Archived: Rosina Lodge

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.

Rosina Lodge is a privately operated care home providing accommodation for up to 19 adults who require personal care and support on a daily basis. At the time of our inspection there were 16 people living in the home.

The home 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.

Staff received training and understood the principles in protecting vulnerable adults. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed. Staff received suitable induction and training to meet the needs of people living at the home and received regular supervision from the manager. This meant people were being cared for by suitably qualified, supported and trained staff.

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

We found that the administration and storage of medications was safe. There were systems and processes in place to monitor the quality of the service. Audits were carried out and where shortfalls were identified the management was using the information to improve the service.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

During our visit we saw that people were treated with dignity and respect by staff. People told us that they felt safe using the service and that that staff treated them well and were kind and attentive. This reflected the care practices that we saw. There were systems and procedures that enabled the manager and staff to learn from events such as accidents, incidents, complaints, concerns, whistleblowing and investigations.

No staff were currently subject to disciplinary action and policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst the manager informed us that no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The provider had been made aware of recent legal changes to decisions affecting people's liberty and had plans in place to review and update current policies.

Is the service caring?

We saw that people were supported by attentive, friendly, kind and caring staff. The staff were patient and gave encouragement when supporting people. One person commented, "It's friendly and the carers are very helpful'. People's preferences and diverse needs had been recorded in their care plans and care and support was provided in accordance with this information.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. We saw that staff understood people's care and support needs and that they knew them well. One relative told us. "They have taken the trouble to get to know her'. Another person told us: 'I would say they really try to make sure people are comfortable and happy'.

We saw that the provider held comprehensive records on people which enabled staff to understand their health and social care needs. Staff were led by team leaders who provided support and supervision. There was good communication and contact between the provider and other services such as social services, pharmacy and community health services.

Is the service responsive?

People we spoke with told us they were satisfied with how the staff responded to any queries or issues. One person told us: 'I have never had any problems here, but if I needed anything I would just mention it to someone and they would sort me out'. A relative said: I have never had any trouble in being able to speak with the manager of anyone else'.

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and had been supported to maintain relationships with their friends and relatives. People regularly completed a range of activities at home and within the local community.

Is the service well led?

People we spoke to were happy with the way the service was managed. One relative told us: 'The manager and his team are fantastic. They are always available to speak to'.

We saw that the leadership, management and governance of the home was carried out on a daily basis by the owner and manager. Both the owner and manager discussed at length with the inspector areas for further development of quality assurance systems and developments in care knowledge and practice which would enable the home to maintain compliance with revised standards. These included building refurbishment, maintaining up to date knowledge of best practice in the areas of dementia care and sensory impairment, person-centred care planning and up to date knowledge of legislation on regulation and mental capacity.

We saw that the manager met regularly with his team and that team leaders provided supervision to care staff.

During our last inspection in October 2013 we found the provider did not meet some of the Care Quality Commissions (CQC) essential standards. We found the service did not have information in place to guide staff when "as required medicines" could be needed. We saw the controlled medicines cupboard had not been secured safely to the wall. We also noted the provider's statement of purpose had not been updated and that some people's care records had not been accurately maintained.

The provider sent us a plan to tell us what action they were going to take to meet the CQC standards.

At our most recent inspection we saw guidance had been put in place for staff to advise them when to administer medicines as and when needed. We saw the medicine cupboard had been securely fitted to the wall. We were shown an amended statement of purpose and we saw the maintenance of people's care records had improved.

We looked at the home's medication administration practices. We found that people received their medicines. People who spoke to us told us that they always received their medicines at the right time. The home did not have information in place to guide staff when "As required medicines" may be required to be administered.

We found the home generally clean and hygienic. Two people who spoke to us told us that their bedrooms were cleaned daily. We found that not all of the soap dispensers in the bathrooms and toilets had been refilled to be used for hand washing.

We saw that were sufficient numbers of staff on duty. People who spoke to us told us said that there was enough staff to support them although three people told us that there had been staff turnover.

We looked at the home's record keeping practices. We found that people's care records had been stored securely but we found that some people's care records had not been accurately maintained.

We spoke to four people using the service and two visitors. People told us that they were able to make choices within their daily lives about what they wanted to do and where in the home they spent their time. One person told us 'there is a quiet room where I can read my book away from the television'.

We saw that staff treated people with respect and addressed people by their preferred name. People told us "the staff are very good", "staff treat me exceptionally well' and 'I doubt I would be better off anywhere else'

Generally people enjoyed the food and told us "the food's good and there's a good choice of vegetables", "the food here is normally very good' and 'the best thing here is the food'. People told us they had a choice of food and would be offered an alternative if the menu wasn't to their liking.

Everyone we spoke with told us that they felt safe living in the home. They told us

that if they did not like something they would tell the manager.

We spoke to two visitors of a person using the service and they told us 'we are always made to feel welcome and there are always lots of activities'.