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Rosewood Lodge Requires improvement

Reports


Inspection carried out on 5 March 2018

During a routine inspection

This comprehensive unannounced inspection took place on the 5 February 2018. Rosewood Lodge 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 service has single and shared accommodation for a maximum of 20 older people, some of whom may be living with dementia. On the day of the inspection there were 17 people living at the service. The service had 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 and associated Regulations about how the service is run.

At the last inspection the service was rated 'Requires Improvement' overall. We issued one requirement notice for a breach in Regulation 12, safe care and treatment. People’s risk assessments and support plans were not always up to date and reflective of people care needs. They were not being followed to prevent people receiving unsafe care. You can read the report from our last inspection, by selecting the ‘All reports’ link for Rosewood lodge, on our website at www.cqc.org.uk.

The provider completed an action plan to show what they would do to meet the requirement of the regulation they had breached. They had prioritised some areas that needed immediate attention including: updating care plans and risk assessments and quality assurance systems. During this inspection, we saw evidence to confirm that the service had improved.

The registered manager and staff had worked to introduce new systems and procedures. Systems had been reviewed and changed; infection control practices had been improved; care plans and associated risk assessments had been updated; quality monitoring of the service had been developed. The registered manager told us this work was on going and during this inspection, we found this was the case.

Whilst improvements had been made with risk assessments and the guidance for staff to support people was now in place, we still found some shortfalls in the recording and storage of medicines and the associated audits.

Staff we spoke with knew how to provide the care and support that people needed.

People, their relatives and staff told us that the service had improved and that the registered manager, head of care and deputy manager were supportive and approachable. The registered manager had begun to seek feedback from people and their relatives. We saw people being encouraged to share their views about the service each day.

We found improvements had been made and people now had the opportunity to take part in a range of activities in-house.

We saw some improvement had been made to the environment to support people living with dementia.

People told us they were happy with the care they received.

Staff were observed to be kind and attentive and demonstrated a caring approach to people.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

There were sufficient numbers of staff to meet people's needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People's capacity to consent to care was considered and the service worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Throughout our inspection, we saw that people who used the service were able to express their views and make decisions about their care and support. We observed staff seeking consent to help people with their needs.

People's health care needs were assessed, monitored and recorded. Referrals for assessment were made when needed and people received regular health checks.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. The registered manager told us, and we reviewed records, that demonstrated they had acted promptly when concerns were raised.

We found one breach 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 this report.

Inspection carried out on 30 August 2016

During a routine inspection

The inspection took place on the 30 and 31 August 2016 and was unannounced. At the last inspection in December 2013 the provider was found to be meeting all of the standards inspected.

Rosewood Lodge residential home provides care and accommodation for up to 20 people. On the days of the inspection 19 people were living at the home. The home was over three floors, with access to all floors either via stairs or the lift. Some bedrooms had an en-suite toilet. There were shared bathrooms, shower facilities and toilets throughout the home. Communal areas included two lounges, one dining area, a front garden and courtyard and hair dressers room.

The service had a registered manager at the time of the inspection. 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 did not always have up to date risk assessments and guidelines that identified how staff should support them with their specific care needs. Where one person was at risk of choking we found staff were not following the support plan so the person received safe care and treatment. Those people at risk did not always have records completed that confirmed what care and support staff had provided relating to their skin care and modified diets.

People felt safe and all but two people had a personal evacuation plans that identified what support they should require in an emergency. Fire checks were undertaken regularly but the building had no fire plan so staff were able to tell the area which would need evacuating in an emergency situation.

People had their medicines administered safely by staff who had received training. People who required their blood sugar levels monitoring did not have their checks undertaken with test equipment that had been calibrated in line with the manufactures guidelines.

People were supported by staff who were happy in the home and who felt supported by the manager. Staff had received regular supervision and training and staff meetings were an opportunity for staff to raise any changes or concerns. Staff had adequate checks completed prior to working with vulnerable people.

People and relatives were happy with the care they received and felt staff were kind and caring. One person who was supported with their lunch did not receive their meal in an inclusive, supportive manner. There was a lack of engagement and one to one support to provide this person with a positive meal experience. People were supported to maintain relationships with people who were important to them.

People’s consent to care and treatment was obtained and care plans reflected if people had capacity to make their own decisions. People were involved in their care planning and referrals were made to health care professionals when required.

