Rose Court Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service under the new provider. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to safe care and treatment, because people’s medicines were not always managed safely.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had effective systems to manage complaints, accidents and incidents. The management team completed regular detailed analyses of events to establish themes and trends and support lessons learned.The registered manager told us lessons learned were discussed with staff during handovers, staff meetings and supervisions. This reflective approach helped ensure people were kept safe from harm and continued to drive improvement in the service.

The registered manager and team were open and responsive to feedback and advice throughout the inspection. They also worked well with external partners to review practice.

The provider had established safe systems and pathways for transitioning people between services. Healthcare partners such as GPs, occupational health therapists and district nurses, as well as people’s families, were involved in ensuring there was continuity of care when people moved between different services. The registered manager told us staff printed out an emergency information pack for ambulance and hospital staff. This information included people’s medical conditions, medicines they were prescribed, allergies, physical abilities, dietary requirements and, if applicable, DNACPR (Do Not Attempt Cardiopulmonary Resuscitation).

A person said, “I trust the staff to do their best for me and their friendliness is reassuring too”.

A relative told us, “We didn’t want to send our [loved one] here, but it’s working out really well. The place is safe and secure, and we have real confidence in our [loved one] being here.”

Staff worked within the principles of the Mental Capacity Act 2005 (MCA). Where appropriate, people had a Deprivation of Liberty Safeguards (DoLS) in place and any conditions to their authorisations were being met. The registered manager maintained oversight to ensure DoLS authorisations were in date and any imposed conditions were incorporated into people’s care plans and were being met.

The registered manager and staff had a clear understanding of safeguarding people from abuse. The provider had up-to-date adult safeguarding policies and procedures to help ensure people were protected from abuse and neglect. Records showed that staff received training on safeguarding adults. Staff were aware of signs to watch out for if they suspected people were at risk of harm or abuse. Staff knew how to raise their concerns within the home and to contact external professional agencies if needed.

Not all risks to people’s safety and wellbeing had been assessed, monitored or mitigated. We found that risks relating to people’s high-risk medicines were not always managed safely. This meant people were at risk of harm.

However, we found that risks relating to people’s other needs were assessed and managed safely. People’s care plans were detailed, with information about their physical health, wellbeing and communication needs. We saw risk assessments were in place for choking, pressure area management, safe mobility and heightened behaviours.

Staff demonstrated good knowledge and understanding of how to support people in a way that ensured risks were managed sensitively, whilst respecting people’s choices and individuality. Staff told us they felt they could confidently support people safely and that the risk assessments accurately reflected people's needs, and the way they should be safely supported.

A member of staff told us the dietitian gave them information and they received online training on diabetes. This member of staff said they had also completed training for safe eating and drinking and the team leader told them what procedures to follow if a person was choking. They explained that, where necessary, the consistency of people’s food and drinks was also modified. Another member of staff told us that risk assessments were reviewed and updated if a person experienced a fall. They said advice was sought from the GP and different things were trialled, such as sensor mats, to help reduce the risk of falls. They also added, “If people are at risk of falls, we make sure there are always staff in lounge with people, as that’s in the risk assessment.”

The provider had effective systems to manage complaints, accidents and incidents. The management team completed regular detailed analyses of events to establish themes and trends and support lessons learned.The registered manager told us lessons learned were discussed with staff during handovers, staff meetings and supervisions. This reflective approach helped ensure people were kept safe from harm and continued to drive improvement in the service.

The registered manager and team were open and responsive to feedback and advice throughout the inspection. They also worked well with external partners to review practice.

People told us they received appropriate care and support in a timely manner. A person told us, “I’m safe here. If I need help and press my call bell, a carer will come without much delay.” Another person told us, “I’m in a wheelchair so, if I am moved, there are always two carers.”

Some staff told us they felt there was a shortage of staff. A staff member told us, “There are not enough staff to meet people’s needs. They cut the staff when the provider took over 2 years ago.” Another staff member said, “This morning was supposed to be 3 care staff and a team leader but we didn’t know until 11 that we only had 2 care staff and a team leader. No one explained why this was the case.”

We spoke to the registered manager about this and they explained that there had not been a decrease or change in staffing levels. They said the provider had stopped using agency staff to cover staff absences and the registered manager and team leader now provided the shift cover where it was needed instead.

The registered manager and the area manager told us the provider had introduced and implemented a new dependency tool that aligned staffing levels and skills of the team with individuals’ assessed needs. Staff arrangements were informed by assessments of people's needs and these were updated monthly, using the provider’s dependency tool.

During this assessment we saw that staffing levels were appropriate and provided staff with enough time to deliver compassionate care and support.

The provider followed safe recruitment practices and staff received appropriate support and training. There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that met their needs.

Recruitment records included employment histories, references, health declarations, proof of identification and evidence that a Disclosure and Barring Service (DBS) check had been carried out. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Staff received effective support, supervision and development. Staff told us they had received supervision and training in relation to people’s care and support needs. They told us they were up to date with the training the provider considered was mandatory. The registered manager provided us with a training matrix which indicated that staff had completed training in areassuch as dementia awareness, fire safety, first aid, equality and diversity, infection control, managing medicines, moving and handling, safeguarding, health and safety, falls, improving hydration, managing malnutrition, the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (Dols )

People told us the home was kept clean and they were happy with this. A person told us “The room is always clean.” Another person said, “My room is clean and they tidy up for me.”

The provider had effective systems to help identify, control and prevent the spread of infections and they shared any concerns with appropriate agencies promptly.

There was effective oversight and auditing of infection control measures and internal audits were completed to a good standard. Areas of improvement identified from audits were recorded on an action plan, given completion timescales and signed off when completed.

Staff were aware of the guidance about current infection risks and the management team had proactively managed risks and responded effectively to guidance provided by local infection control agencies.

The provider employed domestic staff to oversee cleaning and laundry. The domestic staff had a good knowledge of the appropriate cleaning materials and processes required to ensure effective cleaning in the home. The staff understood infection control and the use of personal protective equipment (PPE). Staff wore appropriate PPE, such as gloves and aprons, and followed the correct procedures.

The provider did not always make sure that medicines and treatments were safe and met people’s needs and preferences. People were not always involved in planning and discussions about how they would like to be supported with their medicines.

Although Controlled Drugs (CD) were stored safely and securely, high risk medicines did not always have appropriate medicines risk assessments and care plans in place to ensure that medicines risks were managed safely.We saw some medicines in the trollies had expired. We also noted that people did not always receive their medicines as prescribed. Some people were prescribed ‘time critical’ medicines, but staff did not always administer these in the timely manner required. We found there were not appropriate medicines risk assessments for people who were prescribed with high-risk medicines, such as anticoagulants and insulin. We also found a person’s MAR chart stated that there had either been a double administration of their medicine, or the document had been completed inaccurately. This increased the risk of medicines related harm to people using the service.However, people we spoke to gave positive feedback and said staff supported them safely with their medicines. One person said, “The staff watch me take my tablets.” Another person said, “I get my medicines when I am supposed to, and the staff always check that I have taken them.” A third person said they knew about their medicines and that they needed eye drops twice a day. This person said the staff gave them the bottle and they administered the drops themselves.

The provider failed to ensure there were effective systems in place to manage risks to people using the service. These issues are in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.