The Care Quality Commission
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Archived: Rose Lodge Care Home

Overall: Requires improvement read more about inspection ratings

41 Church Road, Banks, Southport, Merseyside, PR9 8ET (01704) 220061

Provided and run by:
Parkcare Homes Limited

All Inspections

13 September 2017

During a routine inspection

We inspected this service on the 13, 14 and 21 September 2017. The first day of the inspection was unannounced which meant the home were not expecting us on the date of the inspection.

Rose Lodge Care Home provides nursing and residential care for up to 40 older people. At the time of the inspection there were 26 living in the home. Nineteen of these received residential support and seven received nursing care. The home is located in the middle of a residential area in Banks a small town near Southport, Lancashire. The home is situated in its own grounds and is a large single story building with landscaped gardens to the sides and rear of the property. The accommodation is provided over three wings, with all rooms having access to their own en-suite bathroom facilities.

There are large communal areas including two lounges and a dining room. The kitchen and laundry facilities are accessible to cater for the needs of the people living in the home.

The home was last inspected on 10 July 2015. At this inspection the home was found to be in breach of one of the regulations associated with person centred care. We gave two recommendations for improvements in recruitment and the gathering of formal consent. The home was rated as requires improvement overall and requires improvement for four of the key questions, namely safe, effective, responsive and well led. We rated the home good in the caring key question.

At this inspection we have again rated the home as requires improvement overall but acknowledge the home’s new manager is beginning to address concerns noted. There had been some detrimental practices at the home since the last inspection which have impacted on the current quality of the service provided. However the provider and manager have developed action plans and ongoing evaluation to ensure concerns are addressed.

We found the home had met the previous breach in person centred care as people told us they could have baths when they wanted them and had them regularly. We did however note that records of this were poor. We found concerns with a number of the records made which included inconsistencies and contradictions. We also found the home had not effectively audited this to ensure improvements were made. We found this had not directly impacted on the support people received at the time of the inspection but there was a risk it could have. We have found the home in breach of this regulation and have asked the provider to make specific and focused improvements in this area.

At the last inspection we recommended the provider sought formal consent from the people they were supporting. We found this had not been done at this inspection and have found the home in breach of this regulation. This means the home will be required to develop an action plan on how they intend to make improvements in this area. Action plans are required for all breaches found during inspections.

We also found concerns in the management of medication and noted the home were not always following best practice guidelines. This was noted partly in the inconsistent completion of the medicine administration records.

We found the home’s staff continued to have good relationships with the people they supported and it was evidenced to us that they knew people well. When staff were new to post we saw other staff members supporting them and reviewed that they had been recruited safely.

Staff treated people with dignity and respect and people had choices in their daily lives. People told us, if they had specific requests or preferences, they would be met.

The home had taken appropriate steps to ensure the building and the equipment used was safe and secure. Risk assessments had been completed and action taken to mitigate identified risks. Professionals had tested equipment to ensure it was safe to use. The home had a plan in place in the event of an emergency.

We found the home worked within the principles of the Mental Capacity Act 2005 where people lacked the capacity to consent to their care and treatment and used the Deprivation of Liberty safeguards appropriately to ensure people were both kept safe and were supported in the least restrictive way possible.

People we spoke with liked the food provided in the home and the chef was knowledgeable on people’s needs. We saw people who had previously lost weight were now gaining it to maintain a healthy lifestyle. We also saw the chef had supported one person to lose weight and the person was happy with the support they had received.

The manager had gained the trust of the staff at the home and the people in the home including their family members. Everyone we spoke with was positive the home would improve under the new manager.

The new manager had recently registered with the commission and now had a legal responsibility to drive improvements and meet the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home had gathered the views of the people they supported and taken action where things needed to improve. Where complaints had been made the manager had ensured lessons were learnt from the complaint and took steps to reduce the risks of similar events occurring.

You can see what action we told the provider to take at the back of the full version of the report.

10 July 2015

During a routine inspection

This inspection took place on 10 July and 14 July 2015 and was unannounced. This meant the provider did not know we would be coming.

At our last inspection, in August 2014, we found breaches of Regulations with regard to management of medicines, systems which were used to assess, monitor and improve the quality of the service and having regard to complaints and comments made, and views expressed by people who use the service, in relation to the quality of the service provided.

