The inspection of Rose Park took place on Friday 28 November and Monday 01 December 2014 and it was unannounced. We last inspected the service in August 2013 when we found there were minor issues with policies, finance audits, staff recruitment and quality monitoring. These had not generated any compliance actions last year, but we recommended they be addressed. However, we found at this latest inspection that not all of the issues had been put right by the provider.
The service provided care for 11 people with a learning disability. There were nine single occupancy bedrooms with en-suite toilets and one shared bedroom. Bathrooms were shared. There was a small dining room with a sitting/games area off it and a lounge. At the time of our visit there were 8 people using the service.
It was a requirement of registration that this type of service had a registered manager in post. 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. There was a registered manager in post who had been registered and working at Rose Park for the past six years. This person was also one of two registered providers (partners).
The registered manager was not available during our inspection, which we had been verbally notified of. The provider has a legal responsibility to notify us in writing under Regulation 14 of the Care Quality Commission (Registration) Regulations (2009).
The registered manager had only been carrying out their role as registered provider, and the position of registered manager had been filled by the deputy manager in capacity of acting manager since February 2014.
People we spoke with told us they felt safe living at Park Rose and that staff treated them well. They said, “I like living here”, “It’s a nice place” and “At the moment it is ok. The staff are kind”.
Staff had knowledge of how to keep people safe because they had attended training in safeguarding vulnerable people. There were systems in place to ensure any concerns or allegations of harm were reported to the local authority safeguarding team.
Parts of the premises were inadequately maintained which meant people had an uncomfortable and less than pleasant environment to live in. The service was not meeting the requirements of regulations 15 and 12 because the provider had not ensured people had access to a safe, suitably designed and adequately maintained environment that was properly managed according to infection control guidelines.
Recruitment of staff was not being safely carried out because security checks on new staff had not always been completed before staff started working in the service. This meant the service was not meeting the requirements of regulation 21.
Risks to individual people were appropriately managed through risk assessments. There was a concise emergency contingency plan available to staff should there be a problem with the safety of the premises utilities. This document had not been available at our last inspection.
Care staffing levels were not determined by people’s needs, but set at a minimum of two staff on duty at all times due to the low occupancy numbers in the service. These two staff were supplemented by a third staff member (often the acting manager) on certain days of the week. This meant the acting manager was unable to dedicate time to managing the service well.
Care staff also completed cleaning and cooking tasks, which meant the time they spent with people providing care and support was limited. The provider was not meeting the requirements of regulation 22 because the provider was not ensuring there were sufficient numbers of staff to carry out ancillary tasks in the service so that care staff could concentrate on care and support.
At our last inspection there were no records of staff recruitment interviews held and no formal system for involving people that used the service in the recruitment of staff. This was still the case at this inspection.
We saw that people received their medication safely because medicines were given to them on time according to guidelines and according to prescribed instructions.
We found that staff were trained to provide the care people needed. Staff were regularly supervised and supported to provide the best care their skills would allow. They understood the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS) when these applied to the people they cared for.
Staff knew the importance of obtaining consent from people to support them and they had knowledge of people’s nutritional requirements, choices and needs. People’s health care needs were effectively understood, monitored and addressed when required. Health care needs were met with the support of outside healthcare professionals and organisations. The acting manager and staff had good relationships with these professionals.
There was effective communication between the acting manager and staff. However, because the registered manager was trying to oversee the service in their capacity as registered provider, communication between them and the acting manager/staff team was sometimes confused. This meant the acting manager was sometimes unable to make management decisions and staff were sometimes without clear direction, which in turn meant people did not always experience a care service that encouraged them to live life to their potential.
People and relatives told us staff were kind and caring. We observed staff approaching people in a friendly and supportive way and they were sensitive to people’s demeanour and moods.
Care plans contained the information staff needed to support people, but they also contained information that was old or no longer relevant. People had been assessed and plans had been put in place to tell staff how best to support them. This was in the way people chose and wanted to be supported. We found that sometimes information provided about people’s likes and choices was not being used to assist them to meet their needs, as in the example of a person that liked to ride a bicycle. Information was clear about their wish to ride their bicycle and the pleasure it gave them, but the bicycle had not been kept in good repair and so the person was unable to use it.
We saw that some activities inside the service were facilitated by staff and enjoyed by people that used the service, but these were limited. There were few activities organised in the community because of the low staffing levels. This meant people that used the service were unable to do some of the things they wanted to do. They engaged in other pastimes at day care services but this was because support was provided by other organisations.
Complaints were positively addressed. People told us they could speak up any time about anything and were confident they would be listened to and their concerns would be resolved.
We found there was an open and honest culture within the service, based on a desire to ‘do the right thing for and with people’. We found that this desire was constrained however by the low staffing levels and the daily tasks to be completed by care staff.
The provider sought the views of people that used the service and their relatives in annual surveys, as part of the monitoring of how the service was being run, but information gathered was not analysed. This meant people could not influence how the service was operated. People and relative’s views were only used to help provide changes to the way people’s individual needs were met.
There was an incomplete auditing system in operation. There were no formal recording systems, in line with regulation 10, to demonstrate which areas had been audited. There were no audits on infection control, care file contents or staffing levels. Information was not collated, analysed and used to inform future improvements in general practice and care delivery. The provider was not seeking the views of staff about care delivery. This meant the provider was not ensuring the appropriate care of people by means of effective use of audits to inform where improvements were needed.
The provider was in breach of five regulations: 12, 15, 21, 22 and 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 end of the full version of the report.
We recommended that the provider make other improvements to the service which you can see at the end of each section of the full version of the report.