where it is necessary for us to do so.
We have identified continued breaches in relation to the safe management of COVID-19, treating people with dignity and respect, staffing and governance of the service at this inspection.
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 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 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.