We carried out a review of the data available to us about Red Rocks Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Red Rocks Nursing Home, you can give feedback on this service.
The home was clean, tidy and odour free. Domestic staff were allocated to specific areas and rooms. Cleaning checklists and infection prevention and control measures were checked regularly by managers to ensure staff adhered to guidance and standards. Managers used an electronic tablet to record and submit infection prevention and control audits.
The provider and home owner took a proactive approach to maintaining standards of infection prevention and control. For example, they had ensured all fabric chairs were made of antibacterial fabric and had installed brass grab rails in bathrooms, as brass has antimicrobial properties.
Domestic staff cleaned all ‘touch points’ every hour and recorded this on a checklist. Touch points are areas such as light switches and door handles which are touched more regularly by residents, staff and visitors.
Red Rocks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Red Rocks Nursing Home is registered to provide support for up to 24 people with nursing and personal care needs. It has 22 bedrooms, two of which are large enough to be shared. There are communal toilets and communal bathrooms with specialised bathing facilities for people to use and all bedrooms have private washing facilities.
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. There was a registered manager in post who was also the registered provider but they declined to engage with the inspectors or the inspection process. Fortunately for inspection purposes, the clinical lead and the care administrator assisted inspectors with their inspection of the home.
We looked at care plans and found that they covered people’s needs. At our last inspection, risk assessment and care plans were sometimes generic and lacked sufficient detail. At this inspection we saw that improvement had been made. Some of the wording of people’s care plans and risk assessments was generic but we saw that staff had added in extra detail about the person and their needs were applicable. Greater detail had also been added to various aspects of people’s care such as nutrition and falls.
Records showed that people received the day to day care they needed from the staff team and we saw that where people needed support from other health and social care professionals, this had been organised without delay. For example, people received support from dieticians, speech and language therapy, diabetic care, podiatry and physiotherapy.
We saw that there were activities available and people said that they enjoyed them. An activities co-ordinator was employed by the provider and we saw that a range of group and one to one activities were available for people to participate in. This promoted people’s well-being.
The home employed adequate staff in order to meet the needs of the people who lived there. The staff employed were supported by the clinical lead and care administrator to do their jobs well. They had access to regular training, support and supervision. We found the staff on duty to be pleasant, co-operative and attentive to people’s needs. The staff were kind and caring and we saw many examples of how they respected the privacy and dignity of the people who lived in the home. People spoke very highly of the staff and the care that they received. When we spoke with staff, we found they had a good knowledge of the people they cared for including their day to day preferences and likes and dislikes
The premises were cleaned and well maintained. We saw that the equipment was regularly checked to ensure that it was safe for use. We also saw that the service ensured that the maintenance of the home did not disrupt the care that was being provided. We found however that the home was not sufficient dementia friendly to ensure that people’s ability to be independent was promoted. The home lacked adequate signage to promote the ability of people who lived with dementia to navigate around the building independently.
At our last inspection, the manager and staff lacked sufficient understanding of the mental capacity act 2005. At this inspection, we saw that staff had undertaken training in the mental capacity act 2005 and the deprivation of liberty safeguards. Staff we spoke with about this legislation demonstrated they now understood this legislation and their responsibility within it. Records showed that since our last inspection they had applied the act to ensure that people’s consent was lawfully obtained. .
We saw that risk assessments were in place and were updated regularly to keep people safe. This included the assessment of any potential risks associated with the use of bed rails. This was an improvement since our last inspection and ensured that people who had bed rails installed were safe to do so.
Medicines were managed well for everyone who lived in the home. Stock levels of people’s medication were correct and safely stored. Records showed people received the medicines they needed. Medication plans in respect of the application of topical creams and ointments needed improvement.
End of Life care was an area where the service particularly focussed and this had been recognised with the service holding the Gold Standard Framework (GSF) Platinum Beacon status for End of Life Care. It was clear that this award and the values of the GSF were very important for all of the staff.
The management of the home had improved since our last inspection. Improvements had been made to the management of risk, care planning, fire safety arrangements, medicines, staff training and support, mental capacity care and the systems in place to monitor the quality and safety of the service. It was clear that the staff team had worked hard since our last inspection to ensure the service complied in full with the health and social care regulations. People we spoke with confirmed that the service was well led and everyone we spoke with was happy with the care they received.
Red Rocks Nursing Home is registered to provide support for up to 24 people with nursing and personal care needs. It has 23 bedrooms one of which is large enough to be shared. There are communal toilets and communal bathrooms with specialised bathing facilities for people to use and all bedrooms have private washing facilities.
There was a registered manager in post who participated in the inspection visit. 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’.
During this inspection, we found breaches of Regulations 11, 12, 17 and 18 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.
