Archived: Rodney House Residential Home

Updated 10 June 2021

The inspection

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

Inspection team

The inspection was carried out by two inspectors on day one and two inspectors and a member of the CQC Medicines Optimisation Team on day two.

Service and service type

Rodney House Residential Home 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.

There was a manager in post who had applied to become the registered manager for the service. The manager had been in post since November 2020. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

A nominated individual had been assigned to the service to oversee the governance and provide support to the manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

The first day of the inspection was unannounced. The second day was announced.

What we did before the inspection

We reviewed information that we held about the service such as notifications. These are events that happen in the service that the provider is legally required to tell us about. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with one person about their experience in the home. We completed observations of the service. We spoke with the manager, the nominated individual, the nominated individual’s representative who visited the home and eight staff including the deputy manager, care staff, the kitchen staff, housekeeping staff, and maintenance staff. We reviewed five people’s care records. We looked at the medicines policy and audits, medicine administration records and associated care documents for nine people. We looked at seven staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 10 June 2021

Rodney House Residential Home accommodates up to 30 older people in one adapted building across three floors. The service specialises in the care of people who are living with dementia. At the time of our inspection there were 19 people living at the home.

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

There were shortfalls in the staffing arrangements, action was taken by the nominated individual to address this during the inspection. Medicines were not always managed safely, there were shortfalls in staff recruitment files. There were detailed risk assessments in place, we identified one person who did not have all the required risk assessments in place.

There were systems in place to record and escalate any incidents and accidents. We found one instance where staff had not reported incidents via this system. The manager reviewed incidents and took action to prevent a reoccurrence.

Risks relating to infection control were managed safely, however we observed staff were not always wearing masks correctly. The service equipment was maintained.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice.

Due to staffing pressures, staff did not always receive an induction when starting at the service. Staff did not always receive up to date training and formal supervision. The environment of the home was not suitable for people living with dementia.

People’s health care needs were met. People received enough nutrition and hydration and made choices about what they wanted to eat.

There was a lack of activities and stimulation for people. People had individualised care plans detailing their needs and preferences, people’s end of life wishes were recorded. Complaints were acknowledged and responded to.

There were governance systems in place which identified most of the concerns we identified during our inspection. Action points were being worked towards but were not all completed. We identified similar and additional concerns from our last comprehensive inspection in June 2019. The accumulation of shortfalls alongside staffing shortages meant the manager was under increased pressure and their workload had become unmanageable.

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 16 August 2019) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

We undertook a targeted inspection in January 2021, this inspection was carried out to check on a specific concern we had about how infection prevention and control procedures were being managed in the home. During this inspection we identified improvements had been made in relation to infection control.

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

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

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 monitor the service.

We have identified breaches in relation to how medicines are managed, the staffing skill mix, lack of information in recruitment files, people being deprived of their liberty without authorisation from the local authority, the application of the Mental Capacity Act 2005, lack of staff supervision, induction and training and the governance systems at this inspection. Our enforcement actions have taken account of the provider's decision to close the home

Follow up

We will continue to monitor information we receive about the service until the homes closure. If we receive any concerning information we may inspect sooner.