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Rose Hill Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 August 2018

The inspection took place on 13 and 18 June 2018 and was unannounced. There was a registered manager in post, however they were not present on the first day of our inspection. We returned on a second day to obtain some further information from them to complete our inspection.

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.

Rose Hill is a care home, registered to provide nursing care and accommodation for up to 35 people. One the day of our inspection there were 24 people at the service, including some people on short term or respite care.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At Rose Hill, the accommodation is arranged over two floors. A passenger lift provides access to the first floor. Rooms are single occupancy and some have en-suite facilities. There is a large garden to the side and rear of the service.

At our last inspection, in November 2015, the service was then rated as “Good”. However, at this inspection we found there were some aspects of the service that needed to be improved.

The premises needed to be made safer for people living with dementia. In particular, all windows were required to be risk assessed and made secure with restrictors that comply with Health and Safety regulations.

There were also parts of the building where cleanliness needed to be addressed, for example in the laundry and sluice rooms that staff used. The physical environment was not decorated to a consistent standard, and in some bedrooms the bedding and carpets looked stained.

Staffing levels were adequate and people’s needs were met. However, we were told that staffing levels were based on the numbers of people living at the home. We have made a recommendation to the registered provider to also take into account the needs of people to ensure there are always sufficient staff.

Medicines practice was safe and well administered. We noted a gap in recording and protocols that affected a small number of people. These have been corrected since the inspection.

Whilst people were involved in decisions about their care, staff understanding of the legal basis for consent was limited. We could not find sufficient evidence that the service was acting in line with the legal requirements of the Mental Capacity Act 2005 (MCA). There were gaps in people’s records on mental capacity assessments and where decisions were taken in a person’s best interests.

People’s needs had been assessed to provide effective health and social care. Information about people was stored on a relatively new care management system. People’s personalities and needs were known by staff, but some individual care records needed to be updated.

We heard positive feedback about the way the service was managed from staff and relatives, but there were aspects of service governance that needed improvement. The quality assurance system was not effective in reviewing the quality of the service provided. Audits did not identify any actions to mitigate the risks or address the shortfalls we found. Learning from accidents and falls across the service was not developed.

People were looked after by staff who were kind and caring. We heard from relatives who praised the kindness and attention that was shown. However, some staff did not communicate as well as others and appeared task focused. We have made a recommendation to the registered provider that all staff are supported to communicate to a required standard of English.

Staff were trained (apart from in the Mental Capacity Act), supervised and su

Inspection areas

Safe

Requires improvement

Updated 2 August 2018

The service was not always safe.

People were not adequately protected from the environmental risk of falling, or leaving the building unsupervised, by a window.

Staff were aware of infection control measures but cleanliness in some parts of the home needed to be improved.

Staffing levels were adequate. Staff were recruited and managed safely.

People felt safe and staff knew how to identify and report abuse.

People received their medicines safely.

Risk assessments for people were in place and staff were aware of risks.

Effective

Requires improvement

Updated 2 August 2018

The service was not always effective:

People’s consent was sought by staff, but the service was not acting in line with the legal requirements of the Mental Capacity Act 2005 (MCA).

The premises met the needs of those who lived there, but some improvements were needed.

People’s needs were assessed to provide effective health and social care.

Staff had access to training and were supported and supervised to carry out their role.

People had enough to eat and drink throughout the day and their nutritional needs were being met.

People had their healthcare needs met and referred to a specialist if needed.

Caring

Requires improvement

Updated 2 August 2018

The service was not consistently caring.

People were treated with kindness.

Some staff were limited in their interactions with people and focused on tasks rather than the people.

People’s independence was promoted, and their privacy maintained

People, and their relatives, were supported to be involved in decisions about their care.

Responsive

Good

Updated 2 August 2018

The service was responsive.

People received care and support that was responsive to their wishes and needs.

People were supported to undertake activities daily.

People’s communication needs were identified and understood.

People and their relatives knew how to complain and raise any concerns.

End of life care plans were in place.

Well-led

Requires improvement

Updated 2 August 2018

The service was not always well led.

Quality audits were done but were not sufficiently robust to pick up shortfalls.

The records were not always accurate or up to date.

Learning from accidents, incidents and falls was not always evident.

The management was accessible and relatives and people were encouraged to give feedback.

The service had established links with the local services and networks.