Archived: Rose Lodge

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people used the service and with staff who supported them. We also looked to see what systems and processes had been implemented by the provider to show us how they monitored and assessed the quality of the service provided.

If you wish to see the evidence supporting our summary please read the full report.

The acting manager was on duty at the time of this inspection.

Is the service safe?

Since our last inspection the provider had appointed a new manager. This person confirmed to us that they were in the process of registering as the manager with the Care Quality Commission. They outlined their plans to improve systems and processes and they showed us how they had introduced regular audits to reassure them that people received the care and support that they were assessed as needing.

The acting manager and the provider were now aware of their responsibilities in relation to reporting allegation of abuse and poor practice. The manager shared examples with us of how they had recently worked with health and social care professional to improve services for one person who used the service. Staff who spoke with us were aware of how to recognise and report abuse and we saw a workbook completed by a new staff member that had been used by the manager to check their understanding of abuse following the training. This meant that people who used the service could be protected from the risks of poor or abusive practice.

Is the service effective?

We found that people who used the service continued to feel well supported. They told us that they felt well looked after.

We saw the newly implemented auditing and monitoring systems. The manager had started using these systems to assess the quality of the service provided. We saw how audits had identified where improvements were needed and they also showed how the manager had acted to make changes to address issues.

Is the service caring?

At the time of our last inspection in June 2014 we found that people were supported by staff who were committed to meet their needs and genuinely cared about them. Staff told us that they 'Loved' their jobs. We spoke with six people and three relatives. They all spoke highly of the care and support that they received.

Is the service responsive?

During this inspection we found that the provider had made improvements. They had produced an action plan of how they would achieve compliance with the Care Homes Regulations 2008 and were working through it.

Is the service well-led?

We found that since our inspection in June 2014 there had been changes to the management of the home which had resulted in improvements being made to systems and processes. The new acting manager and the provider could demonstrate that they had worked together to ensure that they were meeting the needs of the people who used the service. We saw new auditing systems and we saw how the manager was implementing them. This meant that they were aware of people's needs and could demonstrate how these needs were being met with appropriate support from outside agencies when required.

We spoke with the provider and their advisor following our inspection. They told us how they had supported changes to systems and processes to ensure more effective monitoring of the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who received a service, the staff supporting them and looking at records. We also spoke with the two senior staff who currently had management responsibilities at the time of the inspection and the provider.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We visited Rose Lodge on two occasions. Once on 12 June 2014 and again on 13 June 2014. During this time we spoke with 12 people who received a service and observed how staff supported people. We saw examples of good care and support during this time.

The service did not have a registered manager to be accountable for the running of the home. We spoke with the two senior staff who were currently assuming management responsibilities. They told us that people received good care however they also told us of failing systems and improvements that were required to ensure the safety of the people who received a service.

We saw that care plans had essential information missing such as assessments of identified risks to the person who received a service. This meant that care and support had not been appropriately assessed and documented to ensure a safe and consistent approach. We saw that this had become an issue when one person's support needs had increased.

We saw that staff files were incomplete and some staff had not received basic pre-employment checks. This meant that the provider could not be sure that staff appointed to work at the home had the skills and behaviours to ensure the safety of the people who received a service. We saw how senior staff were addressing this issue by chasing up checks.

Staff were not familiar with procedures for safeguarding people from abuse. The provider did not demonstrate that they had an understanding of how to protect people from abuse and why systems and processes were in place.

Senior staff did not have contact numbers should they need to refer an allegation of abuse to the appropriate agency. Likewise staff had not received training in relation to protecting vulnerable people. Although staff told us that they knew what constituted abuse we saw how, on at least one occasion, a member of staff had failed to recognise potential abuse leaving a person who received a service at risk of harm.

Is the service effective?

We found that people who received a service were well supported. They told us they felt well looked after. One person told us, 'We are well looked after food wise and health wise'.

