Archived: Rodney House Residential Home

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

There were shortfalls in the staffing arrangements, action was taken by the nominated individual to address this during the inspection. Medicines were not always managed safely, there were shortfalls in staff recruitment files. There were detailed risk assessments in place, we identified one person who did not have all the required risk assessments in place.

There were systems in place to record and escalate any incidents and accidents. We found one instance where staff had not reported incidents via this system. The manager reviewed incidents and took action to prevent a reoccurrence.

Risks relating to infection control were managed safely, however we observed staff were not always wearing masks correctly. The service equipment was maintained.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice.

Due to staffing pressures, staff did not always receive an induction when starting at the service. Staff did not always receive up to date training and formal supervision. The environment of the home was not suitable for people living with dementia.

People’s health care needs were met. People received enough nutrition and hydration and made choices about what they wanted to eat.

There was a lack of activities and stimulation for people. People had individualised care plans detailing their needs and preferences, people’s end of life wishes were recorded. Complaints were acknowledged and responded to.

There were governance systems in place which identified most of the concerns we identified during our inspection. Action points were being worked towards but were not all completed. We identified similar and additional concerns from our last comprehensive inspection in June 2019. The accumulation of shortfalls alongside staffing shortages meant the manager was under increased pressure and their workload had become unmanageable.

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 requires improvement (published 16 August 2019) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

We undertook a targeted inspection in January 2021, this inspection was carried out to check on a specific concern we had about how infection prevention and control procedures were being managed in the home. During this inspection we identified improvements had been made in relation to infection control.

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 Residential 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.

We have identified breaches in relation to how medicines are managed, the staffing skill mix, lack of information in recruitment files, people being deprived of their liberty without authorisation from the local authority, the application of the Mental Capacity Act 2005, lack of staff supervision, induction and training and the governance systems at this inspection. Our enforcement actions have taken account of the provider's decision to close the home

Follow up

We will continue to monitor information we receive about the service until the homes closure. If we receive any concerning information we may inspect sooner.

Rodney House Residential Home accommodates up to 28 older people in one adapted building across three floors. The service specialises in the care of people who are living with dementia. At the time of our inspection there were 20 people living at the home.

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

For this inspection we only looked at one key line of enquiry in the safe domain as we were following up on a specific concern we had about infection prevention and control (IPC).

Risks relating to infection control were not all being managed safely. We observed staff were not always wearing personal protective equipment (PPE) appropriately. Not all staff had received up to date training in infection control, COVID-19 and how to put on and take off their PPE. There was a lack of suitable bins to dispose of PPE. The manager was addressing this at the time of the inspection. The storage of mop heads for cleaning did not follow good infection control practice.

People and staff were regularly tested for COVID-19. People who lacked the capacity to consent to the testing had not been assessed in line with the Mental Capacity Act 2005. At the time of the inspection no one living at the home had tested positive for Coronavirus.

There were procedures to ensure the service was clean. Staff had access to enough PPE. There were systems in place for staff to change their clothing at the point of entry into the home. The provider provided staff with clothes to wear whilst on shift. There were visiting policies and procedures in place. There were systems in place to communicate information to staff and people’s relatives.

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 Requires Improvement (published 16 August 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about how infection prevention and control procedures were being managed in the home. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have identified a breach in relation to safe care and treatment at this inspection, relating to infection control. Information about CQC’s response to the breach in regulation can be found at the end of this report.

We have made a recommendation relating to the service assessing people who lack the capacity to make specific decisions in line with the Mental Capacity Act 2005.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rodney House Residential Home on our website at www.cqc.org.uk

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of IPC. We will work alongside the provider and 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.

People’s experience of using this service and what we found: People were supported for by a staff team who were kind and caring. Staff had good relationships with people and knew them well.

The provider and senior staff had completed audits on the home to support quality checks. However, these checks had not prevented shortfalls in the quality of service provision.

There were enough staff to meet peoples' basic needs. Staff training was provided but did not always ensure people's specific needs were covered. Staff recruitment procedures were not always followed appropriately, and staff had not received regular supervision.

Infection control and cleaning audits had not identified areas seen to require improvement. Some environmental safety requirements had not been adhered to in relation to fire risk and storage of dangerous items.

