Rock Cottage Care Services

Rock Cottage Care Services is a residential care home providing personal and nursing care to up to 37 people. The service provides support to older adults, some of whom were living with dementia. At the time of our inspection there were 32 people using the service.

People’s experience of the service and what we found:

People’s risks were identified, monitored and managed, however, they were not always clearly assessed or recorded. The provider did not always learn lessons when things had gone wrong and checks undertaken did not always drive through improvements in the care people received.. The Provider ensured there were enough staff, however, they had not all completed required training for their role.

The provider did not have a fully supported management structure. The provider’s system did not always effectively monitor the quality of care provided to drive improvements.

People were protected from the risk of infection as staff were following safe infection prevention and control practices. People were supported to receive their medicines safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was a positive and open culture at the service. The provider understood their responsibilities under the duty of candour. People and staff were involved in the running of the service and fully understood and took into account people’s protected characteristics The provider worked in partnership with others.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 January 2022).

Why we inspected

The inspection was prompted in part due to concerns received about managerial oversight of the service. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Rock Cottage Care Services on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rock Cottage is a care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 36 people, some of whom may be living with dementia. Rock Cottage accommodates people across two floors in one adapted building.

People’s experience of using this service and what we found

Some people and staff told us they did not feel there were enough staff across the service and told us sometimes people were left waiting to receive support. We did not observe this during our inspection; however, we have made a recommendation about reviewing people’s dependency levels to ensure there are enough staff to meet people’s needs.

There was a registered manager in place, however they had applied to the Care Quality Commission to deregister from this role. This was because they wanted to place an emphasis on their role as a registered nurse. The provider had employed a new registered manager who was due to commence employment at the beginning of January 2022.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Medicines were managed safely, and systems were in place to ensure lessons were learned when things went wrong.

People said they were treated with dignity and spoken to with respect. People and relatives we spoke with were happy with the way the service was managed. The registered manager had improved the governance systems to monitor the quality of the service provided to help ensure people received safe and effective care.

Staff told us they enjoyed working at Rock Cottage. Staff worked well with each other and with other agencies to provide consistent, effective and timely care. The management worked with other organisations to meet people's assessed needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 September 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rock Cottage on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: Rock Cottage is a 36-bedded residential care home that was providing personal and

nursing care to 30 people aged 65 and over at the time of the inspection.

People’s experience of using this service and what we found

The service had improved since our last inspection, but further improvements were still needed.

People received their medicines safely. However, we found that audit systems in place could not sufficiently identify the numbers of medicines people had in stock.

People's support needs were planned and assessed for however, care files were inconsistent with information relating to person centred care and management of risks to people required strengthening.

Governance systems were not being applied consistently meaning that the services people received were

not always effectively monitored.

There were inconsistent recording systems to evidence if people had been repositioned in accordance with their care plan needs.

The service was clean and free of malodour. There were a number of personal protective equipment (PPE) stations positioned throughout the home and staff wore appropriate PPE. Where new admissions came into the home, they were isolated for 14 days with evidence on their room door of when the isolation started.

People told us they felt safe in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was requires improvement (report was published on 09 April 2019) You

can read the report from our last comprehensive inspection by selecting the 'all reports' link for Rock Cottage care services on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people's nursing care and how the service was promoting people's

safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We undertook this focussed inspection to check they had followed their action plan and to confirm they now

met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this

occasion were used in calculating the overall rating at this inspection. The overall rating for the service has

remained the same.

We have found evidence that the provider needs to make improvements. Please see the safe and well led

sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took

account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering

what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to

hold providers to account where it is necessary for us to do so.

We have identified a breach of Regulation 17 (Good Governance) of the Health and Social Care act 2008 (Regulated activities) Regulations 2014. The registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

Follow Up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The service had deteriorated in some areas since our last inspection.

People received their medicines safely. However, we found that protocols and risk assessments for specialist as and when medication was lacking.

Staff were not effectively deployed. People told us that although staff treated them with kindness, there were not able to spend time with them that was not related to a care task. We recommend that the provider source a dependency tool to inform their staffing levels.

People’s support needed were planned and assessed for, however they lacked person centred detail and management of risks to people required strengthening.

Although the service was working within the principles of the Mental Capacity Act (2005), awareness around completing capacity assessments and completing best interest decisions needed strengthening. People had access to healthcare professionals.

