The inspection took place on 9 and 13 April 2015 and was unannounced. Rothsay Grange provides residential and nursing care for up to 60 older people, including people living with dementia, and those requiring respite and rehabilitation support. At the time of our inspection 41 people were living in the home.
The home consisted of three floors. The middle floor, known as Memory Lane, cared for people living with dementia. The ground floor accommodated people with personal care needs. The top floor accommodated people requiring re-ablement and respite care, some of whom had long term care needs.
The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The person managing the home was on leave at the time of our inspection. They were in the process of applying for the registered manager role with CQC, but subsequently left this post on 13 April 2015.
At the last inspection on 19 August 2014 we asked the provider to take action to make improvements to support staff to provide people with appropriate and skilled care, and ensure consent to care was gained following legal requirements . At this inspection we found these improvements had been made.
People were at potential risk of harm, because the provider’s recruitment procedure did not robustly meet legal requirements. Although some checks, such as identity, criminal record checks and registration with professional bodies, had been completed satisfactorily, the provider did not ensure that gaps in applicants’ employment history had been identified or investigated. Evidence of suitable conduct in previous relevant employment positions had not always been requested. There was a risk that staff employed would not be of suitable character to safely support people.
Staffing levels were not always sufficient to meet people’s identified needs. Sufficient staff numbers, identified by the provider to meet people’s needs, had not always been on duty during a four week period in March 2015. Staff had ensured this did not impact on people’s physical support, but acknowledged that they were not always able to find sufficient time to meet people’s social and emotional needs.
Checks and audits completed by staff and the manager had not always identified errors and omissions in people’s records. There was a risk that people may not receive the care and support required to ensure their health and wellbeing. Medicines audits had not been updated to record progress towards completion. The provider’s procedures had not been robustly implemented.
Staff demonstrated the provider’s values, such as encouraging people’s independence and treating people with respect. However, relatives and staff commented that the manager did not always display these values. At times they felt their concerns had been not been addressed satisfactorily, or were dismissed without consideration.
People were protected from the risk of abuse, as staff understood how to identify possible signs of abuse, and the actions required to protect people and report concerns. Risks had been identified, monitored and addressed appropriately to ensure people and others were not placed at risk of harm. Staff understood the actions required to protect people from harm and actions taken had been effective in promoting people’s health and welfare.
People received their prescribed medicines safely. Medicines were stored, administered and disposed of safely. Administration records were complete, and included guidance for staff on ‘variable’ and ‘as required’ medicine doses.
Staff were supported to ensure they had the skills, knowledge and training required to effectively meet people’s needs. Although supervisory meetings had not met the provider’s requirement for quarterly review, staff told us there were effective measures in place to provide them with the support they required to raise and discuss issues and concerns.
Staff understood the principles of the Mental Capacity Act 2005 (MCA), and followed these to ensure people were supported to give valid consent to their care. Where people were identified as lacking the mental capacity to make informed decisions about specific aspects of their care, appropriate actions had been documented to evidence that lawful consent to care was gained from those best placed to provide this.
People were supported to maintain a healthy diet. Where people were assessed to be at risk of malnutrition or dehydration, appropriate measures had been implemented to ensure people maintained a sufficient daily intake of food and fluids. People’s health needs were effectively identified, and referrals to appropriate health professionals ensured they received the care they needed.
Staff were kind, respectful and caring. People sought staff support when they were anxious or confused, and readily chatted with staff. Staff were prompt to take actions to promote and protect people’s dignity, and respected people’s privacy when they chose to be on their own.
People’s care needs had been discussed and assessed with them, or those important to them, prior to their admission to the home, and were regularly reviewed. People’s views and preferences were included in their plan of care. A range of activities were provided, and people’s engagement with these was reviewed to ensure these activities met their preferences. People were satisfied with the care they experienced, and understood the process to raise concerns or complaints.
People, and those important to them, were able to discuss their views, wishes and concerns about the home, and individual care and support, during meetings and care reviews. Their views had influenced changes to menus.
The regional director was in the process of recruiting a new management team for this home at the time of our inspection. They demonstrated the provider’s values in their approach to people and staff. The provider reviewed information such as accident and incident reports to ensure appropriate actions were implemented to reduce the risk of repetition. Learning was shared across homes to develop understanding and shared learning for all managers. This promoted improvements to the quality of care people experienced.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.