Background to this inspection
Updated
16 March 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The inspection was prompted in part by information of concern regarding people’s care and welfare.
Prior to the inspection we reviewed the information we held about the service. This included looking at statutory notifications. A notification is information about important events which the provider is required by law to send us. We spoke with local authorities and health clinical commissioning groups who commission the service and local safeguarding teams. We also spoke with other health and social care professionals to obtain their views. We used this information to help inform our inspection.
The inspection was unannounced and consisted of a team of three. On the 16 January 2017 the team included two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the 17 January 2017 one inspector returned to the service.
During the inspection we spoke with five people using the service, three visiting relatives and two visiting professionals. We spoke with five members of staff including the acting manager, care staff, kitchen staff and the provider’s auditor. We looked at the care plans and records for all 13 people using the service and eight staff records.
Not everyone at the service was able to communicate their views to us so we used the Short Observational Framework for Inspection (SOFI) to observe people’s experiences throughout the inspection. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
As part of our inspection we looked at records and reviewed information given to us by staff. We looked at care plans and records for people using the service, medicine records and records related to the management of the service including audits and incidents logs. We also looked at areas of the building including communal areas and outside grounds.
Updated
16 March 2017
This unannounced inspection was carried out on 16 and 17 January 2017. This inspection was prompted in part by a notification of incidents and concerns regarding people’s care and welfare. These incidents are subject to a criminal investigation and as a result this inspection did not examine the circumstances of these incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk and safe care and treatment of people using the service. This inspection examined those risks.
Rosecroft Residential Care Home is a small care home that provides personal care and support for up to 20 people and it is located in the London Borough of Bromley. At the time of our inspection the home was providing care and support to 13 people. The home had a registered manager in post who was not present at the time of the inspection; however an acting manager was in place at the time of 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.
At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014. We took urgent enforcement action to impose conditions to restrict new admissions to Rosecroft Residential Care Home. We required the provider undertakes audits of medicines, risk assessments, care plans and records of care delivery for people using the service, systems for staff recruitment and an action plan of the training of all staff at Rosecroft Residential Care Home. The provider must tell CQC any action they have taken or will take as a result of the audits. The provider must continue to provide us with such reports following each and every audit undertaken in respect of these matters.
For time periods since the last inspection we found that medicines were not managed, administered, recorded and stored safely and appropriately. Risks to people’s physical and mental health needs were not assessed, monitored and reviewed in line with the provider’s policy. Accidents and incidents were not recorded and acted on appropriately. Safeguarding adult’s policies and procedures were in place to help protect people from possible harm; however concerns had not been reported to local authorities and the CQC in line with best practice and the law. Staff recruitment practices in place were not robust and appropriate recruitment checks were not always conducted before staff started work to ensure applicants were suitable to be employed in a social care setting. There were arrangements in place to deal with foreseeable emergencies and staff knew what to do in the event of a fire or a medical emergency, however there were no up to date fire drills and evacuations conducted. There were no records of maintenance checks or repairs in place to monitor the safety of the environment and equipment.
Staff had not received appropriate regular training to meet the needs of people using the service. There were no records or systems in place to show that staff new to the home had completed an induction into the service in line with the Care Certificate. The Care Certificate sets out learning outcomes, competencies and standards of care that are expected of all care workers. Staff had not received appropriate support, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. People’s mental capacity and consent was not always assessed in line with the MCA and were not always decision specific. People’s nutritional needs were not always assessed and met appropriately. People did not always receive the support they required to access health and social care services.
People's care and support needs were not always reviewed in line with the provider’s policy on a monthly basis and in response to people’s identified needs. People and their relatives told us there was not always enough stimulation and activities on offer at the home. Although there were policies in place to manage and responded to complaints, complaints records were not appropriately recorded or maintained.
People told us that staff currently working at the service were kind and respectful and supported them appropriately but we found this had not been consistently the case. Staff respected people's choice for privacy and promoted their dignity when offering support. Staff showed their knowledgeable about people's needs and supported people appropriately. People were supported to maintain relationships with their families and friends and their independence when venturing out was encouraged. People and their relatives told us they were provided with information about the home in the form of a service user guide.
People and their relatives told us of the recent instability in staffing and leadership at the home and how this had an impact on the care provided. Staff meetings were not held and recorded on a regular basis to ensure safe practice and leadership. Resident meetings were not held on a regular basis and there were no action plans or records in place to show how people’s comments had been addressed. Audit checks had not been conducted within the home prior to the arrival of the acting manager to assess, monitor and improve the quality and safety of the service. Audits that were conducted failed to identify and address concerns and issues and although the provider had sought feedback from people using the service there was no action plan in place or records to show that people’s comments or requests for service improvements had been addressed. The provider failed to notify the CQC as they are required to do, of significant events in order that CQC can monitor the service.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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.