People did not have regular access to the local community and person-centred activities were limited.

Care plans were person centred and there was guidance within peoples' risk assessments for staff to follow. People had access to healthcare professionals and medicines were stored safely.

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.

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 Requires Improvement (published 2 July 2018) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made to the area requiring improvement however the service remains rated Requires Improvement; the provider is in breach of other regulations.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We have identified four breaches in relation to infection control, safety, recruitment staff supervision and quality assurance of the service this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this unannounced inspection on 9 May 2018. The last inspection of the service was carried out on 21 and 22 January 2016, and published on 4 March 2016. At that time the service was rated as good.

Rodney House is a ‘care home’ for up to 28 people in one adapted building. 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 specialises in the care of people who are living with dementia. At the time of our inspection there were 26 people living at Rodney House. The communal areas of the service were all on the ground floor of two connected Victorian houses, comprising three lounge areas, a dining room and outdoor space. At the time of our visit, one of the lounge areas was not in use. Bedrooms, bathrooms and toilets were located on the ground, first and lower floors with stair lifts and an elevator to access these.

There was a registered manager in place. 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.

Staff supported people to have maximum control of their lives where possible. Although staff aimed to support people in the least restrictive way possible, the policies and systems in the service did not always support this in practice.

Some areas of the home had or were being developed to support people living with dementia. People could move around freely inside, however the garden area was not safe for people to use without direct supervision. This restricted people’s opportunities and did not reflect a dementia friendly environment. We have made a recommendation about the garden area.

Systems to monitor and review the quality of care were not always effective. For example, the service had not identified the failure to adhere to the principles of the Mental Capacity Act 2005. We have made a recommendation about managing audit and quality assurance processes.

Medicines were administered to people as prescribed and checks were in place to ensure this was done safely. During the inspection we spoke with the registered manager about improving practices when giving medicines covertly, and a plan was in place to review this in the following few days.

People told us that they felt safe at Rodney House. We saw systems and processes which helped to keep people safe. These included reporting and investigating accidents and incidents and potential abuse, as well as carrying out equipment checks and regular maintenance.

Sufficient staff were employed, and they received training in a range of subjects to make sure people received safe and effective care.

Staff knew what they needed to do to keep people safe. Records showed that risks to people had been assessed. Staff knew people well, and so they were able to provide support if someone became distressed or were at risk of harm.

Staff had a good understanding of people's needs and preferences, and were compassionate, kind and caring. People were comfortable in the presence of staff and confident in their abilities. Relatives told us that staff were kind and patient, and that they supported people with the care and support they needed to be as independent as possible

People were supported to make choices where possible, for example at mealtimes. Choices were offered for each meal and we saw staff encourage people to have enough to drink. People were supported to have a balanced and varied diet.

When there were concerns about a person’s physical health or wellbeing staff liaised with healthcare professionals promptly. The information given to healthcare professionals at times needed to be clearer and more consistent.

People and their relatives were happy about the care they received at Rodney House, and knew how to complain if this was necessary. Complaints were investigated and appropriate actions taken.

Relatives told us they knew who the registered manager was and said they found them to be open, honest and approachable. Staff told us their colleagues and the management team supported them, and that they were informed and included as relevant about the service.

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.

Rodney House Care Home provides accommodation and personal care without nursing for up to 28 people who are living with dementia. At the time of our inspection 27 people were living at the service. There were four residents’ lounges on the ground floor, described as ‘cottages’ named Butterfly, Vintage, Lullaby and Garden Cottage. Residents with the same level of independence were being cared for together in each of these cottages. At the time of the inspection, Lullaby Cottage was not being used by residents.

There was 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 2008 and associated Regulations about how the service is run. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for safely by staff that had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff.

Medication was dispensed by staff who had received training to do so. The home had a system in place for ordering, administering, storing and disposing of medicines and this helped to ensure that people received their medicines as prescribed.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was up-to-date with recent changes to the law regarding DoLS and knew how to make a referral to the local authority where someone was being deprived of their liberty.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met and they were happy with the food. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a GPs and district nurses.

