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Archived: Rosecroft Residential Care Home Inadequate Also known as Rosecroft Residential Care Home

Reports


Inspection carried out on 16 January 2017

During a routine inspection

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 suppo

Inspection carried out on 20 and 21 August 2015

During a routine inspection

This inspection took place on 20 and 21 August 2015 and was unannounced. We had previously carried out an unannounced comprehensive inspection of the service on 14 July 2014 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2010). These were in relation to assessing and managing risks to people, meeting the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, staffing levels, recruitment, induction and staff supervision and appraisals. People’s nutritional needs were not always met and care and support was not always reviewed in line with the provider’s policy. There were no systems in place for monitoring the quality of the service and records were not accurate or fit for purpose and could not be located promptly when required.

Following the July 2014 inspection we had served a warning notice on the provider in relation to the more serious breaches found. We carried out a focused inspection on the 6 November 2014 and found the provider had met the requirements of the warning notice. At this inspection on 20 and 21 August 2015 we followed up the other breaches identified in the July 2014 inspection and found that action required to meet the regulations had been taken and improvements to the service had been made.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider. Rosecroft Residential Care Home provides personal care support and accommodation for up to 20 older people. At the time of our inspection there were 13 people using the service.

There were enough qualified staff deployed within the home to meet people’s needs safely and to an appropriate standard. Staff received training and supervision on a regular basis including annual appraisals in line with the provider’s policy to enable them to carry out their duties appropriately.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. People were protected from the risk of abuse because staff had received training that enabled them to identify the possibility of abuse and take appropriate actions to escalate concerns. Staff had good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and authorisations for DoLS were in place where appropriate. Medicines were stored, recorded, managed and administered safely.

Assessments were completed of people’s physical and mental health needs and risk assessments were completed. Care plans documented guidance for staff that ensured risks were minimised. Accidents and incidents involving people using the service were recorded and acted on appropriately and there were arrangements in place to deal with foreseeable emergencies.

People were supported to eat and drink sufficient amounts to meet their needs and where appropriate people’s food and fluid intake was monitored to ensure well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required. Staff had positive relationships with people and treated people in a respectful and dignified manner.

Care plans demonstrated people’s care needs were regularly assessed and reviewed in line with the provider’s policy and daily records were kept by staff about people’s day to day wellbeing and activities to ensure that people’s planned care met their needs.

People were provided with information about how to make a complaint and we saw information displayed throughout the home for people to access. There were systems in place to monitor and evaluate the service provided and the home took account of people’s views with regard to the service they received.

Inspection carried out on 6 November 2014

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 14 July 2014 at which breaches of legal requirements were found. We took enforcement action and served a warning notice on the provider in respect of a serious breach requiring them to become compliant with Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations by 10 October 2014. The provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 20.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Rosecroft Residential Care Home’ on our website at www.cqc.org.uk’

We undertook this focused inspection on the 6 November 2014 to check the provider had complied with this regulation.

This report only covers our findings in relation to the follow up on the breach of regulation 20 for records. We have asked the provider to send us an action plan telling us how and when they will become compliant with the other breaches. These breaches will be followed up at our next comprehensive inspection of the service.

Rosecroft Residential Care Home is located in the London Borough of Bromley and is registered to provide accommodation and personal care for up to 20 older people most living with dementia.

At our focused inspection on the 6 November 2014 we found that action had been taken by the provider to improve the care plans and records referred to in the warning notice. The home had implemented a new electronic care plan system which detailed people’s needs and risks and provided staff with guidance to support people to meet their identified needs. Care plans we looked at were comprehensive and up to date.

Records relating to staff inductions were available and up to date. Staff supervision and team meetings were held on a regular basis and records we looked at confirmed this.

Inspection carried out on 14 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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Rosecroft Residential Care Home is located in the London Borough of Bromley and is registered to provide accommodation and personal care for up to 20 older people mostly with dementia. There were 15 people living at the home when we visited.

This was an unannounced inspection. During our inspection, we spoke with ten people living at the home, two groups of visiting relatives, three members of care staff, one kitchen assistant, the deputy manager and the registered manager. 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.

We carried out three inspections in April, June and August 2013.  At the April inspection we had concerns about the standards of care in the following areas; care and welfare of people using services, management of medicines, supporting staff, records management and how the quality of the service was assessed and monitored. We carried out a “follow up” inspection in June. Although we found some improvements had been made we still had concerns in relation to the care and welfare of people using services and the management of medicines.  We took enforcement action against the provider.  We carried out a further “follow up” inspection in August 2013 and found that the provider had made the improvements required.

