Archived: Rosebery Manor

We found the following examples of good practice.

People were supported to maintain contact with those who were important to them. Staff supported people to speak with their loved ones through video calls and the telephone. When people were able to receive visitors, safe protocols were in place including booking appointments, a separate screened area and testing prior to entry. The activities team continued to provide a variety of activities in line with people’s needs and preferences.

The provider had devised and implemented a risk-based approach to how the service operated on a day to day basis. This supported registered managers in making decisions in relation to visiting, activities, dining and maintenance. All decisions were made in line with advice from the relevant professionals.

People were cared for in a clean and hygienic environment. Detailed cleaning schedules were in place and followed. Particular attention was paid to frequently touched areas which were frequently cleaned throughout the day.

The service was separated into zones to minimise the risk of cross infection. Staff were allocated to work in a specific zone and separate changing and break rooms were available in each area. People were encouraged to spend time in their rooms when cases of Covid-19 had been identified. Where this was difficult for people, communal areas had been arranged to support people to maintain social distancing.

People and staff received regular testing for Covid-19 and appropriate action was taken in response to any positive tests. Two staff members had been appointed as testing co-ordinators to ensure the process was managed appropriately. In addition, regular screenings for symptoms of Covid-19 such as daily temperature checks were completed.

Personal protective equipment (PPE) was available to staff, visitors and people living at Rosebery Manor. Staff received training in the safe use and disposal of PPE and we observed this was followed. Any questions or concerns regarding the use of PPE were responded to promptly.

Staff told us they had felt supported throughout the Covid-19 pandemic. In addition to practical support, access to well-being information and counselling were also available.

Rosebery Manor is a residential care home providing personal and nursing care to 88 people at the time of the inspection. The service can support up to 95 people. Care is provided in one purpose built building with lift access, communal areas and garden spaces.

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

People told us they felt safe and care was planned and delivered in a way that ensured risks to people were safely mitigated. Improvements identified at our last inspection had been sustained with robust systems in place to monitor incidents, falls and medicines. There were enough staff and staff understood how to identify and respond to potential abuse.

People liked the food they were prepared but we received feedback that food was not always hot. The provider shared with us actions they would take to address this. Staff worked closely with healthcare professionals and we received positive feedback about how staff worked with other agencies. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff they got on well with and staff were committed to the people they supported. Care was planned and delivered around people’s protected characteristics and we saw examples of the service promoting diversity amongst people and staff. People were involved in their care and staff encouraged people to be independent.

People described a wide variety of activities which catered to a variety of interests and we saw examples of personalised activities for people. Care plans were consistently detailed and reflected people’s needs and backgrounds, with frequent reviews. End of life care was planned and delivered sensitively and in line with best practice. Complaints were logged and responded to in line with policy.

People told us they had seen improvements to leadership and culture at the service and there was a new registered manager in post. The service had developed strong links with the local community which benefitted people as well as the public. People’s feedback was sought on a daily basis and action was taken in response to suggestions made by people. Staff felt supported by management and were involved in the running of the service.

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 16 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The registered manager had recently left the service although continued to be employed by the provider. A new manager was in post and had begun the registration process. 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 our inspection on 10 August 2017 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following concerns relating to the care people were receiving we completed a further inspection Rosebery Manor on 24 May 2018 where seven breaches of legal requirements were identified. These were in relation to a lack of consistent leadership and management oversight, risks to people's safety not always being identified and acted upon, people’s medicines not being managed safely and accidents and incidents not being adequately monitored. In addition, we found that sufficient, skilled staff were not always deployed, complaints were not always recorded and responded to, people’s dignity was not always being upheld and people’s care was not always person-centred.

Following this inspection, we issued warning notices in relation to safe care and treatment and good governance. As a result of our concerns Rosebery Manor was placed into special measures. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good.

At this inspection we found significant improvements had been made in all areas of the service and no breaches of legal requirements were identified. The overall rating for the service is requires improvement. We could not improve the rating for well-led and safe from inadequate to good because to do so requires consistent good practice over time. We will check whether these improvements have been sustained during our next planned comprehensive inspection.

People told us they felt safe living at the home and staff understood their responsibility to identify and report any concerns of potential abuse. Staff received safeguarding training which was regularly updated. Risks to people's safety were identified and assessed.

There were enough staff to meet people's needs and regular agency staff were used where required. New staff were appointed through safe recruitment and selection processes. Accidents and incidents were reported and action taken to minimise risks and identify trends. People received their medicines in line with their prescriptions and safe systems of medicines management had been developed. Staff understood their responsibility to protect people from the risk of infection and followed appropriate infection control procedures. People lived in a safe environment which was suited to their needs and contingency plans were in place to ensure people received their support in the event of an emergency.

