Rose Cottage

Rose Cottage is a residential care home providing personal care to adults, some of whom may be living with dementia or have physical disabilities. At the time of the inspection there were 12 people using the service. Rose Cottage can support a maximum of 16 people. Accommodation is provided over two floors with stair lift access to the first floor.

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

People and relatives were positive about the service and reported noticeable improvements in the home and the quality of care provided. Staff were described as kind, caring and respectful.

Quality assurance systems had been improved and these were now effective in identifying and addressing shortfalls. The manager and provider were working in a joined-up way, promoting consistency in practice and expectations, and driving the quality of care through effective leadership.

Medicines were managed safely, and people were in receipt of safe care and treatment. The provider had identified, assessed, and mitigated risks to people. People’s care records were up to date and reflective of their needs. The home was clean and well maintained.

Safeguarding processes were followed, and accident and incident analysis were effective. There was enough staff to meet people’s needs safely. Recruitment processes had been improved and were safe and robust. Staff had received all the necessary training to do their jobs safely and effectively.

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. People received a choice of meals, snacks and drinks and the dining experience was relaxed and inclusive. Activities were taking place which were suitable to people’s abilities and interests.

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 inadequate (published 27 July 2023) and there were breaches of regulation. 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 and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 August 2023. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Rose Cottage on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rose Cottage is a residential care home providing personal care for up to 16 people some of whom may be living with dementia or have physical disabilities. At the time of our inspection there were 14 people using the service. Accommodation is provided over two floors with stair lift access to the first floor.

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

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks. Some areas of the home were not clean or well maintained and infection control was not well managed.

Medicines were not managed safely. There were not enough staff to meet people’s needs and keep them safe. We were not assured staff had received the training they needed for their roles. Recruitment processes were not thorough. People’s dignity was not always maintained and they were not always treated with respect. People’s care records were not always accurate and fully reflective of people’s needs.

There was a lack of consistent and effective leadership and quality assurance systems were not effective in identifying and addressing issues.

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

Safeguarding processes were followed. Accident and incident reporting and analysis had improved. People received a choice of meals, snacks and drinks and the dining experience had improved. There were some activities taking place.

People and relatives were generally positive about the service. Staff were described as kind and caring. People had access to healthcare services.

The provider took action during the inspection to address some of the issues we raised.

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 29 November 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, recruitment, dignity and respect and good governance at this inspection.

We made referrals to the local authority safeguarding team regarding concerns we identified during the 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Rose Cottage is a care home providing personal care to adults living with dementia, and people with physical disabilities. At the time of the inspection there were 15 people using the service. Rose Cottage can support a maximum of 16 people.

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

People were not always safe. Medicines were not always managed safely.

Risks to people were not always managed and some care plans were not reflective of people’s current needs. Infection prevention and control was not properly adhered to or managed with a lack of daytime cleaning.

Staff had been recruited safely but there was not always enough staff to keep people safe.

People’s nutritional and hydration needs were not always met and were not being monitored effectively. Portion sizes of food were small, with no choice offered to people on what meals were available to them. Staff told us the home regularly ran out of essentials. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. We found no evidence of best interest decisions or consents being gained for sensor mats which were in place for multiple people, despite this being a restrictive practice.

The service was not always well led. Governance systems to monitor quality and safety were not effective. Audits were completed and sometimes identified shortfalls found on inspection, but no action had been taken to rectify the issues.

The provider gained feedback from people and relatives and maintained effective communication.

People were generally positive about the staff that cared for them in the service. Relatives were positive about the care provided to their family member. Staff feedback varied about the quality of the service provided and staffing levels.

The service worked with other professionals to benefit the people in the service.

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 1 December 2021) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by information of two incidents following which two people using the service died. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of pressure damage and risk of unreported falls. This inspection examined those risks.

We also undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We inspected and found there was a concern around nutrition and hydration and mental capacity assessments not being completed, so we widened the scope of the inspection to include the key questions of safe, effective and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment, medicines management, infection prevention and control, consent to care, nutrition and hydration and good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rose Cottage is a care home providing personal care to adults living with dementia, and people with physical disabilities. At the time of the inspection there were 13 people using the service. Rose Cottage can support a maximum of 16 people.

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

People were not always safe. Medicines were not managed safely. Risks to people were not assessed and managed. Infection prevention and control was not properly adhered to. Lessons were not always learned when things went wrong. There were enough staff to keep people safe.

The service was not always well-led. Governance and systems to monitor quality and safety were not effective. Audits were not always done and did not always identify issues found on inspection.

People were generally positive about the staff that cared for them in the service. Relatives were positive about the care provided to their family member. Staff feedback varied about the service and staffing levels; however they were all complimentary of the manager in post. The service worked with other professionals to benefit the people in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (published 24 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, staffing levels and risks to people. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe 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 Rose Cottage 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, management of risks, infection prevention and control, good governance 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 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.

Rose Cottage is a residential care home providing personal care to people aged 65 and over. The home accommodates up to 16 people in one adapted building located in the centre of Thornton near Bradford. At the time of the inspection there were 14 people at the home.

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

People and relatives all told us that the service provided high quality and personalised care that met people’s individual needs and requirements.

Systems were in place to protect people from harm. Medicines were managed in a safe and proper way to ensure people received them as prescribed. Overall there were enough staff to ensure appropriate care. The provider increased evening staffing levels in response to our inspection. Staff were recruited safely. The home was clean and well maintained.