We looked at the care files belonging to four people who lived at the home. We found they did not adequately cover all of their needs and risks. Some risk assessments and care plans failed to provide adequate or clear information to guide staff in safe and appropriate care and some care plans and risk assessments were generic. This meant that people’s plan of care was not always personalised to their needs and preferences. Staff lacked sufficient guidance therefore on how to provide people with person centred care and manage their risks. We also found that the risk management advice given by other healthcare professionals in relation to one person’s care had been changed without professional clarification being sought beforehand. This placed the person at potential risk of harm. During the inspection, professional advice was gained and the change agreed.
We found that where people had mental health conditions which may have impacted on their ability to consent to decisions about their care, their capacity had not been assessed in accordance with the Mental Capacity Act 2005. In addition, although deprivation of liberty safeguard applications (DoLS) had been made to the Local Authority they had not been based on capacity assessments in line with MCA 2005, which meant that individuals were at risk of being inappropriately deprived of their liberty. We found that the manager and staff we spoke with lacked a clear understanding this legislation designed to protect people’s human rights. This placed people at risk of being unlawfully deprived of their liberty and their legal right to consent to their care.
We observed a medication round and saw that the way in which medication was administered was not always done in accordance with the provider’s safe administration procedure. This placed people at potential risk. Some prescribed creams were stored un-securely in people’s bedrooms and during the medication round we observed that some medication was put into the palm of the staff member’s hand before putting it was put into person mouth using their fingers. After the inspection, the provider informed us that professional advice had been sought and it had been agreed that this was the best method to use to ensure these people took their medication.
We observed the serving of lunch and saw that there was a choice of suitable nutritious food and drink. People we spoke with were happy with the food and choices on offer. People identified at risk of malnutrition received a fortified diet to promote their nutritional intake and were involved with professional dietary services where this was appropriate.
Staff employed were subject to pre-employment and criminal record checks to ensure they were suitable to work with vulnerable people. The number of staff on duty was sufficient to meet people’s needs. Staff responded promptly to people’s care needs and the delivery of care was unrushed and compassionate.
Staff training records showed the majority of staff had completed the provider’s mandatory training programme but had not received sufficient training in dementia, mental capacity or the deprivation of liberty safeguards. We found that this training gap impacted significantly on the implementation of this legislation at the home.
Staff we spoke with felt confident and supported in their job roles but the staff records we reviewed did not provide evidence that all clinical staff had received regular supervision in their job role or had their performance and development needs routinely reviewed. There was also no clinical lead nurse in relation to the supervision of nurses in the workplace.
We observed staff supporting people at the home and saw that they were warm, patient and caring in all interactions with people. Staff supported people sensitively with gentle prompting and encouragement and people were relaxed and comfortable in the company of staff. From our observations it was clear that staff knew people well and genuinely cared for them. People looked well cared for and people who lived at the home and their relatives were positive about the staff at the home and the care they received. The provider employed an activities co-ordinator who offered a range of activities to occupy and interest people. On the day of our visit, we saw that people enjoyed craft and group activities.
During our visit, we saw some elements of good person centred practice. There were several incidences where people’s needs were responded to by staff in a way that connected with the individual they were supporting. The culture of the home was positive and inclusive and visitors were made welcome by all staff. Staff worked well together and all the staff we spoke with told us they had a good relationship with each other and the manager. The manager interacted with people pleasantly and the atmosphere at the home was relaxed and homely.
The home was clean and well maintained. The home was tastefully decorated and people’s rooms were light, spacious and airy. Whilst the service is not a specialist in dementia care, the home cared for some people who lived with dementia. We found that the home’s décor and signage required some improvement to ensure that people who lived with dementia and other mental health issues were able to remain as independent as possible. Records in respect of the safety of the premises showed that the home’s systems and equipment were regularly serviced and inspected to ensure they were fit for purpose.
People who lived at the home, relatives and other healthcare professionals were able to express their feedback through satisfaction questionnaire which was sent out regularly. The surveys returned so far in 2016 indicated that all respondents were satisfied and very happy with the care provided.
There were audits in place to check the quality and safety of the service but some were ineffective. We found that the manager and the staff team failed to adhere to some of the provider’s policies in order to ensure safe and appropriate care and some legislation in relation to people’s care was not understood or properly implemented at the home. For example, mental capacity and deprivation of liberty legislation. This indicated that the home’s management and leadership required improvement.
At the end of our visit, we discussed some of the issues we had found with the manager and the two nurses and two administrators that the manager invited to this feedback discussion. We found that they were receptive and open to our feedback and demonstrated a positive commitment to continuous improvement.
The inspection took place on 28 January 2015 and was unannounced. Red Rocks Nursing Home is registered to provide accommodation and nursing care for up to 24 people. There are 22 bedrooms and some bedrooms could be shared. All have private washing facilities and some have their own en-suite facilities.