People’s needs were assessed prior to them moving into Rosebery Manor to ensure their needs could be met. Staff received an induction into the service and on-going training to support them in their roles. The monitoring of staff supervision had increased and was under review by the manager. People's weight was regularly monitored and a choice of nutritious food provided. Appropriate referrals were made to health and social care professionals when required and advice provided was followed. People’s legal rights were upheld as the principles of the Mental Capacity Act 2005 were followed.

People and their relatives told us that staff were caring. Staff knew people well and treated them with dignity and respect. People were supported to maintain their chosen lifestyle and were encouraged to maintain their independence. People’s religious views were respected. Visitors were made to feel welcome and there were no restrictions on the times people could receive their visitors.

Care records gave guidance to staff on how people preferred their care to be provided and we observed this was followed. The care people wanted at the end of their life was recorded and staff had received training in this area. A wide range of activities were provided which people told us they enjoyed. The opportunity to participate in activities for people living in The Oaks had increased and people were encouraged to participate. There was a complaints policy available in the communal foyer and complaints had been responded to promptly.

There had been further changes to the management of the service since our last inspection. However, there had been an extended handover to the new manager to ensure this was done in a planned way. People, relatives and staff told us they felt improvements had been made to the way in which the service was managed. Staff felt supported in their roles and felt able to raise suggestions or report concerns. People were involved in the running of the service and the management team were looking for ways to expand this. Quality audits were completed regularly and systems were reviewed to ensure these were effective in driving improvements. Notifications of significant events were forwarded to the CQC in line with the providers legal responsibilities.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rosebery Manor 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. Rosebery Manor provides facilities and services for up to 95 older people who require personal or nursing care. The service is purpose built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called The Oaks. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle. On the day of the inspection there were 86 people living at Rosebery Manor.

At our last inspection on 10 August 2017 four breaches of regulations were identified. The concerns found related to risks to people's safety not being adequately managed, safe medicines practices not being followed, safeguarding concerns not being reported in a timely manner, the lack of effective quality assurance systems and the failure to notify CQC of significant events in line with statutory requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-led to at least good. At this inspection we found three repeated breaches of regulations relating to the management of the service, how people were kept safe and the failure to submit statutory notifications. In addition, we identified concerns relating to the deployment of staff, responding to complaints, treating people with respect and dignity and providing person centred care.

There was no 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. The last registered manager had left the service in April 2017. A manager had recently been appointed who supported us to access information during the inspection. The manager informed us they had begun the process of registering with CQC and our records confirmed this was the case.

There was a lack of consistent leadership of the service. There had been five managers in post in the last year. In addition, there had been changes to other key roles. This had led to a negative culture across the service. Quality assurance systems were not always effective in ensuring improvements to the service happened in a timely manner which protected people from risks. Records regarding the care people required were not always up to date and accurately maintained. The complaints log did not contain details of all complaints made and not all complaints had been responded to.

Medicines management systems were not robust which meant people were at risk of not receiving their medicines in line with prescription guidelines. Risks to people’s safety were not always known to staff. The providers policy regarding people receiving night checks was not consistently followed which put people at risk of harm. Sufficient skilled staff were not always deployed and people told us that the high use of agency staff impacted on the care they received. Staff did not always receive the training they required to support them in their roles. Agency staff did not receive supervision to monitor and develop their practice. Permanent staff supervision had improved within recent months. We will continue to monitor this to ensure that systems are embedded into practice.

People did not always receive person centred care and where people’s needs changed this was not always responded to in a timely way. People were not always supported by staff who knew them well. Detailed records were not maintained of the care people wanted when nearing the end of their life. Activities provided within The Oaks was not always person centred and did not reflect people’s individual interests. People living in The Oaks were not always treated with respect. People did not receive the care they required at mealtimes and staff were task focussed.

In contrast, people in assisted living had access to a wide range of activities and their individual preferences were taken into account. The dining experience for those using the main dining area was positive and people were supported by attentive staff.

Safe recruitment practices were followed to ensure staff employed were suitable for their role. People lived in a clean and comfortable environment and staff practiced good infection control processes. Regular health and safety checks of the premises were conducted and a contingency plan was in place for staff to follow in the event of an emergency.

People’s legal rights were protected as the principles of the Mental Capacity Act 2005 (MCA) were followed. Prior to moving to the service, a detailed assessment of people’s needs was completed and regularly updated. People told us they enjoyed the food provided and had a range of options to choose from. Healthcare professionals visited the service and appropriate referrals to specialist services were made as required. People were supported to maintain their independence and their religious beliefs were respected.

