Archived: Rosemount

Updated 12 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Before the inspection CQC was made aware of an incident where one person did not receive appropriate medical support in a timely manner. This incident was subject to a safeguarding enquiry and we did not look at the specific event during this inspection. We were also made aware of concerns about the care of two people who were also subject to individual safeguarding enquiries. We looked into general concerns raised by health professionals about the care and treatment of people living at Rosemount.

This inspection took place on 5, 6 and 7 June 2018 and the first day was unannounced. The inspection was carried out by one adult social care inspector.

Before visiting the home we reviewed information we kept about the service such as previous inspection reports and notifications of incidents. A notification is information about important events which the service is required to send us by law. We reviewed information shared with us from the adult safeguarding team, local authority, quality and improvement team and the community nursing team. During the inspection we spoke with three visiting health care professionals. This enabled us to ensure we were addressing potential areas of concern.

Not everyone living at Rosemount was able to tell us about their experiences due to cognitive impairments so we used the short observational framework for inspection (SOFI). SOFI is a tool developed and used by CQC inspectors to capture the experiences of people who use services who may not be able to express their views for themselves.

We used pathway tracking to follow people's care through from its planning to its delivery. As part of this we looked at seven people's care plans and daily records, people's medication administration records and a range of other records relating to people's care such as food and fluid charts, bowel charts and repositioning charts. We looked at three staff recruitment files, an overview of the training and supervision for staff and other records relating to the running of the home such as quality assurance documentation and policies and procedures.

We met with all of the people living at the home. We spoke with eight people, with one relative and nine staff including the registered manager, assistant manager, admin assistant and six care workers. We looked around the home and observed care, checked medication rounds and observed lunch and other social activities.

Updated 12 July 2018

This inspection was unannounced and took place on 5, 6 and 7 June 2018.

The last inspection of the service was carried out on 21 and 22 November 2017 and published on 15 February 2018. At that time the service was rated as good.

Rosemount 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.

Rosemount is registered to care for older people, some of whom were living with dementia. Rosemount accommodates 20 older people in one adapted building. On the days of the inspection there were 16 people living at the home.

The service has a registered manager, who is also the registered provider. 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.

Before the inspection we had received concerns relating to the health and welfare of people living at the home. On 4 June 2018, a multi-agency safeguarding meeting was held. As part of that a plan was agreed with the registered manager, health and social care professionals, to protect people's safety and wellbeing. This included health professionals visiting the home every day as part of a support and protection role. The local authority quality improvement team and community nursing team were working with the home to help support improvement. We shared our findings and concerns with the registered manager and with the safeguarding and commissioning teams during and after the inspection.

During this inspection on 5, 6 and 7 June 2018 we highlighted a number of issues that required improvement and identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On this inspection we found there was a lack of effective leadership and governance which impacted on people's safety, the quality of care and support people received. People did not receive safe and effective care because there were insufficient systems in place to ensure this. The checks the provider had in place to monitor the quality and consistency of the service, were not effective in identifying shortfalls and driving the required improvements.

People were not safe and were placed at risk of harm. The registered manager had failed to ensure fire safety equipment was in satisfactory order. We saw a number of fire doors were defective as they had holes in them and two powder fire extinguishers located in high risk areas, were out of date. Emergency arrangements for actions to be taken in the event of a fire or other emergency situation placed people at risk.Since the inspection actions have been taken to address these risks.

Risks to people had not always been assessed and managed appropriately. Risk assessments were not always in place or contain enough information for staff to manage or mitigate the risk and provide safe effective care. Care plans were not always in place, completed fully or up-to-date. This meant staff did not have information on how to meet people's needs. This meant people were at risk of receiving inconsistent care and not receiving the care and support they needed.

People were not protected from the risk of harm as they were living in an environment that was not always safe. For instance, frayed carpets posed a trip hazard and people were at risk from falling from windows that did not comply with Health and Safety Executive guidance. We brought these concerns to the attention of the registered manager and they immediately arranged for them to be addressed.

People did not benefit from a clean environment. The premises were not free from offensive odours. Some carpets were stained and dirty and the home did not have adequate house-keeping arrangements.

The way the home was managed did not promote a caring ethos. People were not always treated with dignity and respect. We observed on occasions, staff would walk into a room and not acknowledge the people there. Some staff spoke in a disrespectful manner about the people they supported. For example, one staff member referred to people needing support to eat as "feeders". We observed continence products left in people's rooms which showed a lack of respect for people's dignity.

We did however see other instances of staff supporting people in a caring way. Some staff were patient with people and encouraged them to retain their independence. People were relaxed and happy in staffs' presence. Staff showed care and compassion to people and spoke about them with affection.

People did not benefit from activities or engagement that had been designed to address issues such as preventing isolation, helping to maintain the person's identity, and helping the person feel valued, helpful and involved. We saw people appeared withdrawn and disengaged with the environment. People were sat in the lounge or alone in their rooms for long periods of time just looking around or falling asleep.

People were not protected from the risks associated with the employment of staff who may be unsuitable to work with people requiring help with their care needs. This was because there was not a robust recruitment system in operation. Staff files we saw contained an incomplete employment history which had not been explored and did not always contain satisfactory evidence of conduct in previous employment, such as references.

We observed there were insufficient numbers of staff to meet the physical and social needs of people living at the home. Our observations showed there were a number of times when communal areas were left unsupervised. We saw interaction between staff and people often only happened when they needed support with a physical care task. In addition to supporting people with their physical care needs, staff were expected to prepare, cook and serve all of the food, do the laundry and attend to some cleaning around the home. This meant staff did not have time to support people in a person centred way.

People did not always receive support from staff with the knowledge and skills they needed to carry out all aspects of their roles. The registered manager had not followed their own policies to ensure staff had the necessary training to meet people’s health needs.

Staff received some training which the registered manager considered essential to their roles such as, manual handling, fire safety awareness and infection control. Staff were supported by regular supervision and appraisal. Staff said they could approach the management team at any time for support and guidance.

People were not always protected from the safe management of medicines. During the inspection we observed staff administering medicine in ways that did not follow safe practice or the home’s policy. Other aspects of medicine management, was safe. Medicines were stored correctly to help ensure they were safe and effective to use. Records showed medicines were given to people at the correct times.

People were seen by GPs who visited the home regularly. However, staff did not always make timely referrals to other healthcare professionals to ensure people's care and treatment remained safe or act on recommendations or instructions. Since the safeguarding process started, all relevant healthcare professionals have been involved in monitoring people's care to ensure their safety.

The home was complying with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of registration.

For adult social services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.