Signature-Hopton

People’s experience of using this service

People told us they were happy with the standard of care and support they received, which was reflected in the services most recent stakeholder satisfaction survey.

The provider ensured staff had the right levels of training and support they needed to deliver effective care and support to people living at the care home. People’s concerns and complaints were well-managed, and the provider recognised the importance of learning lessons when things went wrong. In addition, the services management were keen to continuously improve the care home and operated effective monitoring systems to assure the safety and quality of the care and support people living at Rosemanor-Hopton were provided.

The premises were kept clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. The provider had measures in place to mitigate the risks associated with COVID-19 related staff workforce pressures.

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. People lived in a suitably adapted and furnished care home that was now well-maintained. People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay emotionally and physically healthy and well.

Up to date electronic person centred care plans were in place, which enabled staff to understand and meet their people’s personal, social, and health care needs and wishes. Staff ensured they communicated and shared information with people in a way people could easily understand. People were supported to participate in meaningful recreational activities that reflected their social and cultural interests. People were supported to maintain relationships with family and friends. Plans were in place to help people nearing the end of their life receive compassionate palliative care in accordance with their needs and wishes.

The provider promoted an open and inclusive culture which sought the views of people, their relatives, community-based health and social care professionals and staff. The provider worked in close partnership with various community-based mental health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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 31 January 2020).

Why we inspected

This was a planned inspection based on the previous rating. At the last inspection we found the provider was no longer in breach of regulation’s as they had improved how they managed staff training and support, complaints and governance however, we continued to rate them requires improvement overall because we wanted them to demonstrate they could sustain the progress they had made over time.

We undertook this focused inspection to check the provider continued to follow their action plan and to confirm they could sustain the improvements we found they had made at their last inspection.

This report only covers our findings in relation to the key questions Effective, Responsive and Well-led. We also 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.

The rating from the previous comprehensive inspection for the key question Caring, which was not looked at on this occasion, and Safe, which was only partially inspected, were used in calculating the overall rating at this inspection.

Based on the findings at this inspection the provider continued to build upon the improvements they had made at their last inspection. The overall rating for the service has therefore changed from requires improvement to good.

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

Follow up

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

Rosemanor-Hopton is a residential care home providing support to 13 people with mental health needs at the time of the inspection. The service can support up to 17 people in one adapted building.

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

Since the last inspection, the service had made improvements in relation to fire safety. The provider had taken steps to employ suitable staff to meet people’s needs. Risk management plans gave staff clear guidance on mitigating identified risks. Staff were aware of the provider’s safeguarding policy and how to raise a safeguarding alert. People’s medicines were managed safely. The provider had infection control measures in place to minimise cross contamination.

People received support from staff that underwent training to enhance their knowledge and skills. Staff reflected on their working practices through regular supervisions and annual appraisals. Refurbishment of the service meant the service was more dementia friendly. Food provided reflected people’s cultural needs and met their preferences and dietary requirements. People were encouraged to live healthier lives and were supported to access healthcare services.

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 were treated with respect and had their dignity, privacy and diverse needs met. People were observed as being relaxed in staff’s company. People’s independence was promoted and monitored. People were encouraged to make decisions about the care and treatment they received.

The provider had made improvements in relation to complaints management. Complaints were managed in-line with the provider’s policy. The provider had made improvements in relation to activities. People were encouraged to participate in activities of their choice. Care plans were person-centred and gave staff guidance to meet people’s needs. The provider had an Accessible Information Standard policy in place. People’ end of life wishes were documented.

The provider had made improvements in relation to the oversight and management of the service. Audits were regularly undertaken, and issues identified were acted on swiftly. The provider had notified the CQC of reportable incidents in a timely manner. People’s views were regularly sought to drive improvements. People and staff spoke positively about the management of the service. The manager sought partnership working and guidance given was implemented into the delivery 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 6 August 2019). The service remains rated requires improvement.

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 regulations.

This service has been in Special Measures since 8 November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

• Rosemanor Hopton is a care home for people experiencing mental health issues. At the time of our inspection 13 people were living at the home.

People’s experience of using this service:

• The quality of care had improved in some areas since the last inspection.

• At our last inspection we rated the home ‘Inadequate’, at this inspection it had improved to ‘Requires Improvement’. However the home was still ‘Inadequate’ in well-led; and continued progress was needed to ensure that improvements made thus far were sustained.

• The home was still not as well-led as it could be. Management arrangements required more time to successfully embed into the service.

• The provider needed to ensure that quality assurance systems were robust, and important notifications were not always submitted to the Care Quality Commission (CQC) in a timely manner.

• Efforts were needed to ensure that the premises were well maintained and suitable for the needs of the people that lived there. Shower and bathrooms were not well maintained and the premises were not of a satisfactory level of cleanliness

• Fire safety across the home required improvements. The provider had complied with the action plan following a recent London Fire Brigade inspection and took prompt action to make improvements following their inspection findings.

• Staff training was still not up to date, and staff were not always fully trained in all areas to meet the needs of people living at the home.

• The proprietor had not ensured that duty of candour was duly upheld in responding to concerns raised by people and their relatives. Whilst complaints records had improved one complaint had not been responded to in line with the provider’s policy.