The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.
We last inspected the care home on 12 December 2013. At that inspection we found the service was meeting all the essential standards that we inspected.
Some people had lived at Red Rocks Nursing Home for a considerable time and considered it to be their home, others had moved in more recently. There was a team of 15 staff on duty, five care staff, two nursing staff, the activities coordinator, two kitchen staff, two cleaners the maintenance person and the deputy manager and manager. All of the staff had completed induction training and received regular training by the provider.
The staffing levels were seen to be sufficient in all areas of the home at all times, to support people and meet their needs and everyone we spoke with considered there were enough staff on duty.
The home used safe systems of recruiting new staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home.
People were able to see their friends and families when they wanted there were no restrictions. Visitors were seen to be welcomed by all staff throughout the inspection.
The staff we spoke with were able to tell us the action they would take to ensure that people were protected from abuse. All staff had received training about safeguarding. We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor. Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.
People we spoke with confirmed that they had choices in all aspects of daily living. Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal off the menu that was planned. People we spoke with said they always had plenty to eat. The food we tasted was very well presented and tasted very good.
The five care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. People were all registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed.
The expert by experience commented:
“People were extremely happy with the staff and the care provided. I spent time talking to people and visitors who were all extremely positive about Red Rocks Nursing Home. All staff were friendly and provided care in a respectful way. The lunch looked amazing so tastefully laid out, the queens pudding I ate was lovely. People were happy with the food provided and there was plenty”.
We reviewed six care files and found that an assessment of each person's needs and abilities was undertaken by one of the registered nursing staff. Discussions took place with other professionals and family members to confirm information about the person's previous medical history and their current care requirements to ensure their needs could be met. Care plans were developed from the information obtained at assessment and people's care needs and risks were reviewed on a regular basis.
The home liaised regularly with other health and social care professionals and documented the appointments and discussions which took place. This meant that staff at the home were kept informed about decisions made by all professionals involved in the person's care.
All people who used the service and relatives spoken with told us they were very satisfied with the environment. One relative said 'the house is just beautiful, there is an intimacy and a family atmosphere and the standard of care and cleanliness is second to none'. We walked around the home which was in excellent condition. The public areas were clean and welcoming and there were no unpleasant smells. We found there was suitable space, heating, light and ventilation and the grounds were safe and tidy. There were portable ramps to enable disability access to and from the building.
We checked the recruitment processes for home and reviewed seven staff files. In three of the files we did not find the correct documentation. The owner demonstrated that the anomalies were due to a filing backlog and offered to send the documentation to us which we received shortly following the inspection. This satisfied us that the appropriate measures had been taken to ensure that people living at the home were being cared for by staff of a reputable character with the appropriate qualifications.
We saw the complaints procedure provided details of who to contact in the event of a complaint and explained how this would be dealt with. People spoken with said they knew how to complain but had not found it necessary to do so.
We saw that records were stored securely in the nursing stations and were easily accessible when required. Staff and maintenance records were held securely in the manager's office and records were kept for the appropriate length of time as per the company policy.
"I sometimes like my lunch in my room so I can watch my television".
"I feel the food is very good"
One person told us that they were always asked what they liked to eat and how they would like to have their food. Another person said that they liked to watch morning television in their room and then after lunch go down to the lounge and see what activity was going on. We saw that there was a full list of activities for the week on the board in the main hall way.
We spoke to three people who were visiting the home, one person said "the staff are very good and are very nice", another person said that they "couldn't fault the care".
We observed staff interacting with people who live in the home throughout the day and one person told us that they knew the staff's names and said that the staff "know us very well too".
We spoke to three people who live in the home and they were all happy with the care and treatment that they received. One person visiting the home told us that they couldn't have asked for a better place for their relative to live.
The five people spoken with had never had to make a complaint but knew how they could do so.
During our visit we observed that members of the staff team responded quickly to people who were experiencing difficulties. The support provided was sensitive and encouraged them to carry on with the task they had been trying to complete. People told us they felt fully involved in the planning of the care they received and that staff were always available when they needed them.
The people we spoke with told us they were happy with the support and care being provided. They said the staff listened and acted on what they said and were supportive and helpful. They described the staff as polite and respectful. Some comments made were;
'The care I have received here has literally saved my life.'
'Nothing is too much trouble to the nurses and care staff.'
'When I'm feeling unwell the staff are very attentive and make sure I see my GP if necessary.'
Our observations showed staff were respectful towards the people who used the service. Throughout the visit we observed people being treated in a friendly and dignified manner by the staff team.
Wirral local authority contracts and commissioning team told us they had no current concerns about the care and support offered to people who lived at Red Rocks Nursing Home.