People received effective care and experienced good outcomes. Staff received good quality training relevant to their role and felt well supported. People were provided with a variety of food which was cooked fresh on the premises. People’s healthcare needs were assessed and well managed in conjunction with local professionals.

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.

Staff treated people with kindness and compassion. Staff knew people well and their likes and preferences. People were listened to and cared for in a dignified way. People’s independence was promoted, including staff encouraging people to keep active.

People’s care needs were met by the service, with good quality personalised care provided. People had a range of social opportunities available to them and the service had developed good links with the local community. Concerns and complaints were acted on in a positive way.

People, relatives and staff praised the way the service was managed. They said the management team were helpful and approachable. There was an open and inclusive atmosphere within the home with all levels of staff dedicated in providing personalised care. The provider and manager undertook checks to help continuously improve the service.

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 23 August 2018) and there were two breaches of regulation. 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in April 2017 we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. This was because risks associated with skin integrity were not assessed or mitigated. At this inspection we found improvements had been made in this area. We found routine care to be very good, delivered in a friendly and personalised environment. Staff knew people very well. However, we found some issues with how staff were recruited and improvements were needed to medicine management practices and working practices in relation to the Mental Capacity Act (MCA). Because of this the provider continues to be rated as ‘Requires Improvement.’

A registered manager was not in place. A manager was in place who had put in an application to become the registered manager for the service. 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 said they felt safe living in the home. Risks to people’s health and safety were assessed and mitigated. Where incidents had occurred, action was taken to help prevent a re-occurrence.

We found there were enough staff deployed to ensure people received the required care and support, although there were periods when staff did not have time for much social interaction with people.

Recruitment practices were not always safe. The required checks and documents were not always completed before recruitment decisions were made.

The premises was safely managed and suitable for its intended purpose. It had been adapted to meet people’s individual needs and requirements.

Most people received their medicines as prescribed, although some practices needed improving to ensure medicines were consistently managed in a safe way. We made a recommendation relating to medicines management.

People received a range of training and support to help ensure they could meet people’s needs. Staff said they felt well supported in their role. We made a recommendation around ensuring the manager kept up-to-date with the latest guidance and best practice.

Improvements were needed to working practices to evidence the service was fully compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). We made a recommendation regarding this.

People’s nutritional needs were met by the service. People had access to a suitably variety of food. Where nutritional risks were identified appropriate action was taken to protect people from harm.

The service worked effectively with a range of health professionals to help ensure people’s healthcare needs were met.

Staff were kind and caring and treated people well. Staff knew people very well and delivered personalised care and support that met their individual needs. People were listened to and their views were acted on.

People’s needs were assessed prior to admission and a range of appropriate care plans developed. People said their care needs were met by the service.

People’s complaints were taken seriously by the service, appropriately responded to and used to further improve the service.

People, relatives and staff said the service provided good care. We found a friendly and inclusive atmosphere within the home. Care was personalised and people were cared for by familiar faces.

Improvements were needed to the way the service was managed to ensure consistent compliance with the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. We saw evidence some checks and audits had been effective in identifying and actioning areas for improvement.

People’s feedback was sought and valued and used to make improvements to the service.

The inspection took place on the 5 April 2017 and was unannounced. On the date of the inspection 14 people were living in the home.

A registered manager was not in place. A manager had recently been recruited who was in the process of going through the application process to by the 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in October 2014, we rated the service ‘Good’ overall. At this inspection, we rated the provider “Requires Improvement” overall. Although we saw some areas of the service had positively developed since the last inspection, such as increased social opportunities and the person centred approach to care, we found issues relating to; a lack of robust risk assessments and lack of evidence of compliance with the Mental Capacity Act. These issues meant we could not rate the service better than ‘Requires Improvement,’ despite there being a highly person centred approach to care and support and a kind, caring and stable staff team.

People and relatives were highly satisfied with the care and support provided by the home. They praised the personalised and individual approach provided by the staff and management team.

People told us they felt safe and secure living within the home. Safeguarding procedures were in place which were well understood by staff.

Overall, medicines were safely managed. People received their medicines as prescribed. However, protocols were required detailing how and when to give ‘as required’ medicines.

Risk assessments and updated care plans relating to pressure area care, nutrition and bed rails were not always in place increasing the risk of harm to people.

The premises were warm and homely and suitable for the intended purpose People were able to personalise their rooms. The building and equipment were kept well maintained.

There were enough staff deployed to ensure people received prompt and timely care. Staffing levels were subject to regular review. Safe recruitment procedures were in place.

Staff received a range of training and support relevant to their role. Staff said they felt well supported by the management of the service.

Improvements were required to ensure the service could evidence it was fully acting within the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLs) legislation.

People had access to a range of suitably nutritious food including regular snacks. People praised the food and said it was tasty with suitable choice. Charts recording people’s food and fluid intake were not always properly completed.

People had access to a range of external health professionals to help ensure their healthcare needs were met.

People and relatives told us staff with very kind and caring. This was confirmed by our observations of care and support. We saw staff knew people very well and provided personalised care and support. All staff, including the management team, showed kindness and compassion towards the people they were caring for.

People were listened to and their views respected by the service.

People’s needs were assessed and plans of care put in place which were understood by staff. People’s individual and varying needs were taking into account to develop plans of care that met people’s emotional and social needs.

People had access to a range of activities which included trips out and maintaining links with the local community.

A system was in place to log, investigate and respond to complaints.

Systems to assess and monitor the service were in place. However, these had not been sufficiently robust as they had failed to prevent some of the shortfalls we identified from occurring, for example, relating to risk assessment processes.

People’s views were recorded and used to make positive changes to the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.