Governance systems were not being applied consistently meaning that the services people received were not always effectively monitored.

People were supported by safely recruited staff and protected from potential abuse. Staff knew people well and the registered manager was approachable.

The previous inspection rating was displayed in the service.

Rating at last inspection: Requires improvement (19 January 2017). This service has been rated as requires improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: The next scheduled inspection will be in 12 months. We will continue to monitor information that we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

Rock Cottage Care Services are registered to provide accommodation with personal care and nursing for up to 36 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 36 people.

There was a registered manager at the service. 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.

The provider had made some improvements to the systems in place to assess, monitor and improve the quality of care. However, further improvements were needed to ensure that all the systems in place were carried out regularly.

Some improvements were needed to ensure that care records contained up to date information.

We found that some improvements were needed to ensure that medicines were managed safely.

People felt safe when they were supported. Staff had a good understanding of people’s risks and we saw that people were supported in a safe way.

People were supported to be involved in meaningful hobbies and interests within the service to promote their emotional wellbeing.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. Where people were at risk of malnutrition care plans were in place to ensure people were eating sufficient amounts to keep them healthy.

People were supported to access other health professionals in a timely manner to maintain their health and wellbeing.

People were supported in a caring and compassionate way by staff who knew people well. People’s privacy and dignity was protected when staff provided support and staff promoted and listened to people’s choices in care.

People were involved in their care. People received care that met their preferences because staff knew people well and knew how they liked their care to be provided.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

Staff felt supported by the registered manager to carry out their role and there were values within the service that staff understood and followed.

There was an open and honest culture within the service and the registered manager was approachable to people, staff and professionals.

The registered manager was aware of their responsibilities and had informed us (CQC) of any notifiable incidents that had occurred at the service.

Rock Cottage Care Services are registered to provide accommodation with personal care and nursing for up to 36 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 35 people.

There was a registered manager at the service. 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.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was unable to be identified and rectified by the registered manager and provider.

The registered manager was not fully aware of their responsibilities to inform us (CQC) of any notifiable incidents that had occurred at the service.

We found that improvements were needed to ensure that medicines were managed safely.

People felt safe when they were supported and staff had a good understanding of people’s risks, although records we viewed did not always provide details of people’s risks

People were supported to be involved in meaningful hobbies and interests within the service, but improvements were needed to ensure that people had access to hobbies and interests when the dedicated worker was unavailable.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. Where people were at risk of malnutrition there were plans in place but improvements were needed to ensure the records clearly identified the amounts that people had eaten and drank sufficient amount to keep healthy.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported in a caring and compassionate way that protected their privacy and dignity. Choices in care were promoted by staff and people’s choices were listened to and acted on.

People were involved in their care. People’s preferences had been taken into account and staff knew people who used the service well and knew their likes and dislikes.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

Staff felt supported by the registered manager to carry out their role and there were values within the service that staff understood and followed.

We found that the provider did not have records in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us they had not received training with regards to the Mental Capacity Act 2005. Staff we spoke with did not fully understand their responsibilities with regards to the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. People we spoke with told us they were happy with the care provided and staff listened to their wishes. One person told us, 'The staff are wonderful. I found it difficult to settle in but the staff helped me as they can't do enough for you". Another person told us, 'It's great here. I can choose what I want to do and the staff never make me do something I don't want to".

Staff we spoke with understood the various types and signs of abuse. Staff were able to explain the actions they needed to take if they had concerns that a person who used the service was at risk of harm.

The provider had a recruitment system in place. We saw that staff had been checked to ensure that they were suitable to provide support to vulnerable people.

We saw that the provider had an effective complaints system in place. People we spoke with told us that they knew who to complain to if they needed to.

We spoke with staff who were aware of the individual needs of people and how they preferred the support to be carried out. People we spoke with told us that they were offered choices and staff listened to what they wanted. People told us, "The staff are very good and understand what I need" and "The girls are good at looking after me".

We saw that people were cared for in a clean environment and staff we spoke with were aware of the infection control policies in place. We saw staff wearing protective equipment when supporting people who used the service.

We viewed records which showed that staff had received a detailed induction before they started their employment. Staff we spoke with told us that they felt supported by the manager. One member of staff told us, "I feel fully supported and I know that I can always approach the manager if I have any concerns".

The provider had some systems in place to analyse the quality of the service provided and gain the views of people who used the service.