This unannounced inspection took place on 27 September 2018. Rotherlea is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rotherlea is situated in Petworth in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Rotherlea is registered to accommodate 70 people. At the time of the inspection there were 60 people accommodated in one adapted building, over two floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people and those living with dementia.
The management of the home had been through a period of transition. The home had a registered manager who had been on long-term leave from work. A registered manager is a ‘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 home is run. The management team consisted of team leaders and two deputy managers, one of whom was also on long-term leave from work. A manager from one of the provider’s other homes had been managing Rotherlea, alongside their own service. An operations manager also regularly visited and supported the management team.
At the last inspection on 14 and 15 September 2017, the home received a rating of ‘Requires Improvement’. The provider was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, the provider completed an action plan to inform us of what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. This was because there were concerns about staff’s understanding and use of the Mental Capacity Act 2005 (MCA). The provider had not always complied with the Deprivation of Liberty Safeguards (DoLS). Staff were not always provided with consistent guidance about people’s specific healthcare needs. Records to document the actions of staff were not always maintained. Areas identified as needing improvement related to following advice that had been provided by external health care professionals.
At this inspection, we found some improvements, in relation to MCA, the maintenance of some records and implementing healthcare guidance, had been made since the previous inspection. However, people were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible. The policies and systems in the home did not always support this practice. This was an area of concern.
One person’s needs had been assessed before they moved into the home. This had shown that they had a history of falls. The provider had failed to ensure that these risks were identified and managed to assure the person’s safety. The person had fallen and sustained a significant injury. This was an area of concern.
There were continued concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Not all concerns that had been identified at the previous inspection on 14 and 15 September 2017, had been addressed. Areas that were identified as part of this inspection had not always been picked-up and acted-upon by the provider’s own quality assurance audits.
Records, to document people’s specific healthcare conditions did not always contain sufficient guidance to inform staff’s practice. It was not always evident how people or their relatives had been involved in contributing or reviewing their care.
We made a recommendation about people’s access to meaningful activities, interaction and stimulation.
People were cared for by sufficient numbers of staff to meet their physical needs. People were protected from harm. Staff knew the signs and symptoms to look for if there were concerns about a person’s care. Reflective practice ensured that lessons had been learned when care had not gone according to plan.
Most risks were managed and people received safe care. People told us they felt safe. One person told us, “I feel safe because there are people around and the bell”. A relative told us, “I feel my relative is 100% safer here”.
Medicines were managed safely. People were protected from infection and staff demonstrated correct techniques to ensure that cross-contamination was minimised.
People had access to healthcare professionals when they were not well. There was a coordinated approach to people’s healthcare. One person told us, “If I wanted to see a GP I would only have to ask a team leader”.
People’s hydration and nutrition was maintained. Comments from people included, “The food is wonderful” and “My food is OK, I have no complaints. If you want more you only have to ask”.
People and their relatives were informed about their care. People told us that staff were kind, caring and compassionate. Comments from people included, “The carers are fine, no problem with any of them” and “They are very pleasant and helpful carers”.
People’s privacy and dignity was maintained. People were supported to remain comfortable at the end of their lives.
People were aware of how to raise concerns and complaints. Residents’ and relatives’ meetings, as well as surveys enabled people to voice their opinions and suggestions about the way the home was run.
People had space to be with others, spend time on their own or enjoy the gardens in warmer weather.
People, relatives and staff were complimentary about the management of the home. People and their relatives told us that they could approach the management if they had queries about people’s care. One person told us, “I don’t know who the actual manager is here. However, there seems to be plenty going on and is run pretty well”. Staff felt valued and appreciated and told us that morale had improved.
This is the third consecutive time that the home has been rated as Requires Improvement. We found 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 the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.