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Inspection carried out on 12 January 2021

During an inspection looking at part of the service

Rose Lodge is a residential care home for older people who require nursing and/or personal care. At the time of the inspection, 51 people were living there.

We found the following examples of good practice.

The service was not allowing visitors during the outbreak only receiving essential visitors at the time of our inspection. Any people entering the building were asked to wash their hands and their temperatures were checked. Visitors were asked to take a COVID-19 test and wait a short time in the car park for the result. People were provided with appropriate personal protective equipment (PPE).

People were supported by staff in full PPE, whether that person was COVID-19 positive or negative. This is called barrier nursing. This is to protect both staff and people living in the service. People who were positive had appropriate signs on their doors and staff appropriately changed and disposed of their PPE as required for good infection control.

Staff commencing their shift used the same entrance. They were required to have a temperature check and had hand washing facilities. All staff groups had different changing areas and dining areas to maintain infection control. Staff took their breaks individually. This meant that the provider was following good practice for infection control.

There were areas within the home for donning and doffing (this is where staff put on and take off their PPE) There were good guidance notices on display through out the home about how to wash your hands and maintain good infection control. Staff and residents were regularly tested for COVID-19.

The building was clean and free from clutter. Staff wore their PPE appropriately and were seen to maintain good hand washing and sanitising.

There were cleaning schedules in place to ensure infection control management. Extra staffing hours had been added to these schedules to assist with infection control management.

Inspection carried out on 31 July 2018

During a routine inspection

Rose Lodge is a residential care home for older people. It is registered to accommodate up to 57 people who require nursing and/or personal care. At the time of the inspection, 51 people were living there.

At our last inspection in May 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. 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 home is run.

People were kept safe and staff were knowledgeable about reporting any incidents of harm. Risk assessments were in place and reviewed regularly to minimise the potential risk of harm to people during the delivery of their care. People’s care records were held securely and these records were reviewed and any changes to people’s care and support needs had been recorded.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

People were helped to take their medicines by staff who were trained and had been assessed to be competent to administer medicines.

People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on new staff before they were assessed to be suitable to look after people who used the service.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to healthcare professionals and their healthcare needs had been met. Care records seen confirmed visits to and from General Practitioners (GP's) and other healthcare professionals had been recorded.

People continue to be offered choices and were supported to eat and drink sufficient amounts of food and drink.

Staff knew the people they supported and provided support in a caring way. Care plans gave staff information on how to support people with their care needs.

People participated in a range of activities within and outside the service and received the support they needed to help them to do this.

People were involved in the running of the service. Regular meetings were held for the people and their relatives so that they could discuss any issues or make recommendations for improvements on how the service was run.

People’s concerns and complaints continued to be listened to and were acted upon.

Quality monitoring procedures were in place and action was taken where improvements were identified. There were clear management arrangements in place. Staff, people and their relatives were able to make suggestions and actions were taken as a result.

Further information is in the detailed findings below

Inspection carried out on 18 April 2016

During a routine inspection

Rose Lodge provides accommodation and personal and nursing care for up to 57 people, some of whom were living with dementia. There are external and internal communal areas for people and their visitors to use.

This unannounced inspection took place on 18 April 2016. There were 56 people receiving care at that time.

The service had a registered manager in place. 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 were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained and supported by their managers. There were sufficient staff to meet people’s assessed needs safely. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately and medicines were stored safely. People’s health, care and nutritional needs were met. Staff were aware of people’s dietary needs and people were provided with a balanced diet and sufficient fluids.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and staff were aware of the key legal requirements of the MCA and DoLS.

People received care and support from staff who were kind, caring, courteous and respectful to the people they were caring for. People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care.

Care records provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective. People were supported to maintain relationships. There was a varied programme of events for people to engage in and people were supported to spend their time in meaningful ways of their choosing. People were supported to access the community and visitors were encouraged into the service.

The registered manager was supported by a staff team that including registered nurses, care workers, and ancillary staff. The service was well run and staff, including the registered manager, were approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. The service celebrated success and those staff who performed over and above their everyday job requirements.

Inspection carried out on 9 November 2015

During an inspection looking at part of the service

We carried out an unannounced, comprehensive inspection of this service on 6 and 7 November 2014. As a result of our findings we asked the provider to make improvements to people’s needs being met in a more timely manner, management of medicines, staff knowledge and implementation of the Mental Capacity Act 2005 (MCA), staff training and supervision, and notifying the Care Quality Commission (CQC) of important events.

Since our inspection we had received concerns in relation to safety and the quality of people’s care which the registered manager and local authority had investigated. The registered manager wrote to us detailing how and when improvements would be made.

As a result we carried out a focused, unannounced inspection to check those improvements had been made. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link Rose Lodge on our website at www.cqc.org.uk.

During this inspection on 9 November 2015 we found the provider had made improvements and that the regulations had been complied with.

Rose Lodge provides accommodation and nursing and personal care for up to 57 people, some of whom are living with dementia. At the time of our inspection on 9 November 2015 there were 54 people living at the service.

Since our last inspection the registered manager had changed. The previous manager left the service in March 2015 and the current manager took up post later in the same month. The current manager registered with the CQC to manage this service in August 2015. A registered manager is a person who has registered with the CQC 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.

