Archived: Rose Court Lodge

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present during this inspection.

People told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people’s safety were appropriately assessed and managed. Staff also supported people to retain as much independence as possible.

There were sufficient numbers of suitable staff to meet people’s needs and people received their medicines as prescribed.

When we last visited the service in November 2015 we found the provider was not meeting the legal requirements in respect of the need for consent. During this inspection we found that sufficient improvements had been made. The Mental Capacity Act (2005) (MCA) was used correctly to protect people who were not able to make their own decisions about the care they received.

Staff were provided with the knowledge, skills and support required to give effective care. People enjoyed the food and were given sufficient quantities of food and drink to maintain good health. People were supported to access healthcare services when required.

There were warm, positive relationships between people and staff. People and their relatives were able to be involved in planning their own care and staff respected any choices people made. Staff treated people with dignity and respect and maintained their right to privacy.

People received person-centred care and information about their care needs was kept up to date. There was a range of activities available within the home as well as external trips to various places of interest. People felt able to make a complaint and the complaints received had been appropriately investigated and responded to.

There was an open and transparent culture in the home and people and staff felt able to speak up. There were different ways for people to provide their feedback about the quality of the service and their comments were taken seriously. A range of audits was carried out to assess the quality of the service being provided.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who were using 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.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We spoke with ten people who used the service, two visiting relatives and a health care professional to establish their views on the quality of service provision. We spoke with the acting manager, the area manager and five staff, which included a newly appointed activities coordinator. We also looked at some records held in the service which included the care files for five people. We observed the support people who used the service received from staff and carried out a tour of the buildings.

There was an acting manager in post are the registered manager had left the home in July 2014. The acting manager was available throughout our inspection.

Is the service safe?

People told us they felt they were safe and could raise any concerns with the management team which they felt would be addressed effectively. A relative of a person who had recently passed away told us their relative had received, 'Amazing care,' and said, 'I cannot compliment the staff enough.'

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise.

We established that staff were able, from time to time, to obtain further relevant qualifications pertinent to their roles and responsibilities at the agency.

We found the home was maintained to a good standard of hygiene. We also found staff were adhering to infection control policies and procedures. We spoke with one member of the domestic staff. They told us they had received training in the principles of infection control and also maintained cleaning schedules to show the required cleaning tasks were undertaken. The provider may find it useful to note that we found the cleaning schedules were somewhat basic and would have benefited from additional details to identify specific cleaning tasks undertaken within individual bedrooms.

Is the service effective?

Systems were in place to ensure that people's individual support needs could be identified and met.

We observed people's support was delivered in such a way as to meet their individual needs and preferences. We saw people's care files had been reorganised since our last inspection. Staff told us this was a good improvement as they were well laid out and easy to refer to.

We found staff had a good understanding of people's individual requirements and systems were in place to inform staff of any changes in people's needs. One person told us, 'I am very happy here I have everything I need.' A person's relative told us they felt their relation's needs were well understood and staff had found out information about a particular health care need so they could provide them with appropriate care and support.

Is the service caring?

Throughout the day of our inspection we found staff were friendly and caring in their approach. We saw staff speaking with people in a respectful and caring way. Staff were smiling and cheerful as they went about their work. One staff member said, 'I love my job, I enjoy being at work.' A relative said, 'It is the staff that make the place, they are like sons and daughters to the residents.' A senior care worker said, 'If we say good morning with a smile on our face that means the world to the residents.'

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed when people expressed a desire to use service. We also found an effective ongoing review process was being undertaken to ensure peoples changing needs could be identified and responded to.

Is the service well-led?

We found that since our last inspection we found the registered manager had resigned on 21 July 2014 and an acting manager was on post. We spoke to the newly appointed acting manager and found they were fully aware of what was expected of them and demonstrated enthusiasm and commitment in developing the service.

People told us that they felt confident in discussing any areas of service provision with the organisation's acting manager. They also told us in their opinion the quality of service provision had improved significantly since our last inspection was performed.

Staff spoke positively about the new manager. One staff member said, 'They (the acting manager) know what should be done and get it done.' Another staff member said, 'The manager tells us if we are wrong and tells us if we are right. That is what we needed,' and 'Since the new manager has been here there has been a better atmosphere.'

A person's relative said the acting manager had, 'Turned things around.' They said their relation had not had any curtains up for weeks before the new manager came, and they (the acting manager) had sorted it out straight away.

A visiting professional told us they thought there had been improvements over the last eight weeks. They told us the staff morale and enthusiasm had improved. They also said when equipment was needed the acting manager had ensured it was provided promptly.

Staff told us they received appropriate support and direction from the management team. We found the acting manager had initiated a programme of formal staff supervisions as some staff had not undergone the process for several years. Although the acting manager was making good progress in this area further developments were required to ensure all staff received the support in a timely manner.

On the day of our inspection we found the acting manager had initiated a satisfaction survey so people could make comments about the quality of the service they received. The acting manager told us once the consultation process had been completed an analysis of the results would be undertaken. This was to ensure procedures were in place to develop the quality of the service whilst recognising where improvement could be made.

