Rockley Dene Residential

Rockley Dene Residential is a residential care home providing accommodation and personal care for up to 35 people, some of whom are living with dementia. At the time of the inspection there were 27 people living at Rockley Dene Residential.

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

Effective governance and quality assurance systems were not in place. These would have picked up on the issues we found at this inspection with regard to medicine stock checks, conflicting information in people’s care records, and incomplete recruitment histories. The design, decoration and upkeep of the premises did not safely meet people’s needs. The premises required significant redecoration and refurbishment. We have made a recommendation regarding improving the frequency and variety of activities available to people.

People told us they felt safe living at Rockley Dene. Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by managers. There were enough staff employed to meet people’s care and support needs in a timely manner. Safe procedures were in place to make sure people received their medicines as prescribed.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs. Staff understood the requirements of the Mental Capacity Act 2005. 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 told us they enjoyed the food served at Rockley Dene, which we saw took into account their dietary needs and preferences. People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed. Positive, caring and supportive relationships had been developed between people and staff. People were treated with dignity and respect.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 January 2020). The provider completed an action plan after this inspection to show what they do and by when to improve.

This service was inspected again on 3 September 2020. This was a targeted inspection to check whether the service remained in breach of regulations and because of concerns CQC had about risk assessments, staffing levels, staff training and consent. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. Prior to this the service was rated inadequate for two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the provider’s nursing home on the same site. A decision was made for us to inspect and examine those risks.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rockley Dene Residential on our website at www.cqc.org.uk

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to governance and the premises.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rockley Dene Residential is a residential care home providing accommodation for up to 35 people, including people living with dementia. At the time of the inspection there were 23 people living at the home.

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

We received information raising concerns about how people using the service were being kept safe, staffing levels, staff training, and whether people had consented to their care. At the last inspection we found statutory notifications were not submitted in a timely manner and manager oversight of the service was not fully evident.

We wrote to the manager before our inspection visit and asked for information around their systems and process. This included how environmental risks were managed, details of staff training, staffing rotas, and audits.

We found the provider had failed to ensure appropriate checks and audits took place. Risk assessments and care plans had not been reviewed. Not all equipment checks had been completed. Staff had not received training. This meant manager oversight remained not fully evident.

We found staff were recruited safely, however it was not always evident whether staff who had been re-deployed had the appropriate skills and experience for their new role.

We have made a recommendation about employing staff to new roles within the home.

People felt safe living at the home. People were protected from the risk of acquiring infections by robust infection prevention and controls. The home was clean and odour-free. Personal protective equipment and up-to-date guidance was readily available to staff and this was followed.

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.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (13 January 2020) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this targeted inspection to check whether the Requirement Notice we previously issued in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and because of concerns we had about risk assessments, staffing levels, staff training and consent. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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 management oversight 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 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.

Rating at last inspection: Inadequate (report published November 2018). We placed the service in special measures as breaches of the regulation were found in relation to recruitment, person-centred care, premises and equipment, safe care and treatment, good governance and staff support.

Following the last inspection, we met with the registered provider to discuss their action plan which showed what they would do and by when to improve the ratings in respect of our key questions. At this inspection we found improvements had been made in most areas. However, concerns remained regarding some aspects of governance to demonstrate clear management oversight.

People’s experience of using this service: Aspects of management oversight, including the timely reporting of notifiable incidents, the recording of weekly weights and follow up of a hospital admission had not been well managed.

Other areas of governance showed the home had improved through regular audits and completed action plans. Spot checks were taking place at unsociable hours to check standards were maintained at all times of the day.

People, their relatives and staff were actively encouraged to be part of the running of the home. The registered manager had shown initiative with the use of technology and promoted equality, diversity and human rights.

People felt safe living in this home as they were cared for by staff who had been safely recruited and trained to be able to carry out their role.

Positive caring interactions were seen throughout our inspection. However, we saw some people with long or dirty fingernails. The management team addressed this on the day of inspection.

People were given choices in their daily routines. They enjoyed the food served and could ask for alternatives. Support during mealtimes was provided discreetly and at other times we saw staff working at eye level with people.

Staff received formal support through a programme of supervision, appraisal and training. The culture within the home had improved and staff felt part of a team where communication was usually good.

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

There were sufficient numbers of staff to meet people’s needs. People knew how to complain and a system for managing complaints was in place.

People received access to healthcare and the home worked in partnership with a range of professionals.

Care plans were found to be person-centred and sufficiently detailed. Monthly reviews required more detail, although annual reviews with people and relatives described any changes and action was taken where needed.

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

Why we inspected: To follow up on enforcement action we took at our last inspection and to review whether the action plan the registered provider submitted to us had been acted on.

Follow up: We will continue to monitor intelligence we receive about the service until we are scheduled to return. We inspect according to a schedule based on the current rating, however may inspect sooner if we receive information of concern.

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.

We had previously inspected the home in February 2018 and rated it overall as inadequate and the home was placed in ‘Special Measures’. Our key questions ‘safe’ and ‘well-led’ were both rated as inadequate and other key questions were all rated as requires improvement. We found breaches of the regulations concerning person-centred care, safe care and treatment, premises and equipment and staffing. We took enforcement action in relation to good governance. The registered provider sent us an action plan dated March 2018 which we followed up at this inspection.

