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 supported to undertake their caring role. The provider had carried out appropriate checks on staff to ensure that they were suitable for their roles.
People were looked after by staff who knew about keeping people safe from abuse. There was evidence that risks to people were assessed. Staff knew people well enough to ensure they took actions based on risks and needs. Staff practiced infection control measures when caring for people. There was a plan in place to deal with emergencies.
People had enough to eat and drink throughout the day and their nutritional needs were being met. Meal time was positive with people enjoying their food. The cook was responsive to individual needs and knew about any dietary risks.
Healthcare professionals and specialists were involved in people’s care to monitor and to meet their health needs.
People were supported to undertake daily activities of their choice. There was also a clear programme of events and good use was made of the attractive garden for the benefit of people living at the home.
People could find their way in the building and the premises met the needs of those who lived there. People were enabled to be as independent as possible and their privacy and dignity was maintained by staff.
A complaints process was in place and this was followed. Where concerns by relatives had been raised, these were responded to and changes had been made. The management was accessible and responsive to people.
There was an end of life care plan in place for everyone. The service had established a link with the hospice and had experience of caring for people at the end of their lives.
We received positive feedback about how the service was managed from relatives, staff and visiting professionals. The staff and managers demonstrated they worked well together and were committed to the people in their care.
People and their relatives were encouraged to give feedback on the care and the service.
The service had some good partnerships with local services in order to support people’s healthcare. The registered manager attended local provider forums and was exploring ways the service could improve.
During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made five recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of this report.