Archived: Rosina Lodge

Updated 24 April 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 12 and 13 March 2018 and was unannounced. This meant the registered manager and staff did not know we would be visiting. At the last inspection in December 2016 we found the provider was meeting the regulations and we rated the service “good” in all domains and “good” overall.

This inspection was brought forward earlier than originally planned because a person who used the service died in hospital in March 2017as a result of a choking incident arising from their swallowing difficulties. A Coroner’s inquest was held to investigate the circumstances and concerns were raised with the Care Quality Commission. We carried out this comprehensive inspection to identify any current risks to people and ensure measures were taken to minimise them.

The inspection team consisted of one adult social care inspector and a specialist advisor from a speech and language therapy team. A specialist advisor is an appropriately qualified person who has professional practice experience in the field of speech and language therapy.

We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

We contacted the commissioners of the relevant local authorities, the local authority safeguarding team and other professionals who worked with the service to gain their views of the care provided by staff at Rosina Lodge.

During the inspection we spoke with six people who used the service, five relatives of people, four members of staff and the registered manager. We looked at four people’s care files and three staff files which included staff recruitment, staff training and supervision. The specialist advisor checked policies and procedures for soft food and special diets and choking and resuscitation procedures for people with these needs who used the service.

Updated 24 April 2018

The inspection took place on 12 and 13 March 2018 and was unannounced. When we last inspected the service in December 2016 the provider was meeting the regulations we looked at and we rated the service Good overall and in all five key questions.

This inspection was brought forward earlier than originally planned because a person who used the service died in hospital in March 2017as a result of a choking incident arising from their swallowing difficulties. A Coroner’s inquest was held to investigate the circumstances and concerns were raised with the Care Quality Commission. We carried out this comprehensive inspection to identify any current risks to people and ensure measures were taken to minimise them.

Rosina Lodge provides accommodation, care and support for up to 19 older adults some of who were living with dementia. There were thirteen people living at the service when we inspected it.

Rosina Lodge is a ‘care home’. 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.

The service had a registered manager. 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.

The registered manager did not notify the CQC consistently as required under the Registration Regulations 2009.

We found the auditing processes in place were ineffective in identifying some areas of staff practice and procedure that needed improvement. For example some people’s care plans and risk assessments were not up to date. Also we did not see evidence to provide assurance that audits were robust enough to identify medicines concerns.

At this inspection we found the provider in breach of legal requirements with regard to safe care and treatment, good governance and notifications of other incidents. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.

At this inspection we found the provider had not maintained sufficient levels of support that was appropriate to meet people’s needs. The care files and reviews we inspected were not all up to date. Some people’s risk assessments were not updated or revised following changes in their circumstances and care.

Most care plans, reviews and risk assessments were signed by people to indicate their agreement to what was written down on their behalf. The registered manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home. This is in line with the provider’s own policies and procedures. The manager also told us that staff would receive additional training with this to ensure they fully understand their responsibilities and carry them out as required.

There were enough staff on duty to meet people's needs and there were additional staff able to cover in the event of staff absence. Robust employment checks were in place to help to ensure new staff were appropriate to be working with and supporting people.

People were supported appropriately with the administration of their medicines.

People were supported by staff who received training appropriate to their work. Staff received regular supervision and appraisal.

People's healthcare needs were met and staff supported them to attend medical appointments.

People lived in a comfortable environment which was clean and free of hazards.

Staff had undertaken training in the Mental Capacity Act 2005 and were aware of their responsibilities in relation to people who might be deprived of their liberty. They ensured people were given choices and the opportunity to make decisions.

We observed staff caring for people in a way that took into account their diversity, values and human rights. People were supported to make decisions about their activities in the home and in the community.

Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed by the management.

Work was being progressed to ensure people had a choice about what happened to them in the event of their death and that staff had the information they needed to make sure people’s final wishes would be respected.

There was a clear management structure at the service, and people and staff told us that the registered manager was supportive and approachable. There was a transparent and open culture within the service and people and staff were supported to raise concerns and make suggestions about where improvements could be made.