Archived: Rose Brae Nursing and Residential Home

Updated 28 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

This inspection took place on 24 and 25 February 2016 and the 1 and 9 March 2016. The first and last day of the inspection was unannounced. The inspection was carried out by two adult social inspectors and a specialist advisor. Prior to our visit we looked at any information we had received about the home and any information sent to us by the provider since the home’s last inspection.

At this inspection we spoke with three people who lived at the home. We tried to talk to more people who lived at the home but they were unable to speak to us, so we observed their care. We also spoke with two relatives, the manager, the deputy manager, three nurses, four care staff and the cook. We looked at a variety of records including eight care records, recruitment records for two staff, the supervision records of 7 staff, 13 staff training records and 13 medication administration charts. We examined a range of policies and procedures and other paperwork relating to the quality of the service.

We looked at the communal areas that people shared in the home and did a tour of the home.

Updated 28 April 2016

This was an unannounced inspection carried out on 24 and 25 February 2016 and the 1 and 9 March 2016. We carried out a previous unannounced comprehensive inspection of this service on 10 and 11 September 2015.

During our September visit multiple breaches of legal requirements were found. We found breaches in relation to regulations 9, 10, 11, 12, 13, 15, 16, 17 and 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. .The provider was rated as inadequate and placed in special measures. Services that are placed in special measures are inspected again within six months to ensure the significant improvements have been made to meet the legal requirements. During our visit we followed up the breaches identified at the September 2015 inspection.

Rose brae Nursing and Residential Home provides accommodation with nursing and personal care for up to 30 older adults. The home is a converted three storey mature house situated in the residential area of Spital, Bebington. It is within walking distance of local shops and public transport. Accommodation consists of 29 single bedrooms and one shared bedroom. A passenger lift enables access to all floors for people with mobility problems. On the ground floor, there is a communal lounge/ dining room for people to use.

There was a registered manager in post. 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.’

During this visit, we identified continued concerns with the safety and quality of the service. We found breaches in relation to Regulations 9, 10, 11, 12, 13, 14, 15, 17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were not protected from the risk of abuse. The manager and staff at the home lacked an understanding of safeguarding and the action needed to take to protect people from potential abuse. Two people had unexplained bruising which had not been investigated or reported to the relevant authorities. One person’s personal care was undertaken with the use of the full body hoist due to incidences of challenging behaviour. The use of the hoist in this way meant the person’s freedom of movement was restricted. This was potentially unlawful restraint.

Some people’s needs and risks were not properly assessed, care planned or managed. There was insufficient information in peoples’ files on how to keep people safe and meet their needs in a way they preferred. Dementia care planning was poor and support for people’s behavioural and emotional needs inadequate. This meant staff lacked clear guidance on how to provide safe, appropriate person centred care.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. People’s capacity to make their own specific decisions had either not been assessed or contained blanket statements that covered every and any decision the person may be required to make. There was no evidence best interest meetings took place routinely when specific decisions needed to be made or evidence that any least restrictive options were explored for any decisions about their care. This included decisions to deprive people of their liberty. There was no evidence that staff were trained to support people with these needs.

Medicines were not always administered safely. Medicines received by the home were not always properly accounted for and people did not always receive the medications they needed when they needed them. This meant the management of medications was unsafe.

People did not always receive adequate nutrition and hydration. One person was fed an inappropriate diet for some of their meals which increased their risk of a choking episode and one person went for an 18 hour period without anything to eat and drink. We saw that the way in which staff monitored people’s dietary intake was ineffective in identifying people whose food or fluid intake was insufficient.

Bed rails and bed bumpers were in use but the bed rail bumpers did not fit the full length of the person’s bed. This meant there were gaps that the person’s head or limb could have become entrapped in. This placed the person at risk of serious injury. Pressure relieving mattresses were set at too high a pressure for some people which increased the risk of a pressure sore developing. The mattress would also have been uncomfortable. There were no checks in place to ensure that bed rails and pressure relief equipment was safe and suitable for use and staff lacked sufficient knowledge of either to keep people safe.

The temperature of hot water in people’s room was either lukewarm or a scalding risk. No effective check of the water temperature was undertaken to ensure it was safe. This placed people at risk of harm. The provider also failed to have proper systems in place to monitor the risk of the water being contaminated with Legionella. This was despite, being told of the inadequacy of the current system at the last inspection.

Staff recruitment was poor. Application forms were poorly completed and staff references in the majority were not verified. Where people had criminal conviction these were not properly considered prior to appointment. This meant the provider could not be assured that they were safe and suitable to work with vulnerable people. Staff training and supervision records showed that staff did not receive suitable training or adequate supervision in their job role.

Care staff worked in isolation from nursing staff for the majority of the time. Care staff were patient and kind but some staff practices were unsafe and did not always respect people’s right to dignity, respect and privacy. Nursing staff were not a visible presence in communal areas where people were sat and were observed to be disassociated from people’s care.

The service was not well led. There were no adequate systems in place to ensure the service was safe, effective, caring, responsive and well led. There were no effective care plan audits, medication audits, equipment and facilities audits, safeguarding arrangements or staff recruitment and training systems. At the end of our visit, we discussed the concerns we had about the service with the manager. They were unable to provide a satisfactory explanation as to why the issues we identified during our inspection had not been picked up and addressed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Immediately following this inspection, the provider made the decision to close the home and cancel their registration with CQC.