People told us they were happy living at the home and their relatives told us they felt their family members were well looked after. People said the staff were “good” and that they had no concerns. We observed positive interactions between staff and people using the service. We saw that staff treated people with kindness and respected their privacy and dignity.

Systems were in place to protect people from potential harm or abuse and staff we spoke with knew of their responsibility to safeguard people.

We found that healthcare professionals such as general practitioners (GPs), dentists and district nurses were involved in people’s care and treatment. However, there was no evidence to demonstrate that people and their relatives were involved in making decisions about the care that they received. Staff did not always follow the requirements of the Mental Capacity Act (2005), and people’s liberty may have been restricted unlawfully, without regard to the Deprivation of Liberty Safeguards (DoLS). 

We found that people’s healthcare needs were assessed and each person had a care plan. However, where risks were identified, appropriate risk assessments and management plans were not always in place. Appropriate support was not in place to ensure people ate sufficient amounts to maintain a healthy lifestyle. .

There were arrangements to deal with potential emergencies and staff were aware of actions to take in the event of an emergency.

Staff we spoke with told us there was not always enough staff members available to safely meet people’s needs. We found that appropriate support was not always in place for staff in areas such as induction, supervisions, annual appraisals and team meetings.

We found a number of breaches 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 this report.

Inspection carried out on 6 August 2013

During an inspection to make sure that the improvements required had been made

At our inspection on 06 August 2013 we followed up compliance and enforcement action that we had taken following our inspection on 07 June 2013. We had asked the provider to make improvements to the management of medicines within the home. We also required that they make improvements to the way in which people's care was planned in order to ensure their safety and welfare.

People we spoke with told us they were satisfied with the care they received in the home. One person told us "I'm well looked after" and that they had no concerns. Another person told us they were "very well" and that they were enjoying their day. Everyone we spoke with presented themselves in a positive mood and appeared happy when interacting with staff.

We found that improvements had been made to the way in which people's care was planned and that staff were aware of any potential risks to people and knew how to support them so as to ensure their safety and welfare. We also found that improvements had been made to the way in which medicines were managed within the home.

Inspection carried out on 7 June 2013

During an inspection to make sure that the improvements required had been made

At our inspection on 07 June 2013 we followed up compliance and enforcement action that we had taken following our inspection on 02 April 2013. We had asked the provider to make improvements to the way in which people's needs were assessed and their care planned and delivered. We also required that they make improvements in areas relating to staff training and supervision; the quality monitoring of the service; management of medicines and record keeping in the home.

People we spoke with were generally happy with the care they received. One person told us the staff were "fine", another person told us "they help me when I need them" and that they enjoyed the food on offer in the home. We saw that interactions between staff and people living in the home were relaxed and friendly.

We found that suitable improvements had been made in some areas. Staff had been supported in their roles through training and supervision. Records were stored securely and could be located promptly when requested. However we also found that people were at risk of unsafe or inappropriate care because their needs had not always been adequately assessed and care had not always been properly planned.

The provider had undertaken audits in a number of areas within the home and had acted where any issues had been found. Improvements had been made to the way medicines were managed although some problems remained regarding the recording of medication.

Inspection carried out on 2 April 2013

During a routine inspection

People we spoke with told us they felt "well looked after" by staff working in the home. One relative we spoke with described their loved one as being "more content" since they had moved in. They felt that staff were "considerate" and had the necessary skills to care for people living in the home.

Staff we spoke with had a good understanding of safeguarding of vulnerable adults but had not always been adequately supported in their roles through training and supervision, in line with the provider's own requirements. Medication was not always stored securely and was not always administered in the way that had been prescribed.

We also found that people's care had not always been adequately planned and assessments of peoples' needs were not always consistent. Records were not always fit for purpose or securely stored and could not always be promptly located when required. Whilst the provider had a system in place to monitor key areas relating to the health, safety and welfare of people living in the home, regular checks were not being made in line with the provider's own schedule.

Inspection carried out on 25 April 2012

During a routine inspection

Overall, people we spoke to were happy with the quality of service provided by the home.

People said that the home was always clean and that staff were “excellent” and that they were treated well. Some people said that individuals needed more one-to-one time with staff.

People using the service told us that they felt safe in the home.

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