Archived: Roseland Lodge

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.

There was not a registered manager in post at the time of the inspection. 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. At the time of the inspection, the owner of the organisation was at the home every day acting as manager whilst organising a new management system and recruiting management staff. Throughout the report, the owner will be referred to as the ‘manager’.

We last carried out an inspection at Roseland Lodge on 17 July 2015, when we found that all five key domains were good. At this inspection in August 2017, we found that the home required improvement in the domains of Safe and Well-led with two breaches of regulations, but that it was good in Effective, Caring and Responsive.

The appropriate pre-employment recruitment checks had not always been completed for new staff, such as references and a DBS (Disclosure and Barring list check) before staff began working in the home.

Assessments carried out had not always identified risks to people’s safety on an individual basis and there was not always enough guidance for staff to be able to know how to support people safely and effectively. Risk assessments had not always been updated as needed.

There had been a recent and sudden change in management whereby the registered manager had left the service, and there were not established systems in place to fully monitor the running of the service, identify areas for improvement and take action. However, this was acknowledged and plans were in place to develop these systems.

The premises and associated equipment were well maintained and any safety issues were rectified promptly. People received their medicines as they had been prescribed, and staff administering them had received training to do so.

There were enough staff to meet people’s needs and they had received training. New staff had been employed with existing qualifications and further training was planned to be completed within the organisation. Staff worked as a team and felt supported by their seniors and the manager.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. These safeguards protect the rights of adults using the services by ensuring that, if there are

restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed. Nobody living in Roseland Lodge was currently subject to DoLS.

People were supported to eat a healthy balanced diet and specialist diets were catered for. People did not always receive a choice of meals.

People and their families were involved in planning their care and spoke regularly with staff. People had visitors whenever they wanted. Staff supported people in a kind and compassionate manner and knew them well. People were supported to access healthcare when they needed.

People were supported by staff who had time to spend with them, doing activities if they wished or having conversations. Some people were also supported to go out to the shops. Care records contained guidance about people’s needs and their preferences.