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.

During the inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach 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.

Rosebery Manor provides accommodation, care and support for up to 95 people who require support with personal or nursing care. The home is set over three floors. The second floor provides care and support to people who are living with dementia, this unit is called The Oaks. The other areas of the home provide care for people requiring ‘assisted living’. Some people lead a mainly independent life and use the home’s facilities to support their lifestyle. On the day of the inspection there were 89 people living at Rosebery Manor, 62 people required personal or nursing care.

There was no 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 and associated Regulations about how the service is run. An interim manager had been employed at the service since April 2017 whilst recruitment took place. The interim manager supported us during our inspection.

We carried out an unannounced comprehensive inspection of this service on 3 November 2016. After that inspection we received concerns in relation to safeguarding concerns not being identified and appropriately recorded to the local authority and the Care Quality Commission (CQC). As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to safe and well led key areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosebery Manor on our website at www.cqc.org.uk”

Safeguarding concerns had not always been reported to the relevant local authority to ensure thorough investigations took place in order to keep people safe. Staff had not consistently recognised the signs of potential abuse which had therefore not been reported internally or to external authorities. There had been a number of incidents between people which had not been reported and action had not always been taken to protect those concerned.

Risks to people’s safety and well-being had not always been comprehensively assessed and monitoring systems in place to manage risks were not always effective. Accidents and incidents were not recorded and addressed to minimise the risk of them happening again. People’s medicines were not always managed safely and medicines errors were not always investigated.

There was a lack of management oversight in the service. The manager was unaware of a number of incidents which had taken place in the service over recent months. Quality assurance systems were not effective in ensuring concerns were identified and addressed in a timely manner. Records were not always completed accurately and were not always accessible by the manager of the service. The provider had failed to ensure that the CQC were notified of significant events in the service in line with their legal responsibilities.

There were sufficient staff deployed to meet people’s needs and people did not have to wait for care. However, people told us that the high use of agency staff was a concern to them. We have made a recommendation regarding this. This is because although enough staff were caring for people agency staff may not know everyone of their individual needs and preferences and this affects the care they receive. Robust recruitment practices were followed to ensure that staff employed were safe to work in the service.

People had the opportunity to contribute to the running of the service through forums, resident meetings and annual questionnaires. Where concerns or improvements had been suggested these had been implemented. Staff felt supported by the management of the service and felt their views were listened to.

During the inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

At our inspection in September 2015 we found that people were not always receiving safe care as risks to people’s safety were not adequately controlled and safe medicines systems were not followed. We also found concerns regarding how the service was managed as records were not updated or accessible and quality assurance systems were not effective. At this inspection we found that improvements had been made in all areas although there were some continued concerns regarding medicines management.

There was a registered manager in post who supported us throughout 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.

Safe medicines management systems had improved but there were still a few gaps in staff recording what medicines were given or refused. We have made a recommendation that improvements to this system are continued.

People were protected from avoidable abuse and harm as staff knew what action to take in the event of suspected abuse. Risks to people were identified, assessed and managed safely. Accidents and incidents were monitored to minimise the risk of reoccurrence. Staffing levels had improved and were sufficient to meet people's needs and robust recruitment processes were in place. Staff received an induction into the service and completed on-going training to develop their skills in their role. Supervision had increased and was provided to staff to monitor their performance.

People were complimentary about the food provided and staff monitored people’s dietary needs. There was a wide range of nutritious foods available and people were encouraged to give feedback regarding their preferences. People were supported with their healthcare needs and staff consulted with external healthcare professionals to get specialist advice and guidance when needed.

Staff knew people well and positive, kind and caring relationships had been developed. People and their relatives were involved in decisions regarding their care and support and consent was gained by staff prior to care being given. People were treated with dignity and respect and were encouraged to maintain their independence. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed.

Care plans were comprehensive and provided detailed information to staff about people's care needs and how they wished to be supported. People were supported by staff who knew them well. A range of activities was planned which focussed on people’s hobbies and interests.

The provider had a complaints policy in place which was shared with people and their relatives. Complaints had been investigated and responded to and action was taken to identify trends. People were asked for their views about the service through a range of forums, feedback cards and questionnaires. Results showed positive improvements had been made within the service.

Staff felt the home was well managed and that the registered manager was accessible and approachable. The range of quality assurance systems had improved and were now in place to measure and monitor the standard of care. Where concerns were identified action plans were implemented to improve standards. The registered manager and provider had implemented workshops to ensure that staff were aware of the values of the service. Records were maintained in an organised manner and provided staff with quick access to the information they required to understand people’s support needs.