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Archived: Rossmore Nursing Home Good

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Reports


Inspection carried out on 24 25 February

During an inspection looking at part of the service

This was an unannounced inspection undertaken on the 24 and 25 February 2015.

The service was last inspected on the 21 and 25 July 2014 and found to be none compliant with some of the regulations looked at.

Rossmore Nursing Home is a series of converted large terraced houses in a residential area of Hull, close to local amenities and public transport. Nearby on street parking is available, however, this is permit parking and limited during specified hours of the day.

The service is registered with the Care Quality Commission (CQC) to provide care for up to 56 people who require nursing care and maybe living with dementia. The service also provides, in conjunction with Hull and East Yorkshire Hospitals NHS Trust, a stroke rehabilitation service.

At the time of the inspection there were 35 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Following the last inspection the registered provider was found to be none compliant with regulations pertaining to infection control and cleanliness of the building. Since the last inspection the registered provider had changed the way the domestic staff worked and they now monitored the building and undertook daily audits of the cleanliness of people’s rooms and communal areas. Domestics also came on duty during the evening to clean communal areas such as the lounges. Improvements had also been made to the décor of people’s bedrooms. This meant people who used the service lived in a well maintained and safe environment.

Following the last inspection the registered provider was found to be none compliant with regulations pertaining to staffing levels and staff training. Following the previous inspection the registered provider had increased staffing levels and made sure enough staff were on duty to meet people’s needs. The registered provide had also improved the training the staff received and had provided more specialists training. Staff training was monitored as part of the auditing processes in place. This ensured people were cared for by staff who were provided in enough numbers and had the right skills to meet their needs.

Following the last inspection the registered provider was found to be none compliant with regulations pertaining to the administration of people’s medicines. Since the last inspection the registered provider had put systems in place which addressed the issues identified at the last inspection; these were ensuring people received their medicines on time, employing senior staff who took responsibility for administering medicines along with the nursing staff and improvements to the training staff received. This meant people received their medicines on time and as prescribed by their GP.

Following the last inspection the registered provider was found to be none compliant with regulations pertaining to the way complaints were dealt with. The registered provider had put systems in place which addressed the issues identified at the last inspection; these were, recording what the complaint was, how it had been investigated and whether the complainant was satisfied with the way the complaint had been investigated. The registered provider’s complaint procedure had been revised and displayed around the service. This meant people who used the service, or any others who had an interest in the care and wellbeing of the people who used the service, were able to raise concerns and complaints about the quality of the service and these were investigated and resolved to the complainant’s satisfaction wherever possible.

Following the last inspection the service was found to be none compliant with regulations pertaining to the way the service was monitored and audited. The registered provider had implemented a range of audits which ensured the service was safe a well-run; these included environmental audits, staff training audits and care plan audits. People who used the service, their relatives, staff and visiting health care professionals had been asked for their views about how the service was run, their views had been collated and action plans put in place to address any shortfalls identified.

People were cared for by staff who had been recruited safely and understood the importance of reporting any abuse they may witness or become aware of. People’s needs had been recorded; these were detailed to help staff care for them as they would like and prefer. Assessments were in place which ensured people were not exposed to unnecessary risk in their daily lives. People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005.

People were provided with a wholesome and nutritional diet which was of their choosing. People’s dietary intake was monitored and staff made referrals to health care professionals when required. People’s weight was monitored on a regular basis; people were supported to lead a healthy lifestyle and to access their GP and other health care professionals when they required.

A range of activities were provided for people to choose from and they were supported to access the local community.

People had good relationships with staff who understood their needs and staff were sensitive and caring when undertaking their duties. Staff respected people’s choices and supported them to lead a life style of their own choosing.

Inspection carried out on 21 and 25 July 2014

During a routine inspection

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. This was also part of a pilot for the new inspection process being introduced by CQC. The inspection was unannounced.

Rossmore Nursing Home provides accommodation and nursing care for up to 56 people accommodated over two floors in a series of large terraced houses. The home also provides a stroke rehabilitation service for up to 12 people. The stroke rehabilitation unit operates as a separate facility on behalf of the Hull Clinical Commissioning Group (CCG).