During this inspection, we found that improvements had been made in each of these areas in order to meet the relevant requirements of the Regulations.

Rose Lodge Care Home provides care and support for a maximum of 40 older people. At the time of our visit there were 37 people who lived at the home. The home is set in its own grounds, located in Banks, close to Southport. Accommodation is situated on the ground floor and there is easy access for wheelchair users and people with limited mobility. All rooms have an en-suite facility and are situated over three wings. Communal areas include a lounge, a quiet room, a dining room and a landscaped outside area for people to use.

The service had a registered manager. 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’s written plans of care did not always contain a good level of detail about them, their life histories and preferences. People’s preferences were not always taken into account in relation to the care delivered to them. This was in breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found an accurate, complete and contemporaneous record of the care and treatment provided to each service user had not been maintained. This had been identified by the provider’s quality assurance systems and work was underway to find the most effective way of ensuring these records were complete and accurate.

We were informed by the local authority that the service had not followed correct procedure with regard to an application for a Deprivation of Liberty Safeguards (DoLS) authorisation for one person. We fed this back to the deputy manager when we received the information and received assurances that they would look into their processes to eliminate reoccurrences.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Safeguards were in place for people who may have been unable to make decisions about their care and support.

We received mixed comments from people, their relatives and staff about staffing levels in the home. When we discussed this with the registered manager, they told us, and staff confirmed, they were aware of issues at certain times of the day and were trying different shift patterns in an attempt to resolve the problems.

We found recruitment and selection processes were robust. However, we identified one case where concerns from a previous employer had not been explored and one case where the validity of an employment reference had not been verified. We have made a recommendation about this.

The provider had implemented safe systems with regard to managing people’s medicines, which were followed in practice.

During the inspection we found there was no record of people’s formal consent to care and treatment in their written plans of care. We highlighted this with the manager and regional manager who implemented a form during the second day of our inspection.

Staff told us and training records confirmed that there was a comprehensive induction and rolling program of training to ensure that staff had the necessary skills and knowledge to undertake their role and fulfil their responsibilities.

The registered manager told us and people confirmed that since our last inspection, the provider had consulted with people about what they wanted to see on the menu and had held ‘taster sessions’ with the chef. This helped to ensure people could choose what food was available for them.

People were supported to express their views and be actively involved in making decisions about their care and support. People told us and our observations confirmed, that staff promoted people’s privacy and dignity.

People told us they were able to choose what staff supported them with, how they spent their time, and what activities they participated in. People told us that the activities coordinator took time to get to know them, so they could provide activities which they enjoyed.

The service had implemented a suitable complaints policy and procedure which was last reviewed in July 2015.

People we spoke with and their relatives all knew who the registered manager was. They told us they were confident they could approach them with any concerns and were sure they would be taken seriously.

Regular audits and checks were carried out by the management, including visits by the regional manager, which were designed to assess, monitor and improve the quality of the service provided.

Handover took place between each change of staff. This helped to ensure they were kept up to date with any important items, such as concerns about individual people or the day to day running of the service.

You can see what action we have told the provider to take at the back of the full version of the report.

To Be Confirmed

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to look at the overall quality of the service.

The inspection visit at Rose Lodge Care Home on 05 August 2014 was unannounced.

Rose Lodge Care Home provides care and support for a maximum of 40 older people. At the time of our visit there were 37 people who lived at the home. The home is set in its own grounds, located in Banks close to Southport. Accommodation is situated on the ground floor and there is easy access for wheelchair users and the less mobile. All rooms have an en-suite facility and are situated over three wings. Communal areas include a lounge, a quiet room, a dining room and a landscaped outside area for people to use.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Safeguards were in place for people who may have been unable to make decisions about their care and support.

The registered manager assessed staffing levels to ensure there was enough staff to meet the needs of people who lived at the home. We observed staff made time for people whenever required and took time to explain things to people so they didn’t feel rushed. However, people who lived at the home told us there was not always enough staff on duty, which meant sometimes they had to wait to be supported. We saw there was a range of group activities taking place. However people who lived at the home told us there was not always the opportunity for people to receive time with staff on a one to one basis for activities. This meant people may be at risk of becoming socially isolated.

