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Archived: Rosevilla Nursing Home Good

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Reports


Inspection carried out on 2 October 2014

During a routine inspection

We inspected Rosevilla on 2 October 2014. The inspection was unannounced.

Rosevilla provides accommodation and nursing care for up to 35 people. Nursing care is primarily provided to older people who have physical health needs. However some people who use the service may also have mental health needs, such as dementia.

At the time of our inspection there were 27 people using the service.

There was no registered manager at the service as the previous registered manager had left the service on 12 August 2014. 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 and associated Regulations about how the service is run.

A new manager had been recruited and at the time of our inspection they were working through their induction and probationary period. This showed that the provider had taken prompt action to recruit a new manager and the provider informed us the manager would apply to register with us once they had completed their probationary period.

At the last inspection on 16 July 2014 we asked the provider to take immediate action to make improvements. This was in relation to the content and accuracy of the information contained in people’s care records and how risks to people’s safety were identified, managed and reviewed. We also asked for immediate action to be made to how the quality of care was assessed and monitored and how incidents were investigated and managed. During this inspection we identified that these actions have now been completed.

People who used the service and their relatives told us they were happy with the care and we saw that people were treated with kindness, compassion, dignity and respect. The staff enabled people to make decisions about their care by giving people information in a manner that reflected their understanding.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

The staff understood how to keep people safe and safety concerns were reported and investigated to prevent the risk of harm. Medicines were given to people in a safe manner and the environment and equipment within it were regularly checked to ensure its safety.

The staff received regular training and their learning needs and competencies were monitored by the managers to ensure they had the knowledge and skills required to meet people’s needs.

People were supported to eat and drink and staff monitored people’s health and wellbeing. Staff understood when they needed to seek professional advice and support to enable people to access health, social and medical support when required.

There were enough staff available to keep people safe, but improvements were needed to ensure the staff had the time to meet people’s individual care preferences and wellbeing needs.

People who used the service, their relatives and the staff told us that the new manager and operations manager had made significant improvements to the quality of care. The managers regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who used the service

Inspection carried out on 16 July 2014

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

This inspection was a follow up inspection of the warning notice, which we issued to the provider following our inspection of the service on 20 May 2014. We wanted to check if improvements had been made since our last inspection and to respond to other concerns brought to our attention. We also aimed to answer the five key questions; is the service safe, is the service effective, is the service caring, is the service responsive and is the service well-led?

The inspection was unannounced which meant the service did not know we were coming.

During our inspection, we spoke with five people who used the service and the relative of one person. We also spoke to six members of staff, the registered manager and the regional manager. We looked at seven people’s care records to see if their records were accurate and up to date and their needs met. We also looked at records relating to the management of the home. This included incident reporting records and monthly care plan audits.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, a relative and staff told us.

Is the service safe?

We found that the provider did not always take appropriate action to ensure that people remained safe following an incident. We saw that where people had fallen, management plans were not in place to ensure that further falls were prevented.

We saw that people’s records were not always accurate and did not reflect the care they received. This meant that people were at risk of receiving unsafe care because accurate records were not maintained.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the care and welfare of people who used the service and maintaining accurate records.

Is the service effective?

Each person had a plan that outlined their needs and preferences. The provider had an effective system in place for monitoring people who were on fluid intake monitoring and took appropriate action when concerns were identified.

We saw that information relating to the care needs of people, and people’s care plans did not always contain clear and consistent information required to guide staff on how to meet people's needs in a consistent manner. Staff provided us with conflicting information about how they provided care to people. This meant that people were at risk of receiving unsafe or inconsistent care.

We have asked the provider to tell us how they will ensure that care plans are clear and consistent in order to ensure that effective care is provided.

Is the service caring?

During our inspection, we observed people being treated with dignity, respect and compassion. We observed positive interactions between the staff and the people who used the service.

One person we spoke with said, “The girls are nice”. Another person we spoke with said, “It used to be a nice place, but they haven’t got time to look after you, they say they are too busy when you need help. They just haven’t got time”. The relative we spoke with told us they were happy with the care provided at Rosevilla Nursing Home.

Is the service responsive?