The home had a registered manager who had been registered since November 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Before this visit we had received information of concern about staffing levels at the home, especially at night, staff training and people’s care, treatment and support needs not being met. During our visit we found evidence to support this information.

We found systems and processes to keep people who lived at the home safe were unsafe in that people were not protected from the risks associated with the unsafe use and management of medicines. Medicines at the home were not handled safely, securely and appropriately. The problems we found breached Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People were not protected from the risk of infection because appropriate guidance had not been followed. People were not cared for in a clean and hygienic environment. The problems we found breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. This included care records and records relevant to the management of the service. Documents held by the home were frequently found not to be up to date or were absent. These included policies and procedures, management records, meeting minutes, accident and incident reports, supervision and appraisal records, audit records and complaints. The problems we found breached Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

There were not enough qualified, skilled and experienced staff to meet people’s needs safely and in a timely manner. The problems we found breached Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Training for new and existing staff required improvement to ensure they had the skills and knowledge required to carry out their roles. Staff did not receive appropriate professional development, supervision and appraisal. The problems we found breached Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Assessment and monitoring of the quality of the service provided was inadequate and the issues we found during the inspection had not been identified by the provider. There was no evidence of follow up of audits and satisfaction surveys or any systems or processes in place to demonstrate to us the home had an effective quality management system. The complaints system was not effective; comments and complaints people made were not responded to appropriately. The problems we found breached Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The design, layout and lack of maintenance of the home’s premises and surrounding grounds did not promote people’s wellbeing.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards and had recruitment processes in place which protected people from unsuitable or unsafe staff.

The home was meeting people’s nutritional needs; people were supported to ensure they had enough to eat and drink. People told us the food at the home was good and they got a choice.

People we spoke with and their relatives told us they were happy with the care provided at the home and people’s care and treatment needs were being met. From our observations, and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people’s preferences and care and support needs.

Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect. People were supported by staff to maintain their privacy, dignity and independence. We saw most people looked clean and well-cared-for. People had access to activities and relatives and friends were able to visit the home at any time.

People were supported to access external healthcare professionals as and when required. The local GP visited the home once a day and physiotherapists and occupational therapists came to the home every day to work in the stroke rehabilitation unit.

Inspection carried out on 3 July 2013

During a routine inspection

People�s capacity to make an informed choice or decision had been assessed. People�s preferences and personal choices had been recorded and where people found it difficult to make an informed choice or decision, systems were in place which protected the person�s rights.

We found that information was available for staff to follow which ensured people received care which was of their choosing. People told us they liked living at the home, comments included, �It�s like being at home they are all really friendly�, �Staff know what to do with my leg, they come and massage it if I ask them to� and �I just press my buzzer and the staff come and help me.�

There were systems in place for the reporting of abuse the staff may witness or become aware of and staff had received training about how to protect vulnerable adults.

There was enough staff on duty who had received training to meet the needs of the people who used the service. People told us, �There is always some about to help you when you want it.�

A complaint procedure was in place and people were aware they could use it if they had any concerns or worries; people told us, �I would see the manager or the owner if I had any complaints.� Relatives spoken with were also aware of the complaint procedure.

Inspection carried out on 21 November 2012

During a routine inspection

We spoke with people who used the service, all of whom expressed their satisfaction, including involving them in decisions about their care. One person told us that "they know what I want, when I want it and when they can, they manage to do it." Another person told us that they were glad they could stay at the home rather than move on.

We found that care records for the nursing home included assessments, including risks to be managed, and these were used to inform planning of care. However, records for the stroke unit were not the nursing home's records but those held by The Hull and East Yorkshire Hospitals NHS Trust, which made it difficult to ascertain which provider was responsible for their care.

The premises were clean and tidy, although storage sometimes compromised access to hand wash sinks. There was evidence to show staff were trained in and aware of infection issues. We saw that staff numbers had been consistently to the standard the provider planned for in recent times and there was provision to cover for absences without approaching outside agencies.

The provider had an adequate system of quality assurance, including seeking views of those receiving care and staff. Reviews of care plans and audits informed management decisions.

Reports under our old system of regulation (including those from before CQC was created)