We looked at how medicines were prepared and administered.  We found that two people’s medication records did not match the quantity left in stock. Failing to give people their medicines properly places the health and welfare of people at unnecessary risk. This is a breach of Regulation 13 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.

We found inconsistencies relating to people’s involvement in decisions about their care and how they were supported to make choices as part of their daily life. Most people had a detailed care plan which covered their support needs and personal wishes. We saw plans had been reviewed and updated at regular intervals. This meant staff had up to date information about people’s needs and wishes. Records showed there was a personal approach to people’s care and they were treated as individuals.  However one person who had recently been admitted to the home did not have a complete care plan in place.

Staff spoken with were positive about their work and confirmed they were supported by the registered manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.

The management team used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, ‘residents’ meetings’ and care reviews. Overall satisfaction with the service was found to be positive. However systems to monitor the health, safety and well-being of people who lived at the home, had not been effective in identifying areas where people’s safety was compromised. This included administration of medicines, care planning for new admissions and ensuring adequate staffing levels to consistently meet people’s needs. We found the provider did not consistently have regard to the comments and opinions expressed by people who used the service in relation to the quality of the service provided. This is a breach of Regulation 10 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.

9 May 2013

During a routine inspection

People we spoke with who lived in the home said staff were respectful. We were told that staff knock on people's doors before entering and gain agreement before personal care is undertaken. One person told us, 'There seems to be more happiness here lately.'

We asked people who lived in the home if they felt they were supported and were kept safe. One person said, 'I feel safe and looked after, I can't grumble.'

We were told that communication had improved and people felt involved in making sure everything was in place to keep people safe. However one person told us that extra precautionary steps agreed were not always followed.

People who lived in the home said it was nice and had improved since the refurbishment. The garden remained a focal part of the home and it was due to be opened formally as a memorial garden.

We were told that there were lots of new staff and more staff seemed to be on duty. One person said, 'I get on well with all the staff and I'm well looked after.'

The home had developed an appropriate communications strategy to meet the needs of the home. This included; a daily flash meeting, recorded handover procedures, manager's surgeries and an improved communication diary.

7 September 2012

During a routine inspection

There was a natural waking policy, and people were free to eat their breakfast and other meals where they choose. People we spoke to all said the food was good and had improved in recent months.

When reviewing care files and after discussion with management it is clear that systems for assessing and monitoring needs and risks have recently changed following changes in provider relationships.

Care plans were lacking in consistent reviews, with some key risk assessments not being completed or assessed appropriately.

We spoke to people living at the home about feeling safe and all that were spoken too said they felt safe and had confidence that the staff would look after them in the event of an emergency.

We asked people living in the home and their relatives if they felt they received the care and support they need. One relative said, 'the staff are all excellent there just isn't enough of them'.

We spoke to people living in the home and relatives about their thoughts on how the home was run. People generally praised the staff and said they were very good.

14 September 2011

During a routine inspection

We spoke to a range of people about the home. They included, management, staff and residents. We also had responses from external agencies such as Social Services in order to gain a balanced overview of what people experience.

People living at the home told us staff were respectful and treated them with dignity, one resident said, "They are all respectful",another said, "Despite being busy they are kind and competent". All people we spoke to said good things about the way they were treated by staff.

We discussed individual care needs with staff and they all had a good awareness of the care and support people need. Records looked at confirmed this. One staff member said, "The care records are excellent however we don't have enough staff to provide the care everyone requires".

It was evident from our general observations of daily routines, talking to staff and residents, there was not enough care staff to ensure people received the support and care they required on a daily basis. Comments from people living at the home included,"The staff are really good but there is not enough of them". Another person said, "They are always to busy to spend time with us, I feel so sorry for them because they do a great job and are always smiling despite being busy". Staff also talked about their concern of lack of staff which affects the way they can provide quality care, comments included, "I do not have enough time to get around to everyone first thing because I have to help with other duties". Also," We cannot physically get round to everyone". We looked at what relatives had said in the minutes of a recent meeting which highlighted the lack of staffing levels, a quote from the meeting read, ' Staff are run off their feet'.

Personnel also told us how this has affected morale with people leaving, and high levels of sickness. One member of staff said, "Lots of staff are leaving or have left its not good".

We spoke to Lancashire County Council Contracts monitoring department and they have no issues with the service and have not received any 'safeguarding' alerts recently.