Archived: Rosewood Court

Updated 3 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 12 and 13 September 2017. We also received information by email from the provider on 20 September 2017. On 12 September, the inspection was carried out by two inspectors, a specialist advisor for medicines and an expert by experience. An expert by experience is a person who has personal experience of using, or caring for someone who uses this type of care service. On 13 September, the lead inspector returned with another inspector to complete the inspection.

Before our inspection we looked at all the information we held about the service including notifications. A notification is information about events that the registered persons are required, by law, to tell us about.

We asked for feedback from the local authority, the local clinical commissioning group and Healthwatch Bedfordshire.

During our inspection nine people told us about their experience of living at Rosewood Court, and we also spoke with two relatives. We also spoke with the provider’s representative, the compliance manager (who was managing the service during our inspection), one agency nurse who worked regularly at the service, two senior care workers, three care workers, an activities co-ordinator, the head house keeper, three domestics and a cook. We also spoke with a management consultant who was supporting the provider. Throughout the inspection we observed how the staff interacted with people who lived in the service.

We looked at care records relating to eight people and the medicine administration records of 19 people. We also looked at staff training records and other records relating to the management of the service. These included audits, rotas, meeting minutes and records relating to complaints, maintenance, and accident and incidents.

Following our inspection visits we spoke with three further relatives. We also received information by email from the provider on 20 September 2017. This included further information in relation to staffing the home, medicines and people’s hospital appointments.

Updated 3 November 2017

Rosewood Court was added to the provider’s registration in April 2016. It is a purpose built care home that provides accommodation, nursing and personal care for up to 66 older people, some of whom are living with dementia.

Our last inspection took place on 11 July 2017 and included information received from the local authority on 1 August 2017. We rated the service as requires improvement with three breaches of regulations.

This unannounced inspection took place on 12 and 13 September 2017. We also received information by email from the provider on 20 September 2017. There were 19 people receiving care, and one person in hospital, at that time.

Prior to this inspection we received further concerns from the local authority and Clinical Commissioning Group in relation to the management of the service and the care people received.

Before this inspection the provider's representative told us they planned to temporarily stop providing nursing care in order for them to focus on making the necessary improvements to the service.

During our inspection visit on 12 September 2017 the provider's representative told us they had decided to close the service. They engaged a consultancy company to assist senior managers with the closure.

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 had not had a registered manager since January 2017. Since that time the provider had appointed five managers. The current manager took up post on 6 September 2017. However, they were not present during our inspection and senior managers told us the new manager was unlikely to return to work. The compliance manager was managing the service during our inspection. The lack of stable management had negatively impacted on the service, causing confusion and low staff morale.

The provider had failed to follow the required process to notify CQC of changes in the service’s managers.

Systems to continually assess, monitor and improve the quality and safety of care provided at the service were lacking and remained ineffective.

There were opportunities for people and their relatives to provide feedback to the provider. However, these were not always communicated to them and that little had changed as a result of their comments. Relatives were not always informed of changes in their family member’s well-being. We therefore concluded that complaints were not always thoroughly investigated and complainants were not always kept informed of the progress of their complaints.

Not all staff received sufficient training and support to carry out their roles.

Staff had not always supported people with decision making. The provider told us this would be addressed by 20 September 2017.

People’s nutritional needs were met. However, people’s health care needs were not always effectively monitored or met and people did not always receive their prescribed medicines.

Potential risks to people had not always been assessed and were not always well managed.

There was not always enough sufficiently skilled and experienced staff on duty to make sure people’s needs were fully met and people were kept safe. Staff knew how to recognise incidents of potential harm but did not always know how to, or feel confident in, reporting these.

Some people were happy with the care they received. However, staff did not always follow people’s care plans and people did not always receive the care they needed. However, we were aware the provider was in the process of reviewing people’s care plans.

People received care from staff who were kind, respectful and supported their independence. Staff treated people with dignity and respect. However, care was not always person-centred and people were not always involved in every day decisions about their care.

There were opportunities for people to develop and maintain interests and hobbies.

At our previous inspection on 11 July and 1 August 2017 we found two breaches of the Health and Social Care Act (Registration) Regulations 2014 and one breach of the Health and Social Care Act (Regulated Activities) Regulations. We were waiting for the provider’s action plan detailing the improvements they planned to make. During this inspection on 12, 13 and 20 September 2017 we found a further five of the Health and Social Care Act (Regulated Activities) Regulations 2014 had been breached, in addition to the breaches identified at our previous inspection. You can see what action we told the provider to take at the back of the full version of the report.

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.