Archived: Rossmore Community Rehabilitation Centre

Rossmore Community Rehabilitation Centre is a residential care home providing personal care to a maximum of 52 people. At the time of inspection, 33 people were using the service. This consisted of 14 people who required support and treatment following a stroke, 15 people who required reablement to prevent hospital admission or to facilitate an early discharge from hospital, and four people who were permanent residents at the service.

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

People received safe, effective and well-led care.

There was an effective quality monitoring system, which ensured checks and audits were carried out., People's views were obtained and listened to and shortfalls were addressed. Accidents and incidents were analysed so that lessons could be learned. The provider had oversight of the service and completed regular checks.

People were happy with the service they received and felt staff had a clear understanding of their needs and preferences. People admitted to the stroke service had support and treatment provided by therapy staff based at Rossmore Community Rehabilitation Centre, such as physiotherapists and occupational therapists. There were good outcomes for people.

There were enough staff. Safe recruitment processes had been followed. Staff were trained and their skills and knowledge checked through competency assessments.

People were protected from abuse and avoidable harm. Staff had completed training in how to safeguard people and risk assessments were completed to identify potential hazards. People received their medicine as prescribed.

People and their relatives were involved in the service. Care was planned around people's choices and preferred routines. People and their relatives were supported to receive information in an accessible way to enable them to be involved in their care and support.

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.

The culture of the service was open, and people and staff felt able to raise concerns.

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

Rating at last Inspection

The last rating for this service was good (published 14 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rossmore is a residential care home providing personal care to a maximum of 56 people. There are 17 placements for people who require support and treatment following a stroke. There are 25 placements for people who require reablement to prevent hospital admission or to facilitate an early discharge from hospital. Currently, there are six people who are permanent residents at Rossmore.

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

There were improvements in governance and the oversight of the stroke service. The improvements related to closer monitoring of people’s needs, preparation for multidisciplinary meetings, recording systems, and communication between staff. Care and therapy staff reported an improvement in morale and partnership working.

The environment was clean and safe for people. Staff knew how to safeguard people from the risk of harm and abuse. Risk assessments were completed and kept under review, so staff had up to date information on how to minimise risk. The provider had a safe recruitment system and employed enough staff to support people’s needs.

People’s nutritional needs were met. People told us they liked their meals and had enough to eat and drink; the menus provided choices for them. They were supported to access dieticians when needed.

People’s health needs were monitored and met, and they received their medicines in a safe way as prescribed. Staff supported people to access a range of health care professionals when required. Those people admitted to the stroke service had support and treatment provided by therapy staff based at Rossmore such as physiotherapists and occupational therapists. There were good outcomes for people.

Staff approach was described as kind and caring. They treated people with dignity and respect and supported them to be as independent as possible. People had care plans, which were detailed and provided staff with good information on how to meet their needs in the way they preferred.

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. Staff had a good understanding of the need to seek consent from people before carrying out care tasks.

People told us staff knew how to care for them. Staff received induction, training, supervision and appraisal to help with their development and confidence when supporting people’s needs.

The provider had a system for the management of complaints, and people felt able to raise concerns knowing they would be addressed.

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 16 January 2019) 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, we found improvements had been made and the provider was no longer in breach of regulations.

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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Rossmore 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.

Rossmore is situated in a residential area and is several town houses linked to make one building. The service is registered to provide residential care for up to 56 people, although due to refurbishment, the number of beds had been reduced to 50. There are designated beds for stroke rehabilitation, enablement following a period of ill health or hospital admission and for permanent residency. There are bedrooms and communal space on the ground floor and further bedrooms on the upper floors. The service also has a separate building used for therapy support for people recovering from a stroke. At the time of the inspection, there were 17 people using the stroke service, 15 people admitted for support with their enablement and 11 people who lived at the service.

Whilst there were no concerns raised with care and treatment in the enablement service and the main part of the home, there were issues raised by health and social care professionals with management oversight of the stroke service. We found there was an approach to care and treatment in the stroke service that was not as effective as it could be. Staff morale was described as low and there was a lack of teamwork between care staff who worked in Rossmore and external staff who delivered therapy. There were also issues with the consistency of records and some elements of quality monitoring required improvement. Senior management were aware of the concerns and were taking steps to address them. There had been occasions when delays in preparing for weekly multi-disciplinary meetings had impacted on treatment decisions and discharge planning. We found a pressure relieving mattress was not set at the correct level and two other mattresses were displaying a fault. The issues with mattresses had not been identified by staff. Those mattresses registering a fault were addressed straight away by the deputy manager.