The environment was not always enabling a dignified environment for people living at Rosewood Lodge. People had access to activities and people told us they enjoyed the meals.

People, relative’s, health professionals and staff views were sought. People and relatives felt able to raise any concerns and there was a complaints policy in place. The provider had quality assurance systems in place that monitored the quality and safety of the service and identified areas for improvement, although some areas of concern had not been identified prior to this inspection.

We found a breach 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 this report.

Inspection carried out on 19 December 2013

During a routine inspection

We spoke to three people that use the service at Rosewood Lodge, and all stated that they were happy with the care and attention they received from the staff. Some of these people have a degree of dementia care needs, so their communication with us was varied.

We looked at three care plans in detail and saw that people had signed consent forms in their care plans and the care documentation was written using the expressed words of the people using the service where possible.

We observed staff speaking with people who used the service and saw that they spoke to the people at eye level and offered assistance to them before carrying out tasks.

We spoke to a district nurse visiting the home who told us that the staff working at Rosewood Lodge were quick to highlight changes in care needs of the people living there. They also told us that the staff responded promptly to their advice and provided a high standard of care.

Inspection carried out on 1 February 2013

During a routine inspection

During our visit we spoke with five people who used the service and two people who had relatives who used the service. People who spoke with us said they could choose how to spend their day. One person described the home as “it was the home’s loving and caring atmosphere which persuaded me to stay.”

We saw there was information for people in the reception area of the home so that people were aware of the activities available.

One visitor told us they had always been welcomed in the home and staff members were always polite and caring. They told us the “the staff are very good, you couldn’t wish for a better place.”

People we spoke with told us they were happy and safe at Rosewood Lodge. One person commenting on the home told us, “I cannot think of anywhere better than here.”

The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw people were treated with respect and dignity, for example, staff were observed to make good eye contact and used touch to reassure people.

Staff told us they were aware of the home’s policies on recognising and reporting abuse and would not hesitate to report any concerns to the manager.

We observed the atmosphere and general ambiance of the home to be friendly, calm and relaxed.

During an inspection to make sure that the improvements required had been made

The purpose of this review was to check that improvements had been made to achieve compliance with this outcome. We did not involve the people living in the home

Inspection carried out on 17, 18 May 2011

During a routine inspection

People told us the staff are very respectful and helpful, encourage them to do what they can for themselves, and remind them what to do if they are forgetful. They are able to participate in a range of different activities. However, we were told by the staff that the majority of people in the home decline any entertainment as they are not interested.

We saw staff speaking to the people in the home and observed how they treated them in a calm reassuring manner and were aware of those people with dementia care needs.

One person who lived in the home told us “my future daughter in-law can visit at any time. She came yesterday and nobody bothers. We can stay in the lounge or go to my room. We are free to go any where we want”.

We saw staff speaking to the people in the home and observed how they treated them in a calm reassuring manner and were aware of those people with dementia care needs.

We saw that staff do receive mandatory training and are competent to do their job, but we noted that there are some gaps in training that the manager and staff have received which would help them to further understand and respect the cultural, social values and beliefs of people they support and enable them to challenge anti- discriminatory behaviour. This training would also help them to ensure people’s best interests and to recognise when people are being deprived of their liberty and what to do about it.

We spoke to an advocate of a person who lives in the home who told us ‘I cannot be more pleased with care provided to the person I visit. They look better than they have done for years’. We were told how the home had supported this person to make choices and decisions about their care, including moving to a different room to help them feel less isolated and nearer to he People who use the service are encouraged to be involved in decisions about their care and support and are encouraged to express their views. There are no records in peoples care plans to show that they, or their representatives, have been involved in their care planning.

People are supported to have coordinated care from other care professionals and services, but we found there had been a significant delay in the service referring one person to health care professionals when their needs had changed.

One visitor told us that they had lived in the home three years ago and they now come in to eat lunch at the home twice a week, as they enjoy the food and the company. This person was very complimentary about the home. They said the staff would do anything for you.

One visitor told us that there was always enough staff on duty when they visited. They said there were usually four or five staff.

People receive appropriate attention and treatment but they cannot be completely confident that important events that affect their welfare, health and safety are reported to the Care Quality Commission.

The people who live in the home, a visitor and the staff that we met and talked with at Rosewood were complimentary about the staff and the manager

One person spoken with said “the girls are brilliant and the manager, but we do not see her much”.