Archived: Rose Cottage

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.

This was Rose Cottage’s first inspection since being registered by the Care Quality Commission (CQC) on 04 July 2015. Rose Cottage is 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 did not have a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had notified the Care Quality Commission that there had not been a manager in post since December 2015 and stated they were in the process of recruiting to the post. In the interim the provider was acting as the manager.

People covering the manager’s duties were not clear on their roles, leading to poor monitoring of some aspects of administration. Training was not up to date. Safer recruitment guidance was not consistently followed. Staff were working long hours and did not always have adequate breaks between shifts.

Some data management records were inconsistent, unclear and not easily accessible. Audits and maintenance checks were not routinely being carried out.

Policies and procedures had been reviewed but the content had not been updated to reflect current legislation.

There were risks to people’s wellbeing as the environment was not always well maintained. A number of rooms had mould. Not all rooms, including toilets, were thoroughly cleaned.

Since the last CQC inspection, The Fire Authority carried out an inspection in July 2015. The service implemented the recommendations, however not all emergency routes were clear and / or accessible. Additionally staff we spoke to could not give a clear indication of how a single member of staff would evacuate service users during the night in the event of a fire.

On 19 March 2016, the provider responded to a request for further information on the above issues around the environment and advised a number of rooms had been redecorated which addressed the above concerns and the fire routes had been made accessible.

There were good individual risk assessments in place and an appropriate number of staff on duty. Files indicated staff supported people to attend regular medical appointments. Staff administered and stored medicines safely.

The people who used the service were involved in a number of activities in the community and feedback received from other professionals was positive. Relatives were also positive about the service. Staff were caring and person centred.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA) for one person who used the service. The manager agreed to seek advice on making a DoLS application for a second person.

Staff knew the needs of the people who used the service and there was a family atmosphere in the home. People using the service were given choice and involved in day to day decisions. Care plans were up to date and reviewed within the last year.

We found two breaches in 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 the report.