People received their prescribed medicines appropriately. Medicines were managed safely by staff who had received appropriate training and whose competency had been assessed. The registered manager had plans in place to make further improvements to the systems for administering topical medicines.

Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting and escalating concerns to protect people from harm. Risks were regularly reassessed to take account of people’s changing needs.

People were encouraged to make choices about their everyday lives. The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. DoLS applications were in progress and had been submitted to the authorising body. People’s rights to make decisions about their care were respected and where people lacked mental capacity, they were supported with the decision making process.

There were sufficient staff to meet people’s assessed needs. Staff were appropriately trained to meet people’s needs. People’s care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

Care records were detailed and provided staff with sufficient guidance to provide consistent care to each person that met their needs. Changes to people’s care was kept under review to ensure the change was effective.

People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. Staff and the registered manager were approachable. People’s views were listened to and acted on.

Inspection carried out on 06 and 07 November 2014

During a routine inspection

This unannounced inspection took place on 06 and 07 November 2014 and was completed by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of caring for someone who uses this type of care service.

At our previous inspection on 11 June 2013 the provider was not in breach of the regulations we looked at.

Rose Lodge provides accommodation for up to 57 people who require nursing or personal care. At the time of our inspection there were 54 people living at the service. The service had a registered manager in post. They had been a registered manager since 26 September 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 2008 and associated Regulations about how the service is run.

People told us they were safe living at the service and staff were knowledgeable about reporting any abuse. However, we found that there was not always a sufficient number of suitably qualified and trained staff employed by the provider. People were not assured that their care needs would be met in a timely manner.

The provider’s recruitment process ensured that only staff who had been deemed suitable to work at the home were employed. This was after all pre-employment checks had been satisfactorily completed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager was knowledgeable about when a request for a DoLS would be required. However, only two out of seven staff were able to tell us when a person would need to be considered for a DoLS application. In addition, restrictions placed on people’s freedom had not been authorised by a supervisory body.

All staff respected people’s privacy at all times. People were not always provided with their care when this was required and people sometimes had to wait over two hours for their care needs to be met. This meant that people’s dignity was not always respected.

People’s assessed care needs were planned and, in most cases, met by staff who had a good understanding of these and how to meet people’s needs effectively. However, administration and recording of people’s prescribed medicines was not always undertaken accurately.

Care was provided by staff in a caring and compassionate way. People’s hobbies and interests had been identified. However, there were limited opportunities for people to be supported with these. Records also confirmed the limited social stimulation people had been provided.

People were supported to access a range of health care professionals. People were consistently supported by the appropriate health care professional in a timely manner. Health risk assessments were in place to ensure that people were safely supported with their health risks.

People were provided with a varied menu and had a range of healthy options to choose from. People with complex care needs, including those people at an increased risk of malnutrition or dehydration, were supported with appropriate food and drink. There was a sufficient quantity of food and drinks available at all times in the home.

A complaints procedure was in place. Complaints had been recorded and responded to. This was to the satisfaction of the complainant. People could raise concerns with the staff at any time.

The registered manager and staff were not always supported effectively. This included not having sufficient staff and staff whose training, supervisions and appraisals had lapsed.

The provider had quality assurance processes and procedures in place. We found that these had not always been effective in identifying the issues we found. This put people at an increased risk of unsafe care.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 11 June 2013

During a routine inspection

People�s right to consent to their support, care and treatment was respected. Where people were not able to give their valid consent, there were �best interest� systems in place to maintain and promote people�s health, safety and wellbeing.

Support, care and treatment was provided to ensure that people who used the service received safe and appropriate, dignified, support, care and treatment. People said that they were satisfied with the standard and quality of the service provided.

To maintain their nutritional health, people received adequate amounts of food and drink. People said that they liked the food and always had enough to eat and drink.

Checks and tests were carried out on a range of available equipment to ensure that Rose Lodge was a safe place for people to live, work and visit. One person said that they were satisfied with the safety and management of equipment which was used to support them with their moving and handling.

Staff said that they felt well supported and trained to do their job, which they enjoyed doing. Systems were in place to train and supervise members of staff. Arrangements were in place to improve the training and supervision of staff members. People demonstrated that they liked the staff and had confidence in their work abilities.

People were provided with opportunities to make their suggestions, comments, concerns and complaints known. People said that they knew who to speak with if they were unhappy about something.

Inspection carried out on 12 June 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Before our visit, on 12 June 2012, we spoke with social care professionals and during our visit we spoke with a visiting health care professional. All of these people said that, in their view, people who used the service were in receipt of good quality and safe care.

We used the Short Observational Framework for Inspection (SOFI) during lunch time. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. During our SOFI we noted that staff engaged with people who used the service in a kind and attentive way.

We also observed other staff working and we also noted that people were supported by kind and attentive staff.

All of the six people we spoke with said that they felt comfortable because their individual personal support and care needs were met.

People we spoke with said that they felt, "Safe" living at the home. This was due to staff being kind, skilled and knowledgeable to provide the person with the support and care to meet their individual needs.

We were also told that people had opportunities to make suggestions in the running of the home. This included attending residents' meetings and taking part in the recruitment process of new staff.

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