The acting manager had made significant progress in developing the quality of service provision. We were told they would only remain in post until a suitable candidate was appointed to take over the permanent managerial responsibilities at the service.

The Care Quality Commission will continue to monitor the service to assure ourselves that the new management team will continue to develop the quality of service provision and ensure the improvements are sustainable.

We spoke with five people who used the service, two relatives and a visiting community staff nurse and asked them for their views. We also spoke with eight staff members, the deputy manager and the registered manager and carried out several periods of observation. We looked at some of the records held in the service including the care plans of five people. We observed the support people who used the service received from staff and carried out a partial tour of the building.

This is a summary of what we found-

Is the service safe?

On the day of our inspection we considered that the service was not always providing care to people that was safe. We saw care staff providing support to people that was no longer appropriate because care plans had not been updated to reflect the person's current needs. This could put people at risk of injury.

We observed staff wearing long, false nails and not always wearing gloves when supporting people, which increased the risk of spreading infection and possible injury to the person.

We observed staff using a hoist to move people and not using an allocated sling. We saw there was no consideration for the person's dignity.

Care files seen did not always contain charts to record a number of essential care tasks such as repositioning people whilst they were being cared for in bed.

People who had been assessed as at risk of malnutrition did not always have their dietary intake recorded and there were no records for people who required assistance to access the toilet at two hourly intervals, to show this took place.

Is the service effective?

On the day of our inspection we considered that the service did not always provide care which was effective. We asked several members of staff, including the manager and the deputy manager, which people needed to be moved with a hoist. None of the people asked, could provide us with that information. Staff we spoke with were not always aware of the assistance people needed.

We asked staff about the care and support needs of some of the people living at the service and they were unable to tell us what the person's care plan said.

It was clear from our observations and from speaking with staff that they did not have a good understanding of the people's care and support needs , therefore, there was a risk that people would be moved using incorrect equipment, putting them at risk of injury.

Is the service caring?

On the day of our inspection we considered that the service was not always caring when supporting people.

We observed that people were not always supported to go to the toilet at regular or frequent intervals and their dignity was not always respected.

We saw that people were not always involved in the planning of their care or in the decisions that were being made for them.

We saw that people were not offered choices at meal times and were not always provided with nutritious food which they enjoyed

Is the service responsive?

On the day of our inspection we considered that the service was not always responsive to people's care needs.

We saw care plans were being reviewed on a regular basis; however, changes had not always been made when required. On the day of our inspection care staff were providing support to people that was no longer appropriate and therefore put people at risk.

We saw a pre-admission assessment had been completed after the person had been at the service for three days.

The manager told us that a person who had been in hospital for over two weeks had returned to the service without an assessment of their changed needs taking place.

Is the service well-led?

On the day of our inspection we considered that the service was not well led. Staff we spoke with told us they did not feel 'listened to'. They told us they were not having supervision and they did not feel the training adequately equipped them to do their work.

We asked the manager what action they had taken with regard to staff wearing long, false nails and they told us they had raised it with staff but they still wore them. We observed the deputy manager wearing them and when we asked staff about this we were told, 'Why shouldn't we. The deputy manager wears them and she does personal care.'

Staff files we looked at did not contain records to show that staff had been supported or supervised following disciplinary matters even though the manager told us they had been.

We also spoke with the registered manager, and five other members of staff. We looked at records including the care files for seven people. We observed the support people who used the service received from staff and carried out a tour of both buildings.

Records we saw showed Mental Capacity Act assessments were inadequate and 'best interest' procedures were not in place. Additionally the records showed that some people's needs may not have been re-assessed and they may not have received care which met their needs.

We saw people being offered choices and opportunities which were respected. One person who used the service we spoke with said, 'The staff are great, so caring and always ask if it is ok to help me, they show respect.'

People were protected against the risk of abuse. We saw the provider had a safeguarding policy and procedure in place and staff members we spoke with told us their training included the area of safeguarding vulnerable adults. They told us they were also supported to obtain further qualifications relevant to their role.

We found that the building was safe and there were systems in place to assess and monitor the quality of service provided. Staff we spoke with felt the home was well led.

All of the people we spoke with who were using the service told us they were happy with the care and support they received. Also that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed. They said that staff always treated them with respect.

One person told us, 'I really enjoy the regular entertainment here.' Another person told us, 'I couldn't be in a nicer place. They go out of their way to make you feel comfortable.'

People who were visiting relatives told us, 'Staff are very caring and good at keeping you informed.' Another person told us, 'Nothing seems to be too much trouble for the staff.' Another said, 'I've been really impressed with everything and the staff always make you very welcome no matter what time you visit.'

All of the staff we spoke with said the provider was good in terms of ensuring that staff training was up-to-date and that they really enjoyed working at the service, some of which had worked there for a number of years.

People who were visiting relatives told us they were happy with the care and support their family members received. One relative told us 'I think staff have a difficult job, but they all seem to go out their way to do their best.'