Staff were attentive to people's needs and were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People and their relatives knew how to make a complaint and complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including using questionnaires, observations and by talking with people, staff, and relatives. The manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

Before our inspection, we received some information of concern about the care provided at the home. The information came from two different sources and related to the care and welfare of people. In particular, the concerns related to moving people safely, the frequency of people being repositioned and meal times for people needing support.

During our visit, we did not see any evidence that people's personal care needs were not being met. People told us they were happy with the service they received. Staff

supported people to change their position to minimise the risk of pressure ulceration.

We saw people receiving support where necessary to eat and drink.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that staff treated them well. We spoke with three relatives who told us they had confidence in the staff supporting their family member. They said their family member was safe whilst living at the home.

People were cared for by staff who were aware of the risks to people's health and safety. Staff knew how to support people in a safe way.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to improve.

Care plans provided guidance for staff on how to meet people's needs in a way which minimised the risk for the individual. Where people were at risk, staff followed effective risk management procedures to protect the person. This ensured staff were able to support people whilst respecting their dignity and protecting their rights.

There was a member of senior staff available on-call in case emergencies arose.

Equipment was well maintained and serviced regularly. This reduced the risk of harm to people and staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager was in the process of submitting applications for the authorisation of deprivations following recent changes in the interpretation of this legislation. The service had suitable policies and procedures in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and their care needs were met. Relatives told us they were happy with the care that had been delivered and their family member's needs had been met.

We saw from observations and from speaking with staff that they had a good understanding of people's care and support needs. Staff we spoke with told us they had received training to meet the needs of the people they were supporting.

People's care and welfare needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs.

Signage was available throughout the home. This enabled people to move freely and safely about the home.

Visitors confirmed they were able to see their friend/relative in private and visiting times were flexible.

Is the service caring?

We saw people were supported by kind and respectful staff. Everyone we spoke with was complimentary of the staff. Comments included, "There is always a nice atmosphere here, it's a brilliant home" and "The carers are very friendly, they all really do care."

We saw staff responded to people in a friendly, caring and attentive manner. They regularly offered a choice of drinks and snacks.

People told us that they could do the things they enjoyed. Our observations confirmed this.

Is the service responsive?

We saw information in people's records which indicated they had been consulted about the care they received.

People were supported to maintain relationships with people that were important to them.

The service worked well with other agencies, health professionals and family members to make sure people received consistent care. Records contained details of appointments with health professionals and any outcomes. We saw referrals had been made to the appropriate health services when people's needs changed.

Relatives we spoke with confirmed staff would always contact the appropriate health professional if their family member required an appointment.

People completed a range of activities in and outside the service regularly. This included gardening, making scones and visiting a local caf'. Relatives told us the home regularly arranged activities and staff facilitatde day trips.

Staff rotas took into account people's individual needs when determining the numbers, qualifications, skills and experience required. This helped to ensure people's needs were always met.

Is the service well-led?

The home had quality assurance processes in place. People and their representatives were asked for their feedback on the service they received.

Relatives we spoke with confirmed they knew how to make a complaint if they were not happy with services provided. Each relative explained how they were quite happy to raise any concerns they may have with the manager or other staff members. They were confident any concerns raised would be dealt with quickly. One relative described how they had made a complaint in the past. They said it was investigated in a timely way and to their satisfaction.

All of the staff we spoke with said they would report poor practice if they witnessed it.

People who were able to express an opinion said they were very happy with the care they received. One person said 'I'm certainly being well looked after here.' Another person told us 'You get help with everything. If you want anything you only have to ask.'

People received care in a way that respected their privacy. All bedrooms at the home were for single occupancy which enabled staff to provide care to people in private. We saw that screens were used to protect people's privacy when they required assistance in communal areas.

Throughout the inspection we observed that staff spoke with people, and assisted them, in a patient and kind manner. People told us 'Staff are very sweet' and 'I'm very happy here. Everyone is very good to me.'

There were adequate numbers of staff to safely support the people who lived at the home. We saw that people received care and assistance in a timely manner and no one was left waiting for assistance. One visitor said 'There always seems to be enough staff and I've noticed that they always have time for everyone.'

There were systems in place to effectively monitor the quality of care and to identify and minimise risks to people.