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Rockley Dene Residential Requires improvement

The provider of this service changed - see old profile

We have edited the inspection report for Rockley Dene Residential from 2 July 2019 in order to remove some text which should not have been included in this report. This has not affected the rating given to this service.

Reports


Inspection carried out on 21 May 2019

During a routine inspection

About the service: Rockley Dene Residential provides care and support for people with residential needs. The home is registered to accommodate a maximum of 39 people. On both days of our inspection, 26 people were living in the home. Some people who used the service were living with dementia.

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

Inspection carried out on 18 September 2018

During a routine inspection

This inspection took place on 18, 25 and 26 September 2018. The first day of our inspection was unannounced. The second and third days were announced to give the registered provider an opportunity to receive our feedback.

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 ne

Inspection carried out on 6 February 2018

During a routine inspection

We carried out this inspection on 6 and 8 February 2018. The inspection was unannounced, which meant the people living at Rockley Dene and the staff working there didn’t know we were visiting. This was the service’s first inspection since the new registered provider had registered with the care quality commission (CQC) in December 2016.

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