The Rookery Care Home

We found the following examples of good practice.

The home looked clean and there were cleaning schedules in place; however, some items of the equipment and furniture were visibly worn. The deputy home manager told us they would raise this issue with the proprietor.

The home had systems and processes to prevent visitors to the home from catching and spreading COVID-19. All visitors were screened for symptoms of the infection and were required to show negative Lateral Flow Device test (LFT) upon entering the home. Visiting professionals were asked to show proof of their vaccination before they were allowed into the home.

The home had ample supplies of personal protective equipment (PPE) and we saw staff wearing their PPE in line with latest guidance. PPE stations were located in the key areas of the home allowing staff to have quick and easy access to hand sanitisers or face masks.

During the recent COVID-19 outbreak some people were self-isolating in their own room. People who were unable to self-isolate because they lived with advanced dementia spent their time in a designated communal areas. Enhanced cleaning had been introduced which included regular disinfection of high touch points, such as handrails or door handles.

People and staff who were more vulnerable to the COVID-19 had individual risk assessments in place to mitigate the risks.

The Rookery Care Home is a residential care home providing personal care to older people, some of whom live with dementia. The service can support up to 30 people. At the time of our inspection there were 21 people living at the service. Care was delivered over two floors in one building, with lift access.

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

Improvements were found to the recruitment and training processes; People lived in a clean home where infection control measures followed government guidelines. The provider had updated their Infection Prevention and Control (IPC) procedure to reflect national COVID-19 guidance. Issues identified at our last inspection to assess and manage all risks had been actioned and rectified to ensure people were kept safe. Medicines were managed safely, and people received them as prescribed. Systems were in place to keep people safe

The provider and the manager demonstrated a willingness to make further improvements and had implemented service improvement plans to evidence how they were committed to improve the running of the service.

Systems and new processes to drive improvement had been implemented to ensure quality care was being delivered. More robust monitoring processes were in place and improvements had been noted. However, the service still required improvement in some areas.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 03 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing) and Regulation 19 (Fit and Proper Persons employed).

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether the provider had followed their action plan and to confirm they now met legal requirements regarding Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Registration Regulations 2009 Notifications.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

The Rookery Care Home is a residential care home providing personal care to older people, some of which live with dementia. The service can support up to 30 people. At the time of our inspection there were 21 people living at the service. Care was delivered over two floors in one building, with lift access.

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

At the time of our inspection there was an outbreak of COVID-19 at the service. We found multiple failings in the provider's infection prevention systems and processes which increased the risk of the transmission of COVID-19. This placed people at significant risk of harm.

People's care plans and risk assessments had not been reviewed following the outbreak of COVID-19. Medicines were not always managed safely. Recruitment checks were not thorough and did not ensure staff were safe and suitable to work in the service.

The provider's systems for assessing and monitoring the safety and quality of the services provided were not effective in identifying shortfalls and improving the service. Quality control audits were carried out; however, they were not robust or effective in some areas. Staff worked in partnership with other health and social care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 February 2019)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about an outbreak of COVID-19 at the service.

A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with infection prevention systems and processes, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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 The Rookery Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, safe care and treatment, management of medicines, staffing and recruitment and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People told us they felt safe and well cared for. They told us they felt safe when staff supported them with transfers.

People had a personal emergency evacuation plan to be used in the event of an emergency, such as a fire. Fire safety arrangements for people were safe. A fire exit for staff in a cellar was not easily accessible. This was addressed by the provider on the day of our inspection.

Care plans had risk assessments that included information for staff about how to support people safely with their care. We saw staff do this.

The premises were clean. Staff followed infection control and prevention procedures, they wore personal protective equipment when they supported people with their personal care.

We saw there were enough suitably recruited staff to meet people’s needs.

People received their medicines when they needed them. Arrangements for the storage of medicines were safe.

The registered manager and senior care worker’s assessed people’s needs and developed care plans. People, if they were able, were involved in developing their care plans and their relative’s views were sought and listened to.

People told us that staff understood their needs and appeared to be well trained. Staff told us their training equipped them with the skills and knowledge they needed.

Staff supported people to have enough to eat and drink. People told us they liked their meals. However, not all people had a positive meal time experience.

Staff supported people to access health services when they needed them.

The premises provided a homely and comfortable setting for people.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us that staff were kind and caring. We saw that staff were attentive to people’s needs. People were supported to express their views.

People received care that was responsive to their needs. Care plans were detailed and included information for staff about how to support people.

People and relatives knew how to raise concerns or make a complaint using the provider’s complaints procedure.

Care plans included information about people wanted to be cared for towards the end of their life

People told us the registered manager was friendly and approachable and often seen.

The provider’s quality assurance included seeking feedback from people, their relatives, staff and health and social care professionals who visited the home.

About the service: The Rookery Care Home is a residential care home for up to 30 older people, some of whom may be living with dementia. At the time of the inspection 12 people lived in the service.

Rating at last inspection: Good (published 2 August 2016).

Why we inspected: This was a planned inspection based on the rating of Good at the last inspection. The overall rating at this inspection is Requires Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected The Rookery on 10 June 2016. The Inspection was unannounced.

The Rookery is a care home in the Eastwood area of Nottingham, owned by Dual Care Limited. The accommodation consists of a large Georgian building which has been extended to provide additional bedrooms. Care is provided over two floors of the building and a lift was available. The service is registered to accommodate up to 30 older people who require nursing or personal care. The service does not provide nursing care. At the time of our visit 14 people were living at the Rookery.

The service had a registered manager in place at the time of our visit. 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.

We found that people were safe at The Rookery and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began working at The Rookery.

People received their prescribed medicines when required and these were stored and administered safely.

People received effective care from staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for care staff was scheduled to help staff maintain their knowledge.

Where they were able to, people provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities.

Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities. They knew how to raise an issue and were confident these would be listened to and acted on.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.