Archived: Rock House Residential Care Home

People’s experience of using this service:

• People and their relatives spoke positively about the service. Improvements had been made in some areas since our last inspection, for example a television had been placed in reception and a new family room had been adapted from a bedroom. However, we found several breaches of regulations.

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was breached because medicines were not always correctly recorded or administered. The medicines fridge and trolley temperature checks had gaps in the records. Records related to people’s challenging behaviour was not clear in how staff should have supported the person.

• Records related to incidents involving people’s behaviour had not been reviewed to identify themes. This may have helped people identify useful strategies and help relieve people’s distress.

• We found information related to people’s nutritional and hydration needs were not always available. We observed one person struggling to eat with little help, and information about people’s dietary needs was not always understood by staff.

• People were not always treated with dignity and respect. Records about people and the way staff spoke with them was not always respectful. People were not allowed to leave the dining room at meal times until they had received their medicines. As a result, we found the service had breached Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This also meant people were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• The registered manager had breached Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. because they had not sent to CQC the required notifications. Furthermore, the registered manager and the provider had not identified the areas requiring improvement that we had found. This meant they had not achieved a clear overview of the service, which was required to ensure they assessed, monitored and improved the quality and safety of the service provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• Activities were available to people, however at the time of the inspection they were not always person centred. We have made a recommendation about training staff in this area.

• Staff had received training in how to identify and report concerns of abuse. Information was readily available to guide staff on how to report concerns to the local authority safeguarding team.

• Safeguarding concerns were dealt with appropriately by the senior staff.

• Checks were made on the utilities and equipment to ensure they were safe to use.

• The premises were kept clean and hygienic, people were protected from infections that could affect both staff and people using services through regular cleaning.

• People spoke positively about the staff describing them as “Caring and Professional”.

• Records showed where people required support from external medical professionals this was sourced.

• Staff received support to carry out their role through training, supervision and staff meetings.

• Both staff and people living in the home were treated as equals, there was anti discriminatory policy in place which was adhered to by staff.

Rating at last inspection:

At our last inspection the service was rated Good. (Report published 31 March 2016)

Why we inspected: We inspected the service as part of our scheduled inspection plan.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Please see the ‘action we have told the provider to take’ section towards the end of the report

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rock house is a residential care home registered to care for up to 38 older people including people who live with dementia or mental health problems. At the time of our inspection 29 people were living permanently in the home and one person was receiving respite care. The home 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.

During our previous inspection in August 2014 we had concerns about the cleanliness of some parts of the home. During this inspection we found cleaning schedules were in place and the level of cleanliness had improved.

People told us they felt safe living in the home and staff knew how to identify signs of abuse and responded appropriately. On the first day of the inspection we raised some concerns about how people’s medicines were recorded. We found on the third day of the inspection improvements had been made. We have made a recommendation about how the home manages medicines.

People told us they felt safe living in the home. They told us their needs were met, and when they needed help from staff their requests were responded to quickly. People’s needs were assessed and care plans reflected how staff would meet their needs. Risk assessments were in place to ensure the risk of injury to staff and to people was minimised.

Records were frequently updated in relation to the care provided, and information about people was shared in the changeover meetings which took place each day.

The systems used for recruiting staff included making checks on candidate’s backgrounds. This was to ensure they were safe to work with people.

The provider had an assessment tool in place to gauge the staffing levels required to meet the needs of people at any one time. People, staff and relatives told us they thought there were enough staff in place to meet people’s needs, and our observations confirmed this.

Staff told us and documentation verified they were being supported by the provider through regular supervision, annual appraisals and training. Staff meetings were held where discussions took place on how the service could be improved through improved performance by staff and management.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant where people were unable to make decisions for themselves, staff acted in a way that was agreed was in the person’s best interest.

People’s health was maintained and where professional advice was required to assist people to remain healthy this was sought by staff. For example, dietician and GP.

People told us and we observed staff caring for people in a sensitive and appropriate way. They demonstrated a kind and caring nature and they were knowledgeable about people’s needs and how to meet them. Care plans recorded people’s choices and preferences and these were respected by staff.

There was a range of activities in the home to minimise the risk of social isolation. People told us they enjoyed the activities on offer.

People told us the service was well managed. Staff commented on how supportive and approachable the management were. Quality assurance checks had been completed and were on going alongside feedback from people which was used to improve the quality of the service to people.

We spoke to one person living in the home who said that the staff 'had the patience of Job' and another said 'they look after us so well and nothing is too much trouble, no matter how silly I am'.

The deputy manager showed us the paperwork which was well maintained and organised. The home had recently transferred all the care plans to an electronic system and we saw how well that was being used to record and monitor progress. The managers at the home had a strong commitment to providing a high quality of care. We saw evidence of this in the diligent way in which they recorded even tiny suggestions and comments, what they called 'niggles and moans'. We saw that they considered and responded constructively to each one of them and used them to improve the service.

We looked at how people's care was planned and managed and found that there was a comprehesive system of care planning in place. We also found that generally people were happy with their level of care.

We looked at safeguarding people from abuse and found that staff had done safeguarding training and were able to identify different types of abuse. We also found that staff felt comfortable in being able to report abuse if necessary.

We looked at staffing levels and found that there were sufficient numbers of qualified staff to cover all the rotas. However, we also found that for a brief period there appeared to be a shortage of staff in the two lounge areas.

We looked at how the provider monitored and assessd the quality of the service and found that there were effective systems and processes in place including regular reviews of the whole service and feedback from staff and people who used the service.