Rockley Dene Residential 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. Rockley Dene Residential provides care and support for people with residential needs. The home has a maximum occupancy of 39 people. On the first day of our inspection, 26 people were living in the home and one was in hospital. On day two this number was 27 and on day three it was 26.

Due to their identified concerns, the local authority was visiting on a daily basis to check on the care provided and to ensure shifts were fully staffed. The local authority had taken the decision to suspend new placements at this home.

At the time of our inspection a manager was still registered with the Care Quality Commission. However, four weeks before our inspection, they left the home and were no longer in day-to-day control. Since the registered manager had resigned, a senior care worker had been temporarily appointed as the acting home manager within the home.

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.

On the second day of our inspection, we met the new home manager who had commenced their employment one day earlier. Throughout our report, we refer to them as the ‘home manager’. The home did not have a deputy manager in post, although this post had been offered to a candidate expected to commence employment in October 2018.

The registered provider had not ensured the acting home manager had the necessary skills and knowledge to be able to fulfil this role. We became aware of one incident which should have been reported to the Care Quality Commission which had not been communicated to us.

General maintenance in the building was not well managed. Two people living in the home had not had a hot water supply for several months. Certificates concerning the safe supply of water and lifting equipment had lasped. The supply of toiletries and disinfectant had been allowed to run out, despite this being identified beforehand. Some staff had purchased toiletries for people out of their own money.

Issues identified at the last inspection regarding locks on bathrooms and toilet doors not working had still not been resolved. This meant people were not supported to maintain their privacy and dignity.

Care plans did not reflect people’s needs as information was not consistently recorded throughout. There was a lack of evidence to show how people and their representatives had been involved in care planning. End of life care and planning for this had improved. The storage of archived records was chaotic and it took staff a long time to find the records we requested.

The management of medicines was not robust as not all staff had an up-to-date assessment of their competency. Some controlled drugs which were no longer needed had been returned. Medication audits had not been completed in March, April and August 2018.

The registered provider and registered manager had not taken sufficient action to make improvements where we had previously taken enforcement action. The audits carried out by the registered manager were not effective. There were no action plans and we saw issues identified had not been resolved. The registered provider was unable to demonstrate their oversight of the home through their own checks.

People spoke positively about the staff and we witnessed there was a positive relationship between them. People enjoyed the activities provided, although there was no provision when the activities coordinator had been absent.

People enjoyed the food provided, although we saw areas of improvement were needed to the mealtime experience. People received access to healthcare from a variety of sources. For several weeks, the home did not have a chiropodist and nothing had been done to remedy this.

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

An up-to-date fire risk assessment was in place and people had personal emergency evacuation plans in place. Staff had a visible presence in the home and most people felt there was enough staff. Some staff were working back-to-back shifts which covered a total of 14 hours, which meant they were at risk of becoming tired and more likely to make mistakes.

Staff satisfaction surveys completed in June 2018 had not been analysed, meaning there was no feedback for staff. Staff were critical of the registered manager as they felt they had not been adequately supported and felt unable to approach them. Some staff had taken the decision to leave the home, but changed their mind once the manager left. Staff had felt unable to report their concerns directly to the registered provider.

At this inspection we found individual risks to people had not been properly assessed and the systems in place for the safe management of medicines were not robust. Staff had not received appropriate induction support, training, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. Records relating to people’s care needs were not adequately recorded and privacy and dignity was not consistently maintained. Detailed records of responses to complaints had not been maintained. There were continued breaches of the regulations and there was insufficient leadership and oversight.

We have made a recommendation in relation to how the registered provider ensures this care home is compliant with the Accessible Information Standard. You can see this within our report.

The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Rockley Dene Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rockley Dene Residential Home accommodates 34 older people in one adapted building. This included people living with dementia. At the time of our inspection 33 people were using the service.

The service had a registered manager. ‘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.’

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted a safeguarding referral for one person to the local authority.

The registered manger used a dependency tool to determine staffing levels. However, we found this was not accurate as the dependency used the risk assessment scores and we found these were not reviewed effectively and therefore the staffing levels were not accurate. Staff also told us there was not enough staff on duty at certain times to meet people’s needs in a timely way.

Risks had been identified and management of the risks were documented. However, these were not reviewed correctly so the level of risk was not accurate.

Systems were in place for safe management of medicines. Staff received appropriate training and competency assessments.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service and some equipment was not kept clean or hygienic to ensure people were protected from acquired infections.

We found procedures were followed for the recruitment of staff. Staff supervision took place and staff received an annual appraisal of their work. Staff received training. However we identified this was not always effective.

We found the service meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. We also found where required some best interest decisions were made however there was not a consistent approach to ensure all decisions were made in people’s best interests.

People were offered a well-balanced diet. However, through our observations we saw people were not always supported to maintain a balanced diet. People accessed health care services when required. But we identified that referrals were not always made when people’s needs changed to ensure people’s safety.

People and relatives spoken with all said the staff were kind and caring. People also said staff respected them and maintained their dignity.

Care plans identified people’s needs and had good detail of how to manage people’s needs. However, we identified some documentation did not always reflect peoples current or changing needs.

People told us they were listened to by the management team and were confident any concerns would be dealt with by them.

Activities took place, people told us the activities were very good and they thoroughly enjoyed them.

There were processes in place to monitor the quality and safety of the service. However, these were not effective.

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 our inspection, we found five breaches 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 the report. ‘Full information about CQC’s regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.’