Archived: Roseland Lodge

Updated 4 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 is 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.

The inspection was prompted in part by information that had been raised to us from whistle-blowers and from other professional staff who had visited the service. The information shared with CQC indicated potential concerns about recruitment, the management of risk, care planning, scalding from hot water, and environmental risks. This inspection examined those risks.

This inspection took place on 23 and 26 January 2018 and was unannounced. The inspection team consisted of two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector returned for a second day to complete the inspection, and announced this in advance.

As part of our inspection planning we reviewed all the information we held about the service. This included previous inspection reports and any notifications sent to us by the service including safeguarding incidents or serious injuries. This helped us determine if there were any particular areas to look at during the inspection. We also spoke with the local authority’s quality assurance and safeguarding teams who had visited the service. Following the inspection we spoke with the local fire service.

At the time of inspection there were eight people living at the service. To help us assess how people's care needs were being met we reviewed four people's care records and other information, including risk assessments and medicines records. We reviewed four staff recruitment files, maintenance files and a selection of records which monitored the safety and quality of the service. During the day we spoke with four people who lived at the service, the provider, the senior carer, and two members of care staff.

Updated 4 July 2018

This focused inspection took place on 23 and 26 January 2018, and was unannounced. A focused inspection looks at specific concerns that we may be aware of, or which have been reported to us. At our last inspection in August 2017, we found a breach of two regulations in relation to staff recruitment and governance of the service. We rated the service as requires improvement overall. We asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe and well-led to at least good, but we did not receive this. In September 2017, we contacted the provider and asked for the action plan to be sent. Again this was not received, until we contacted them in December 2017. When we did receive the action plan, it was not sufficiently detailed to assure us that breaches of regulations and areas requiring improvement were being addressed in a timely manner.

We subsequently undertook an unannounced focused inspection of Roseland Lodge on 23 and 26 January 2018. The team inspected the service against all of the five key questions we ask about services: is the service safe, effective, caring, responsive and well led.

At this inspection of 23 and 26 January 2018, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to environmental risks, staffing, governance, and recruitment. We also found a breach of Regulation 16 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Roseland Lodge 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. Roseland Lodge accommodates eight people in one adapted building. Most were older people, some of whom were living with dementia.

There was not a registered manager in post. The provider had been managing the service since the previous registered manager left in July 2017. 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.

People's health and safety were at risk because the provider had failed to identify where safety was being compromised in relation to environmental risks. Hot surfaces, such as radiators and heaters, had not been covered to prevent people scalding themselves were they to lean or fall against them. Fire evacuation equipment was not in place to support people out of the building in the event of an emergency and staff had not received fire training. Health and Safety Executive guidelines in relation to safety in care homes were not being followed.

Staffing levels were not sufficient to ensure people’s safety at all times. Staff were not always able to be responsive to people’s needs during the day. At night only one staff member was on site, to support eight people which posed a risk to people’s safety in the event of an emergency.

Appropriate recruitment checks had not been carried out on new staff, to ensure they were of good character and suitable to work with people in the service. This included obtaining references and ensuring DBS (disclosure and barring checks) were in date.

A safeguarding concern had not been reported to the relevant safeguarding authorities, which put the person involved and those visiting the service at risk. Staff were able to tell us the types of abuse they may come across in their work, however, they were not always aware of who to contact with a concern.

Some practices did not support the prevention of Infection and cross contamination.

Records made reference to people’s ability to consent, and we saw staff asking people for their consent when they were supporting them. However, the management team acknowledged that they needed to increase their understanding of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards to ensure they were delivering care in line with this.

We could not be assured that suitably competent and skilled staff were deployed to ensure that people's care and treatment needs were met. There was not a training matrix in place to show when staff had undertaken training, and how often they should receive refresher training. Not all staff were receiving appropriate on-going or periodic supervision, or appraisal of their performance to ensure competence.

People received their medicines safely, however, improvements were required in relation to medicines which were taken ‘as required’.

Auditing processes used to monitor the quality of the service were not robust and had not been carried out regularly. Analysis of accidents and incidents which occurred in the service was limited.

People were supported to live healthier lives by receiving on-going healthcare support. Records confirmed that people had received the help they needed to see their doctor and other healthcare professionals.

Care plans were person-centred, and contained detailed information regarding people’s preferences and choices. Improvement was required in relation to end of life care planning as not all records were completed.

Staff were observed to be kind and caring in their interactions with people. Relatives and visitors could visit at any time and there were no restrictions.

There was a complaints process in place, and people felt confident that they could raise any concerns with staff. However, details of how to complain were not displayed in the service.

Staff were confident to raise concerns with the provider and told us they felt listened to and supported.

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 or 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 their registration.

For adult social care 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.