We saw how staff supported people appropriately. We also saw that people who received a service were well groomed with attention to detail. They told us that this made them feel good about themselves. For example one person told us how they liked to have their nails varnished and one person only felt dressed when they had all of their jewellery on. We found that overall people's care and support needs were being met and when their health and support needs changed they were referred appropriately. People told us that they were satisfied with the service they received. Visiting health professional told us the home had a good reputation locally.

We saw care plans and risk assessments had not always been completed to reflect people's care and support needs. This meant that when a person's support needs increased staff may not have the appropriate guidance and training to offer effective support. We saw how incidents in relation to changes in behaviours had been recorded however care plans had not been updated to reflect increased support measures.

The senior staff assuming management responsibilities told us they had identified shortfalls in relation to staff training. They told us how they were currently addressing these shortfalls while training was being sourced and provided.

We found that systems in place for monitoring and assessing the quality of the service were not effective. The provider had failed to pick up issues within the home that had the potential to place people who received a service at risk of harm.

Is the service caring?

People were supported by staff who were committed to meet their needs and genuinely cared about them. Staff told us they 'Loved' their jobs. We saw examples of kindness and attention to detail that people who received a service valued. People were offered choices about what they had to eat and drink. People told us that the food was, 'Excellent'. Visitors and relatives also told us that staff were kind and gave examples of how they had been involved and consulted about people's likes, dislikes and preferences.

Is the service responsive?

Although we found that the senior staff currently assuming management responsibilities were acting to make improvements we did not find that the service had been responsive overall.

We found there had been occasions when staff had not received guidance to follow when people's care and support needs increased. Following these incidents the provider had not put systems in place to identify how increased support needs would be met in the future. This meant the provider was not responsive in meeting people's support needs.

On the day of the inspection we shared our concerns about senior staff not having time to fulfil management duties. The provider then took action to ensure that additional staffing would be made available to enable senior staff to dedicate their time and resources to addressing shortfalls within the service.

Is the service well-led?

Staff told us they received good support and leadership from the two seniors currently assuming management responsibilities.

The provider had been aware of some issues in relation to the management of the home yet they had not acted upon them. They did not have effective monitoring systems in place to identify issues and as a result could not be sure that people received a safe service.

We saw the provider was currently investigating a number of issues. We found that they had not followed up on information received appropriately. They could not provide us with key information to support this investigation.

We found improvements had been made to monitor and assess people's needs. The provider had put systems in place to ensure the staff followed clear guidelines to assess the quality of the service they provided.

We spoke with three members of staff during our visit.

Although the changes brought about under new management of the home had unsettled some people, we were also told this had been mostly welcomed and things had improved. Two people told us they felt safe at the home and one person said, 'Everything's better now.'

The inspection found improvements were being made at the home however we found that more needed to be done to ensure that people benefitted from safe quality care, treatment and support through the organisation of effective quality monitoring systems.

The new care plan system, albeit in its early stages, was more reflective of people's needs and gave staff most of the information they needed to deliver care and support safely.

There were improved systems in place to protect people from abuse or the risk of abuse. Two people told us they felt safe in the home. However, records showed staff had not received the training and instruction needed to be confident about their responsibilities.

Improvements had also been made to the management of medicines although more needed to be done to monitor compliance with the standards and ensure medication was stored in accordance with the manufacturer's instructions.

A person who used the service described the home as, 'Comfortable and pleasant.' They said, 'I like the people who work here, I just wish we had more to do like before.' Another person also expressed a preference to have more planned activities. They explained, 'At one time they did bingo; played dominoes and had quizzes, but not now. I have to make my own entertainment now.'

We found that people were supported to be independent and make their own choices and decisions. This included being responsible for their own healthcare needs although improvements were needed in the management of medicines and record keeping.

One person gave us a balanced opinion of their experience of living at the home. They were aware of their right to express their views and report any concerns and they were confident to do this without fear of subsequent discrimination or disadvantage. However they also disclosed information of concern to us which, with their permission, we asked the manager to look into using the complaints procedure. We asked the manager to tell us the outcome of their enquiries and confirm if the matter needed to be referred to the local authority under safeguarding procedures.

There is no registered manager at the home.