Prior to the inspection, we received information of concern that people had to wait for long periods of time when they needed assistance. One person told us they often had to wait before they received help. They said, “I’ve waited hours sometimes to go to the toilet”.

During this inspection, we observed that people’s call bells were responded to in a timely manner and people did not have to wait before they received the support they required.

We saw records that other healthcare professionals visited the home regularly. We saw that people were referred to other professionals when there were concerns about their health or welfare.

People who used the service had opportunities to be involved in social activities within the home and in the community. We saw that activities were based on people's individual interests and preferences.

People who were at risk of developing pressure ulcers or had pressure ulcers were at risk of further deterioration because staff did not always provide the care as planned. There was also conflicting information about how care should be provided.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the welfare and safety of people who used the service.

Is the service well led?

Systems were in place to assess and monitor the quality of the care provided so that improvements could be made. Some of the systems in place were not always effective, as the problems we identified with safety had not been identified by the registered manager. The registered manager told us they carried out daily checks on records and signed that required monitoring of care was carried out as planned.

Incidents that occurred in the home were recorded but not always analysed to ensure that actions were put in place to prevent them for reoccurring.

Care plans were audited on a monthly basis but the systems in place for ensuring that actions were recorded and monitored were not utilised. This meant that the registered manager could not be assured that recommendations were acted on.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that they have effective systems designed to enable them to protect people who used the service against the risks of inappropriate or unsafe care.

Inspection carried out on 20 May 2014

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

This inspection was completed by an inspector for adult social care. The purpose of the inspection was to identify if the improvements had been made since our last inspection on 7 January 2014 and to answer five key questions; is the service safe, effective, caring, responsive and well-led?

During our inspection we spoke with seven people who used the service and the relatives of three people. We also spoke with seven members of staff, the registered manager and the operations manager. We looked at four people’s care records to see if their records were accurate and up to date. We also looked at records relating to the management of the home. These included audits and minutes of meetings.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People and their relatives told us they felt safe. One person said, “There is always someone here and the doors are always shut”. A relative said, "I know there are always staff here 24 seven”.

The provider had a system in place that ensured the staff were of suitable character to support the people who used the service. We saw that people were protected from abuse because the staff had received training in how to identify and report possible abuse.

We saw that some of the risks posed to people’s health and wellbeing had not been assessed or planned for. We found that where assessments had occurred the risk management plans had not always been reviewed as required. This meant that accurate information to guide staff on how to keep people safe was not always available and people were at risk of receiving unsafe or inconsistent care.

The staff were aware of the systems in place to ensure the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed. These requirements are in place to protect people who are unable to make their own decisions about their health and wellbeing. This meant people could be assured that important decisions about their health and wellbeing would be made in their best interest if they did not have the ability to make decisions for themselves.

Is the service effective?

Each person had a care plan that outlined their needs and preferences. However, these plans did not always contain all the information required to guide staff on how to meet people’s needs in a consistent manner.

We saw that people and their relatives were involved in the planning of care. This meant there was a system in place to gain information about people’s care preferences.

We saw that arrangements were in place to request health and medical support when needed. People were able to access doctors, nurses and dieticians when required.

Is the service caring?

The people and relatives we spoke with gave mixed views about the care. Positive comments included, “It’s absolutely marvellous here” and, “The rapport I have with the staff is great”. Some of the feedback we received suggested that some people were not happy with the care they received from some of the staff at the home. These comments included, “If I could pick the bad ones (staff) out, the care would be wonderful” and, “Some staff are not so good, but I don’t want to say as I have to live here”. We informed the registered manager of people’s feedback and they assured us they would follow up the themes raised.

During our inspection we observed people being treated with dignity, respect and compassion. We observed positive interactions between the staff and the people who used the service.

Is the service responsive?

People were supported to make choices and decisions about their care. The relevant legal guidance was followed to support people to make decisions when they were unable to do this alone.

We saw that people had the opportunity to participate in social and leisure based activities. Staff told us that these were based on people’s individual interests and preferences.

We saw that the registered manager sought feedback about the care from people and their relatives. Feedback relating to concerns and complaints was appropriately acted upon.

Is the service well led?