We found a breach in regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report. We have also issued a recommendation in Effective for the provider and registered manager to follow through with plans to improve monitoring and preparation for multi-disciplinary meetings.

Staff had completed safeguarding training and knew how to safeguard people from the risk of abuse. They knew the different types of abuse, how to recognise potential signs and symptoms and what to do if they had concerns.

People had assessments completed to identify any potential risks, for example with falls or nutritional needs. These provided guidance for staff in how to minimise risk without detracting from people’s choices and right to make their own decisions.

Medicines were ordered, stored and administered safely to ensure people received them in line with prescribing instructions.

People had access to community health and social care professionals when required. There was also a range of external professionals who visited people in both the stroke and enablement service to deliver therapy, medical treatment and nursing care. People could remain at Rossmore for end of life care if this was their choice.

People’s nutritional needs were met and their likes and dislikes recorded; menus provided alternatives to the main meals on offer. Drinks and snacks were served in between meals. There were positive comments from people about the meals.

There were meaningful activities for people to participate in and entertainment organised by the two activity coordinators.

People could make their own decisions about their care and staff were aware of the need to gain consent before carrying out care tasks. When people lacked capacity, decisions made in their best interest followed good practice guidelines. The provider worked within current legislation when people’s liberty was deprived for safety reasons.

Staff were recruited safely and employment checks were carried out before new members of staff started work in the service. There were sufficient staff employed, which included care and ancillary staff and a range of therapists to provide treatment to people who received a stroke service and enablement before going home. The organisation and deployment of staff within the stroke service had raised some negative comments from staff. Senior management were aware and were taking steps to address them.

There was a staff training and supervision programme to ensure members of staff had the correct skills required to meet people’s needs.

There were lots of improvements noted with the environment. It was safe, clean and tidy and a programme of refurbishment was underway. Staff had access to personal protective equipment such as aprons, hand gel and gloves, which helped to prevent the spread of infection. Staff had completed training in infection prevention and control.

Rossmore Nursing Home provides personal and nursing care for up to 56 people. The service is accommodated in a series of converted, large, terraced houses in a residential area of Hull, close to amenities and public transport; there is on-street parking available. The service has 17 placements for people who have had a stroke and who require therapy input to assist their rehabilitation. There is a separate building in the grounds of Rossmore Nursing Home specifically for stroke rehabilitation and an adjoining house to this has been purchased to extend the area. There are eight step-down placements for people who require an interim service following discharge from hospital until a package of care can be arranged for them in the community. The remaining 31 placements are for people who require on-going residential or nursing care. There is a large sitting room, a small seated area and a dining room on the ground floor. There is a mixture of single and shared occupancy bedrooms on the ground and first floors; the upper floors are accessed by a passenger lift, a stair lift and stairs. There are bathroom and shower facilities on both floors.

At the time of the inspection, there were 12 people using the stroke rehabilitation service, 15 people admitted for residential care and four people requiring nursing care. The hospital step-down beds had been closed to admissions since the last inspection.

The service is required to have 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. A new manager had been in post for the last few months and was undergoing registration with the Care Quality Commission; their interview was due to take place on the day of the inspection. We liaised with our registration team to rearrange the interview until a later date to ensure the manager could focus on the inspection. As the registration process has not been completed yet, the manager will be referred to throughout the report as ‘the manager’.

We found there had been improvements with the overall management of the service and also regarding governance from directors. We saw documentation which highlighted the directors had made visits to the service, spoke with staff and people who lived there, looked at records and checked on the progress of action plans. Staff confirmed management had improved and said they could raise concerns with directors if required. We found people had been informed of the changes underway and those planned for the future.

There had been a change in the structure of the therapy service, which at the last inspection was provided by staff from a local hospital trust. However, the therapy staff were now part of the provider’s organisation and measures were being put in place to begin team-building, improve communication and address the issues with disjointed working between care/nursing staff and therapy staff, which was found at the last inspection.

