We conducted an inspection of Rosedene Nursing Home on 14, 16 and 20 June 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second and third days. At our previous inspection on 7 August 2014 the service was meeting all regulations inspected. Rosedene Nursing Home is a nursing home that provides care to up to 67 people with a broad range of health needs, with the majority having a diagnosis of a mental health condition. There are three floors to the building and people of different genders, mobility and mental health diagnosis were placed on each floor. At the time of our inspection there were 46 people using the service.
There was no registered manager at the service although the manager was in the process of registering with the CQC. 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 had completed medicines administration training within the last year and were clear about their responsibilities. However, staff were not recording the site at which they were giving people their injections creating the risk of causing people unnecessary pain by potentially injecting them in the same place and the date of opening on some topical medicines was not marked.
When questioned, staff appeared to be clear about safeguarding procedures and when to report an incident. However, we became aware of two safeguarding incidents which had not been reported or investigated and potential safeguarding concerns were not always addressed.
Staff told us they had received training in what to do in the event of an accident or incident, but most staff told us they had not received training in how to manage instances of violent aggression from people and the training records supported this. We observed one incident where a care worker did not manage a potential incident appropriately.
Information in care records and risk assessments was inconsistent and confusing. We found some examples of known risks not being fully explored through specific risk assessments and care planning as a result. We also found that staff did not always respond to risks appropriately to ensure that people were protected from avoidable harm.
Care staff gave us mixed feedback about whether they felt there were enough of them on duty to do their jobs properly. The manager was unable to provide us with evidence of how they determined safe staffing numbers or ensured that people with the right skills were on duty.
Recruitment records contained the necessary documentation to recruit staff safely.
The service was not compliant with the Mental Capacity Act 2005. We found examples of people being deprived of their liberty without having the necessary authorisations from the local authority.
However, staff told us they had received training in the MCA and were able to demonstrate that they understood the issues surrounding consent.
Care records did not contain consistently up to date information about people’s current healthcare needs.
Care records contained very little detail about people’s life histories and some care staff lacked basic knowledge about the people they were caring for. Some care staff had very limited knowledge about some of the common mental health conditions people had and some staff providing one to one care were unable to explain why the person they were supporting required this level of care from them or what risk they were addressing by doing so.
People were encouraged to eat a healthy and balanced diet. People provided good feedback about the food available and the chefs were clear about what food they were required to prepare to cater for people’s individual health needs.
Staff training records were incomplete so we could not be assured that care staff were receiving the mandatory training required to conduct their roles. Staff told us and records demonstrated that they were not receiving regular supervisions or appraisals of their performance.
We saw some examples of caring interactions between staff and people using the service. However, some of our observations were of a dismissive attitude towards people’s care needs and we observed some instances of unkind treatment. We reported this behaviour to the manager who took appropriate action.
People’s dignity was not protected. We saw some examples of care staff not respecting people’s dignity.
People provided good feedback on the activities on offer. However, there was little evidence of appropriate activities provided for people to aid their therapy or rehabilitation
People and care staff gave mixed feedback about the manager. There was a complaints policy in place, but complaints were not responded to appropriately.
The organisation did not have good systems in place to monitor the quality of the service. There was no evidence of regular auditing being conducted.
During this inspection we found breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance and submitting notifications to the CQC. You can see what action we told the provider to take at the back of the full version of the report. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.