Archived: Rose Cottage

Updated 18 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 28 September 2017 and was unannounced. The inspection team consisted of two inspectors.

Prior to the inspection, we looked at all the information we held on the service including notifications of significant events and safeguarding. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We viewed the action plan the provider sent us following the last inspection and we contacted the local authority's locality team and safeguarding team for their feedback about the service.

We spoke with one person using the service. The majority of people using the service were not able to share their experiences about living at the service with us. However, we spent time observing the way staff engaged and interacted with people. The company director was not available on the day of the inspection but we spoke with the deputy manager and three care assistants.

We looked at the care plans for four people who used the service. We saw personnel files for five staff which included their recruitment, supervision and some training records. We reviewed medicines management for three people and we also looked at records for monitoring and auditing the quality of the service.

After the inspection we spoke with one relative to gather feedback on their experiences of the service.

Updated 18 November 2017

This comprehensive inspection took place on 28 September 2017 and was unannounced. The last inspection took place on 24 February 2016, when we identified breaches of Regulations relating to staffing and good governance. We rated the service ‘Requires Improvement’ in three of the key questions we ask providers and overall. During the 28 September 2017 inspection, we saw the provider had not made enough improvements to the service to meet the Regulations.

Rose Cottage is a family run business registered to provide accommodation and personal care for up to five adults. The service supports people with learning disabilities, including autism, and people who may also have a physical disability. At the time of the inspection there were five men using the service.

The service had not had a registered manager since December 2015. The company director and the deputy manager were sharing the duties of the registered manager. On the day of the inspection we met the deputy manager but not the company director. 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 the inspection, staff could not always provide a good account of the types of abuse and how to keep people safe from potential harm. Risk management plans were not always robust and we could not be sure they reflected people’s current needs. There were no lone working risk assessments, despite one member of staff being on duty at night. Completed incident and accident forms did not have a record of the action to take to minimise the risk in the future and not all incidents had been recorded. People using the service did not have personal emergency evacuation plans to minimise identified risks and help ensure people were not exposed to the risk of harm in the event of an emergency.

The premises were not always safe or fit for purpose for the people using the service, staff or visitors. Nor were the premises always clean, secure or properly maintained.

Medicines were not always managed in a safe manner as we found one person had an excess of two tablets indicating they had not received the medicine as prescribed. There were no medicines protocols or plans in people’s care files where medicines had been prescribed to be given as required and the weekly medicines reconciliation was not recorded.

The provider had not ensured there were sufficient staff on duty to meet the needs of the people using the service and the provider did not always follow safe recruitment procedures to take sufficient steps to ensure staff were suitable to work with people using the service.

The deputy manager said training was up to date but did not show us any evidence to confirm this, so we could not be sure staff had all the required support to help them to develop their professional skills. However, we did see staff received regular supervision.

The principles of the Mental Capacity Act 2005 were not being followed as authorisations under the Deprivation of Liberty Safeguards were not applied for in a timely manner and care plans did not record consent or identify how people were supported to make decisions.

We saw little evidence of positive interaction between staff and the people using the service and on the day of the inspection there was no activity.

We did not see evidence that the provider involved people in their care planning and care plans were mainly task orientated and were not person centred.

The provider did not have effective quality assurance procedures. They did not ensure record keeping was always complete or contemporaneous and there was no analysis of information to develop and improve service delivery.

People’s dietary requirements were met and we saw evidence that relevant health care professionals were involved to maintain people’s health and wellbeing.

People were supported to have choice and staff knew people using the service well. Relatives’ surveys were positive about the level of care provided. Staff told us the deputy manager was approachable. We saw the provider followed their complaint procedures.

We found seven breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing and fit and proper persons employed.

We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.