The quality assurance and monitoring system had improved. This consisted of audits, checks, meetings and surveys. The audits and checks had highlighted shortfalls and we saw action had been taken to address them or measures were planned. There was refurbishment and redecoration of communal areas and several bedrooms underway which when completed will improve the quality of the environment for people who live there and staff who work there.

The environment was much safer and cleaner. Since the last inspection, there had been a deep clean of all areas and equipment used in the service. All unused equipment had been disposed of and sluice rooms and store rooms were made inaccessible when not in use. People who used the service had all had their moving and handling needs assessed to ensure the availability of the correct equipment; this had resulted in new items being purchased. There were systems in place to check bedrooms and toilets to ensure these remained clean and ready for use.

Staff knew how to safeguard people from the risk of harm and abuse. There were safeguarding procedures to guide staff and most had completed training. The manager was aware of which members of staff still required training or updates and this had been planned. In discussions, staff were knowledgeable about the different types of abuse and they could describe the signs and symptoms that would alert them. They knew how report concerns and the manager was aware of their responsibilities in referring issues to the local authority safeguarding team. People had individual risk assessments completed which provided information to staff in how to minimise risk. Following a visit by the local authority commissioning team, Personal, Emergency, Evacuation Plans (PEEPs) had been completed. These provided guidance to staff and professionals should people need to be evacuated in emergency situations.

We found people’s health care needs were met. They had access to a range of community health care professionals when required. We saw there were safe systems in place to manage medicines and people received them as prescribed. However, there was some concern highlighted regarding the checking arrangements for ensuring medicines were correct on discharge. This was discussed with the manager to address. People who used the stroke service received therapy to assist their rehabilitation from physiotherapists, occupational therapists and speech and language therapists; there was daily medical cover for them and social work support when discharges were planned.

People’s nutritional needs were met and menus provided them with choices and alternatives. There were also special diets when required. Since the last inspection, there had been errors made regarding people being given food and drinks of the wrong consistency and systems had been put in place to monitor this. Staff had received supervision and signs were in bedrooms to remind them to check the consistency of fluid required before giving people drinks.

At the last inspection, we found there was an inconsistency in ensuring people’s capacity was assessed and that any decisions made on their behalf in their best interest, were recorded. Some progress had been made in these areas. However, there were still more assessments and decision-making records to complete for people’s specific restrictions or to ensure the requirement for a deprivation of liberty safeguard. The deputy manager was auditing care files to ensure this was completed quickly. Staff were clear about the need to obtain consent prior to carrying out care tasks.

People had assessments of their needs completed and care plans formulated to guide staff. The care plans were being updated following advice from dementia care mappers to ensure these reflected people’s individual needs and to guide staff in how to deliver care in line with their preferences. The provider had commissioned the dementia care mappers to visit the service and observe staff interactions with people living with dementia. Their observations and advice to staff had resulted in a more person-centred approach and an improvement in the quality of life for some people.

There was a range of activities provided to people. The activity coordinator had weekly plans and recorded when people participated in them. One person told us they would like to have more activities for younger people. This was mentioned to the manager to address.

Staff were recruited safely and in sufficient numbers to meet people’s needs. There were designated staff for the stroke service and the provider was in the process of recruiting a stroke specialist nurse.

Staff had access to training relevant to their roles. There was a training plan which identified the courses they had completed and when updates were due. Shortfalls in training had been identified and planned. Staff also had supervision meetings to discuss issues and there were formal observations of their practice.

The provider had a complaints procedure which was on display in the service. People told us they felt able to complain if required and staff knew how to manage complaints.

Rossmore Nursing Home is registered to provide personal and nursing care for up to 56 people. The service is accommodated in a series of converted, large, terraced houses in a residential area of Hull, close to amenities and public transport; there is on street parking available. The service has 17 placements for people who have had a stroke and who require therapy input to assist their rehabilitation; an adjoining house has been purchased next door to extend the stroke unit. The day therapy activity is currently provided by Humber NHS Foundation Trust in a separate building in the grounds of Rossmore Nursing Home. There are also eight step-down placements for people who require an interim service following discharge from hospital until a package of care can be arranged for them in the community. The remaining 31 placements are for people who require on-going residential and nursing care. There is a large sitting room, a small seated area and a dining room on the ground floor. There is a mixture of single and shared occupancy bedrooms on the ground and first floors; the upper floors are accessed by a passenger lift, a stair lift and stairs. There are bathroom and shower facilities on both floors.