• Improvements were still needed to ensure that people were suitably stimulated and supported to engage in a range of activities. We have made a recommendation in relation to this.

• Medicines were now well managed and people received their medicines safely.

• Any applications to deprive people of their liberty were suitably applied for and records were well kept.

• People appeared settled at the home and felt staff were kind and caring towards them.

Rating at last inspection:

• At our last inspection the home was rated ‘Inadequate’. (Report published 01 February 2019)

Why we inspected:

• All services rated "Inadequate" are re-inspected within six months of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received, and check whether they had complied with their improvement plan following the findings at our last inspection.

Enforcement:

• The service continued to meet the characteristics of Inadequate in the key question of well-led. It met the characteristics of Requires Improvement in safe, effective and Good in caring. We are taking enforcement action and will report on this when it is completed.

Follow up:

• Following the inspection, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety

of the service improves.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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

Rosemanor Hopton 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.

Rosemanor Hopton accommodates up to 17 people in one adapted building. At the time of our inspection 13 people were residing at the home. People primarily presented with mental health issues, and each person had their own room.

When we completed our previous inspection on 28 July 2017 we found concerns relating to people’s involvement in decisions about their care. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Responsive. Therefore, for this inspection, we have inspected this key question and also the previous key question to make sure all areas are inspected to validate the ratings.

At the last inspection we found breaches of the regulations in relation to safe care and treatment, person-centred care, staffing, premises and equipment and good governance. 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 safe, effective, caring, responsive and well-led to at least good.

At the last inspection on 27 July 2017, we asked the provider to take action to make improvements to the premises, and this action has been completed.

At this inspection of 11 September 2018 we found the service continued to be in breach of the regulations in relation to safe care and treatment, person-centred care, staffing and good governance. In addition, we also found a breach of the regulations in relation to complaints. The provider had not taken appropriate action to improve the quality of the service, and continued to be in breach of the regulations.

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 is added to reports after any representations and appeals have been concluded.

There was a registered manager at the time of our 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.

The registered manager did not have day to day oversight of how the home was run, as well as finding multiple breaches of the regulations at this inspection. Compliance audits were not effective in driving improvements across the service.

Staffing levels were not appropriate to meet the full needs of people living at the home. Appropriate records were not kept of incidents and accidents, and the full investigations into them. People’s risk assessments were not clear in defining appropriate action to be taken to help mitigate any potential risks. The administration of medicines was not safe, nor were medicines always securely stored.

Applications to the Deprivation of Liberty Safeguards (DoLS) were not made in a timely manner. People did not always receive person centred care that reflected their preferences. There was not always sufficient information to guide staff to support people effectively. The provider was unable to provide full records of complaints received and appropriate action was not always taken to remedy issues raised.

Staff did know the steps to take to safeguard people from abuse, and improvements had been made to the maintenance and hygiene of the premises. People were supported appropriately at mealtimes, and referred to other healthcare professionals at times that they needed them. Staff worked together to support people and communicate between shifts. People felt cared for by the staff supporting them, and staff were aware of the importance of respecting people’s privacy and dignity. People were supported to express their end of life wishes.

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.

Rosemanor-Hopton is registered to provide accommodation for a maximum of 17 adults who require nursing or personal care. At the time of our inspection, Rosemanor-Hopton was home to 16 male adults with mental health difficulties.

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. The service was being managed day-to day by a manager who had been appointed three weeks before our inspection.

The home is situated in a residential road close to Streatham High Road with access to good transport links and a variety of shops. The home was of a suitable layout for the people living there but needed to be refurbished.

People were not adequately protected against the risk and spread of infection because the provider did not have effective systems in place to ensure that an appropriate standard of hygiene and cleanliness was maintained. The communal areas of the home were visibly unclean.

People felt safe living in the home and staff knew how to report any concerns. However, people were not always protected as they could be against the risk of avoidable harm because the provider did not have appropriate arrangements in place to ensure that risks to people were adequately assessed and managed. Furthermore, staff were not always aware of the content of people's risk management plans.

People received their medicines as prescribed and there were appropriate arrangements in place for ordering, storing, recording and disposing of people's medicines.

People were satisfied with the quality of their meals and told us they had a sufficient amount to eat and drink. Staff worked with external healthcare professionals to support people to maintain good health.

The provider used effective and safe staff recruitment procedures which were consistently applied. The provider did not offer newly appointed staff an appropriate induction and this affected their ability to provide effective care.

There was a sufficient number of staff to meet people's needs. People were complimentary about the staff. Staff respected people’s privacy and interacted with people in a caring and respectful manner. However, people were not as involved in their care planning as could be and the care people received was not personalised.

Improvements were required to ensure the service was well-led. The registered manager and provider did not have effective quality assurance systems in place to assess and monitor the quality of care people received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people being at risk of avoidable harm; people not being protected from the risk and spread of infection; staff not receiving an appropriate induction; the lack of person-centred care and the lack of effective systems to assess and monitor the quality of care people received.

You can see what action we asked the provider to take at the back of the full version of this report. 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.