Archived: Rosewell

Rosewell is registered to provide personal care and nursing care for up to 96 people. Three areas of the home named Rose, Sunflower and Bluebell accommodated people with personal care and nursing needs. The Farmhouse area accommodated people with personal care needs only. At the time of our inspection there were 57 people living in the service.

There has been no registered manager in place for over a year. 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. The business support manager has been in post for approximately six months. They told us that they would submit their registered manager’s application form.

In July 2015 people were not cared for in a safe, clean and hygienic environment. At this inspection the provider had not made sufficient improvements.

In July 2015 we found systems were not being operated effectively to assess and monitor the quality and safety of the service provided. At this inspection the provider had not made sufficient improvements.

Medicines were not consistently managed safely. We found two medication errors during the inspection and neither of these had been reported by the nursing staff and neither had been identified through the provider’s own audits and checks that were being undertaken.

In some areas of the building the premises were not suitable for the purpose for which they were meant to be used. Some bathrooms were not fully operational and there was a lack of adequate storage facilities throughout the service.

Care plans were person centred and provided details on people’s preferences, but there was not always enough detail provided for staff on how to promote people’s choices.

People’s nutrition and hydration needs were not met. People’s food and fluid intake was not managed effectively because food and fluid charts were not being monitored.

In July 2015 the lunchtime service was not organised which resulted in food not being consistently served at an appropriate temperature. At this inspection we found inconsistencies at the lunch time service and this required further development.

In July 2015 staff were not consistently supported through an effective training and supervision programme. At this inspection the provider had made sufficient improvements.

In July 2015 we found staffing levels were not sufficient to support people. At this inspection the provider had made sufficient improvements.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Care documentation demonstrated consideration of the Mental Capacity Act. The provider in some cases adopted a blanket approach to the mental capacity assessments. Some assessments of capacity were not decision specific.

The current Deprivation of Liberty Safeguards (DoLS) arrangements showed that the service followed a procedure to ensure they had an appropriate agreement to restrict people's rights.

Records showed a range of checks had been carried out on staff to determine their suitability for the work. For example, references had been obtained and information received from the Disclosure and Barring Service (DBS).

Staff we spoke with demonstrated a good understanding of how to recognise and report abuse. All staff gave good examples of what they needed to report and how they would report concerns.

People were treated with kindness and compassion. Staff knew people well, understood their support needs and were familiar with people’s personal preferences.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found four 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.

People said they were happy with staff looking after their medicines. One person said 'I'm glad staff give me my medicines'. One person told us the doctor had discussed their pain relieving medicine with them. They were able to tell the staff how they wanted to take the medicine. Another person liked staff to leave their medicines for them to take independently. One person told us that staff put all their medicines out for them. So they could check they were correct before taking them. This meant people could be confident staff would give them their medicines safely, in a way that suited them.

We also found that the provider was not meeting Regulation 15 relating to unsafe or suitability of premises within the farmhouse area.

While the provider had assessing and monitoring systems in place, they were not always effective in identifying the quality of service that people received. Following our inspection the provider supplied an action plan that highlighted how they intended to make the necessary improvements.

During this inspection we saw that documentation was in place that ensured people were involved in making decisions about the care they received.

We observed that areas of the Farmhouse had been refurbished and most furniture had been replaced.

However we saw that audits had not been completed on a regular basis in accordance with the provider's action plan. This included audits relating to infection control and the cleanliness of the home. This could put people at risk of infection.

We served a warning notice requiring the provider to make the necessary improvements by 11 November 2013.

We inspected on the 13 November 2013 to check that the necessary improvements had been made. We found that improvements had been made and the provider had met the requirements of the warning notice. People were cared for in a clean hygienic environment.

We will be completing a further inspection to check up on the compliance actions set at the September inspection.

One person we spoke with told us 'they don't forget your tablets and they are all so kind'.

People we spoke with told us that staff explained things to them and asked them how they would like to be assisted with their personal care. However we saw in two care files that recent Mental capacity Assessment had not been completed for one person and evidence of best interests meetings had not been recorded for one person.

We saw that on the Sunflower, Rose and Bluebell units the areas were clean and well maintained.

We found that the Farmhouse area of the home had not been maintained adequately and that some areas were dirty. People were at risk because the home did not have adequate infection control procedures in place.

We found that the providers system of audit had not identified areas for improvement with regards to maintenance and cleanliness of the Farmhouse Area of the home.