The service had a registered manager in post as required by a condition of their registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Due to concerns found during the inspection, 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.

Following the inspection, we met with the registered provider and have received an interim action plan. We also requested and have received weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. 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. You can see what action we told the provider to take at the back of the full version of the report.

We found concerns with how the service was governed. The support system for the registered manager had shortfalls which meant they were managing the four distinct areas of the service as one, without effective clinical guidance and support. The registered provider told us directors, and a senior nurse employed within the company, were available to support the registered manager. The CQC had not always received notifications of incidents which affected the welfare of people who used the service. Communication and documentation was poor in some areas which meant the registered manager had not been informed of important incidents to enable them to take action. There were discrepancies and inaccuracies regarding the records of some people who used the service which made it difficult to check if the correct care and treatment had been delivered. There were different systems of recording in the service which added to the confusion. For example, therapists in the stroke unit recorded their care plans and treatment records on a computerised system but the nursing and care staff did not have access yet so were unable to see the information.

The quality monitoring system was very new and had not been fully developed; the registered provider had concentrated on external structural work, had completed a full infection control audit and a full medicines audit. However, there was a range of internal issues that had not been addressed effectively. These included cleanliness, documentation, medicines management, nurse staffing arrangements, inconsistent application of mental capacity legislation, safeguarding reporting, safe care and treatment, risk management, assessments and care planning. We found accidents had been logged, which highlighted specific issues but lacked analysis to ensure lessons were learned to prevent reoccurrence.

We found the arrangements for nurse cover during the day and night had led to shortfalls on occasions and an over-reliance on agency nurses on others. This meant there had been an inconsistency of care and treatment, poor communication in sections of the service and people’s care needs being overlooked.

Some people had not received their medicines as prescribed due to stock control issues and errors in administration. There were occasions when people’s health care needs were not met in a timely way and there were concerns about how the staff team worked with other health professionals when people’s care and treatment was shared between them.

There was a lack of robust risk assessment and management; staff had not always followed policies and procedures, guidance from health professionals and outcomes from risk assessments. Areas of the environment were cluttered with equipment and rooms such as sluices were constantly accessible to people which made them unsafe. These issues had placed people who used the service at risk of harm and injury.

Not all staff had received safeguarding training and there had been occasions when incidents had not been reported properly to the local safeguarding team so they could review how they were being managed.

Not everyone who used the service had a care plan and there were significant gaps in care planning for other people. Also care plans were not always updated when people’s needs changed. This meant staff did not have up to date information about people’s individual needs and important person-centred care could be missed.

We found there was an inconsistent application of mental capacity legislation. Some people had assessments to determine their capacity to consent to specific restrictions such as bed rails but others did not. Documentation that showed best interest decision-making had not been completed appropriately. There was also one person whom we felt should have been assessed to see if they met the criteria for a deprivation of liberty safeguard; they were agitated, confused and wanting to leave the service.

There were concerns with the management of infection prevention and control as some areas of the service and equipment required cleaning. Refurbishment was underway; at present this was the exterior of the building but there were also plans to upgrade the interior in the near future.

Staff had access to training and those spoken with confirmed this had improved since the new registered provider took over. There were gaps in training but these had been identified and plans put in place to address them. We made a recommendation that the registered provider follows through with the training plan and we will assess this at the next inspection. New staff supervision support meetings had just started and the registered manager had plans to ensure senior staff were suitably trained to enable them to carry out formal supervision. Staff told us they felt supported by the registered manager.

People told us the staff approach was kind and caring and they felt able to raise issues with them. We observed positive interactions between staff and people who used the service although improvements could be made in some areas to ensure privacy and dignity was enhanced.

We found people’s nutritional needs were met. There was a varied menu which provided people with choices and alternatives. People told us they liked the meals provided to them.

There was a range of activities and therapies for people to participate in; some people were supported to attend a local social club and enjoyed outings when possible.

Staff were recruited safely and employment checks were carried out before new people started work in the service.

There was a policy and procedure to guide staff in how to manage complaints and a record was held of investigations and outcomes. The new registered provider’s complain