Archived: Rosier Home

Following concerns raised by the local authority, we carried out a comprehensive inspection in October 2017 and found continued breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service was rated ‘Inadequate’ and placed into special measures. We took immediate enforcement action to restrict admissions to the service and sent an urgent action letter regarding the seriousness of our concerns. The provider submitted an action plan to address our concerns and to ensure compliance with the regulations. We met with the provider and placed conditions on the provider’s registration to encourage improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosier Home on our website at www.cqc.org.uk

We undertook this comprehensive inspection on 25, 30 and 31 July and 1 August 2018 to check that the registered provider had made the required improvements and to confirm they now met legal requirements.

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.

Rosier Home 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. The care home accommodates up to 16 older people who may have dementia.

Rosier Home is situated in a quiet residential area and is close to the seafront and amenities. The premises is on two floors with each person having their own individual bedroom and communal areas are available within the service. At the time of our inspection, nine people were using the service.

There was a registered manager in post. The registered manager was also the provider. 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.

Since our last inspection of the service, some improvements had been made, however, we found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). Further improvements were still required to ensure the quality assurance arrangements were robust and effective to drive and sustain improvements; and to achieve compliance with regulatory requirements.

The managerial oversight in the service had improved and the registered manager was more pro-active. However, the auditing and monitoring systems had not been effective in identifying the concerns found during this inspection and these needed to be improved, embedded and sustained.

Staffing levels had been reviewed and there were sufficient numbers of staff on duty to support people and meet their needs and people were provided with adequate supervision, stimulation and meaningful activity.

Safe processes were in place for the administration of medicines and there were procedures and processes in place to ensure the safety of the people who used the service. However, improvements were required around cleanliness and ensuring that equipment was fit for purpose.

There were systems in place to safeguard people from abuse and the recruitment of staff was safely completed to make sure that they were suitable to work in the service. Staff were aware of their responsibilities and knew how to report any concerns, although they had not received any recent training.

Training for staff was still not managed effectively. The training that staff had received was not always recorded and some training updates were required. Staff did not demonstrate an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.)

People were supported to have maximum choice and control of their lives and staff did supported them in the least restrictive way possible, although the recording of best interest decisions required improvement.

People were supported effectively with their nutritional needs and received personalised care from a staff team who respected their privacy and dignity and promoted their independence.

There were 15 people living in the service when we inspected on the 26 October and 1 November 2017. This inspection was prompted in part due to information received from the local authority. This was an unannounced inspection.

There was a registered manager in post. The registered manager was also the provider. 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.

At our comprehensive inspection of 13 November 2015, we found that improvements were required around Deprivation of Liberty Safeguard (DoLS) applications and the environment and the service was rated as ‘Requires improvement.’

At our comprehensive inspection of 03 and 12 May 2017, we found that improvements had been made around DoLs applications, however the environment still required development to ensure it was dementia friendly for the people who lived there. Additional improvements were required as environmental risks had not always been identified and managed and improvements were required around cleanliness. We also identified that improvements were needed to ensure that risks to people's health, safety and welfare were effectively assessed and that care plans provided clear guidance to staff of the support that people required. Improvements were required regarding the storage and administration of medicines to ensure that the process was safe. We found that policies and systems in relation to the Mental Capacity Act 2005 (MCA) were not up to date and capacity assessments had been completed incorrectly. There had been a lack of oversight of the service by the registered manager to ensure the service delivered was safe and effective and that it was up to date with best practice. The service was again rated ‘Requires improvement.’

At this inspection, we found that improvements had not been made and we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. The service 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.

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 this inspection, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. An action plan was returned to us the following day. You can see what other action we told the provider to take at the back of the full version of the report.

There were 15 people living in the service when we inspected on the 3 and 12 May 2017. This was an unannounced inspection.

There was a registered manager in post. The registered manager was also the provider. 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.

At our comprehensive inspection of 13 November 2015, we found that improvements were required as Deprivation of Liberty Safeguard (DoLS) applications had not been made to the local authority where needed. We also identified that areas of the premises could be developed to make the environment more dementia friendly for the people who lived there. At this inspection, we found that while some improvements had been made, further improvements were still required and we identified 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.

There were some procedures and processes in place to ensure the safety of the people who used the service. However, not all environmental risks had been identified and managed and improvements were required around cleanliness.

Improvements were needed to ensure that all risks to people's health, safety and welfare were effectively assessed and that care plans provided clear guidance of the support that people required.

Improvements were required regarding the storage and administration of medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Policies and systems in relation to the Mental Capacity Act 2005 (MCA) were not up to date and capacity assessments had been completed incorrectly.

There had been a lack of oversight of the service by the registered manager to ensure the service delivered was safe and effective and that they kept up to date with best practice.

People told us that they had good relationships with the staff that supported them and people were encouraged to be as independent as possible by a staff team who knew them well.

People were complimentary about the food and had sufficient amounts to eat. Their dietary and nutritional needs were met.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Rosier Home provides accommodation and personal care for up to 16 older people and people who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were 16 people using the service.

The service was managed on a day-to-day basis by the provider, who is also the registered manager, with the support of senior staff. As a registered person, the provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had not followed the MCA code of practice in relation to DoLS.

The provider had some systems in place to check the quality of the service. Informal systems to seek the views and concerns of people and their relatives required further development. Notifications about important events were not submitted with sufficient detail.

People were safe because the management team and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health and social needs were managed effectively with input from relevant health care professionals and people had sufficient food and drink that met their individual needs.

People were treated with kindness and respect by staff who knew them well.

Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

We saw that people received care in ways that met their individual needs. There were processes in place to ensure that care was delivered safely. Relatives told us they were happy with the standard of care; one relative told us the care was: 'Excellent. The staff go the extra mile.'

It was evident that staff knew people well and we saw that there were caring conversations between members of staff and people living in the home. We saw that staff listened to people and treated them with respect when people were anxious staff understood what to do to help them relax.

Staff received support and training to make sure they had the skills and knowledge required to care for people safely. Relatives told us they were happy their relative was cared for safely at Rosier Home.

The service provided a choice of menus and adequate drinks throughout a 24 hour period. People spoken with during our inspection told us that they enjoyed the food and that they ate and drank well. Multidisciplinary team members were involved with all people who used the service, ensuring that all clinical, professional and emotional needs of the people were appropriately managed.

The staffing levels at the service were based on the needs of the service and the people who were cared for. It was seen during our inspection that there were enough suitably qualified and experienced staff available to meet all the people's needs. There was an effective complaints process in place to manage all concerns and complaints.