Background to this inspection
Updated
8 March 2024
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out over 2 days by 2 inspectors. An Expert by Experience also attended on the first day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Roop Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with 8 people who lived in the home and 2 relatives. We spoke with 9 staff, as well as the acting manager and the regional manager. We also spoke with a visiting professional. We reviewed a range of records. This included 5 people’s care records, plus additional care plans for specific information, as well as medication records. We looked at a variety of records relating to the management of the service.
After the inspection
We continued to seek clarification from the provider in support of the inspection.
Updated
8 March 2024
About the service
Roop Cottage is a care home providing residential care to up to 35 people. At the time of the inspection there were 19 people living in the home.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Support: People’s choice and independence were not maximised. Where people had a learning disability, there was no engagement with them about where or how they would like to spend their time.
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.
Right Care: Care was not person-centred and did not promote people’s dignity or human rights.
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people were leading confident, inclusive or empowered lives. Leadership and management was not robust. There was a high turnover of managers and the manager appointed since the last inspection was no longer working in the home.
Risks to people had not been assessed or addressed and there was little evidence of lessons learned from previous inspections. People had been received into the service without adequate assessment of their risks or care needs. There was limited evidence of action taken to address care and safety concerns raised with the provider since they took over this home. These issues included: leadership in the home, systems to ensure the safe management of medicines, person centred care, risks in the environment, and safe recruitment.
Mealtimes were based around staff availability and not personalised to the times when people preferred them. People were not always supported to have a drink until breakfast after 9am, although many people were awake much earlier. There had been a continuous lack of action from the provider to resolve this since they took over the service in 2021. People’s dietary needs were not safely managed to mitigate risks in relation to malnutrition, dehydration, choking and diabetes.
Staff had received some training, but this was not sufficient to meet the needs of people being cared for at Roop Cottage. No staff had completed training to support people with a learning disability and only 1 member of staff had completed dementia awareness training.
Care provision was not managed around people’s needs and preferences. Some people were not supported to come out of their rooms and there was a lack of meaningful activity. There was disregard for people's privacy, dignity and independence. Recording of people’s care and needs lacked detail and was of poor quality.
Some staff knew people well and had established caring relationships with them. Staff interaction was kind and patient when carrying out care tasks.
At our last inspection of the responsive key question, we recommended that the provider works with relevant partners to ensure staff receive suitable training in end of life care and support, and people have well developed care plans in this area. At this inspection, this recommendation had not been acted upon. No staff had received any training for end of life care and care plans were not reflective of people’s wishes.
During feedback following the inspection, the provider showed us some developing systems and processes, intended to make the management of the service more robust. However, these were in the early stages of development and not yet implemented.
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 11 August 2023). 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 due to concerns received about people being unkempt and remaining in their rooms, poor management of choke risks, dietary needs, weight loss, diabetes, pressure care, privacy, dignity and cleanliness of the environment. A decision was made for us to inspect and examine those risks.
A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with person-centred care, so we widened the scope of the inspection to look at all 5 key questions, which included; safe, effective, caring, responsive and well-led.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report.
We have identified breaches in relation to person centred care, privacy and dignity, people’s safety, safe recruitment, staff training and management of the service 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
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.