Systems were in place to assess and monitor the quality of the care provided so that improvements could be made. Some of the systems in place were not always effective as the problems we identified with safety had not been identified by the registered manager.

Incidents that occurred at the home were investigated, acted upon and monitored by the registered manager.

Inspection carried out on 7 January 2014

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

We completed this inspection to check whether the home had made improvements to the care provided to people. During the inspection we spoke with people that used the service, relatives, care and nursing staff and the manager.

We saw that improvements had been made. People said they were satisfied with their care. One person said: "I am looked after well, the staff seem busy but they care. That's the main thing". Relatives said they were happy with the care. One told us that they felt the home had improved since the previous inspection. They described their relative's care as 'excellent'.

An improved plan of care had been developed and was in the process of being implemented. People's needs were being evaluated every month to ensure that the care provided was appropriate. There was little for people to do at the home. There were few opportunities for people to take part in activities and to meet with other people.

People's nutritional needs were regularly assessed. A new system had been put in place to make sure that people received the correct diet and had appropriate support to eat their meals. The amount people ate and drank was being effectively monitored.

Staffing levels had increased. This meant that people's personal and health care needs were responded to more promptly and effectively.

The provider had improved the way it responded to people's concerns. Complaints were recorded and acted upon to improve the care people received.

Inspection carried out on 18 October 2013

During a routine inspection

We inspected Rosevilla on 18 October 2013 as part of our scheduled unannounced inspection plan; the registered provider did not know we were visiting.

An expert by experience took part in this inspection and talked to the people who used the service and their visitors. We met and spoke with the registered manager, two nurses and four care staff. We spoke with 12 people who lived in the home and nine visitors of people that used the service.

To help us to understand the experiences of people less able to talk to us, we used our Short Observational Framework for Inspection tool (SOFI). The SOFI allows us to watch what is going on in a service and see how people spend their time, the type of support they get and whether they have positive experiences.

We looked at three people’s care plans which all required further input. We saw staff supervision records and the training matrix which were also incomplete. We looked at how equipment was used in the home to support people’s independence or assist staff with moving and handling. Some staff had not been trained. We reviewed the complaints policy and procedure and found issues about their documentation.

During the inspection we identified non-compliance relating to the provider not meeting people’s nutritional needs, the poor administration of medicine and inadequate staffing; these outcomes were included in the inspection.

The care home currently had 28 people using the service, one person was in hospital.

Inspection carried out on 26 September 2012

During a routine inspection

People we spoke with told us that they were settled in the home. Relatives told us they were very happy with the staff at the home and felt that people were respected and their views were listened to.

One person living in the home told us, "I prefer to stay in my room and the staff respect that. I have some visitors but prefer the peace and quiet". One relative told us, "Sometimes the staff do activities in the lounge for people to join in but I think most people prefer the one to one sessions than big groups. The staff are very caring and attentive, we are delighted with the home".

We looked at the management of medicines in the home and found this to be in order. No issues had arisen with the dispensing pharmacist.

We looked at the staffing rotas and the skill mix in the home. The trained nurses who lead the team of carers were supported by the manager and her deputy. People that lived in the home and relatives we spoke with told us they were very appreciative of the care and attention shown by the staff. We saw that the staff were appropriately trained and supervised.

We saw that the home audited the quality of the service being delivered. The manager had received thank you cards from grateful relatives. Relatives and people that lived in the home spoke very highly of the care and attention they all received.

Inspection carried out on 27 April 2011

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

Not applicable

Inspection carried out on 27 April 2011

During a routine inspection

People that use the service told us that staff do ask if they can complete certain tasks such as hoisting and bathing assistance. One relative told us “The staff do consider the persons individual needs and preferences.”

People that use the service told us that they had no complaints about the meals and enjoyed the variety of meals offered. Several people told us that they were given an alternative meal should they not like the menu choice.

People that use the service told us that the home is well maintained and safe. One person told us “The staff check to make sure there are no trip hazards and my room is tidy. Sometimes the bulbs need replacing in the lights but they change them quickly.” A relative told us “The home is well maintained, the staff seem to want the place to look nice and keep it in good order. I was impressed with the environment as soon as I visited the home.”

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