Archived: Rose Martha Court

Rose Martha Court is a residential care home providing personal and nursing care for up to 76 people aged 65 and over in one adapted building. At the time of the inspection the service was supporting 36 people.

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

The leadership, management and governance arrangements provided some assurances to suggest the service was being managed well. Quality assurance and governance arrangements at the service were much better since our last inspection of the service in February 2020. However, improvements were still required to ensure risks to people were recorded and mitigated, records relating to their care and support were accurate and infection, prevention and control measures were safe and in line with current national guidelines.

Since our last inspection in February 2020, people were protected by the service's safeguarding arrangements. The deployment of staff was suitable to meet people's care and support needs. Proper arrangements were now in place to ensure people received their medication as they should. Staff were recruited safely to support people to stay safe.

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 received and induction and training to carry out their roles. People were supported to access healthcare services and receive ongoing healthcare.

Care plans covered most people’s care and support needs, including the needs of people who were at the end of their life. People were supported to take part in social activities. Effective arrangements were in place to manage people’s concerns or complaints.

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 Inadequate [published 10 June 2020].

At this inspection we found improvements had been made and the provider was no longer in breach of Regulations 9 [Person-centred care], 12 [Safe care and treatment], 14 [Meeting nutritional and hydration needs] 17 [Good governance] and 18 [Staffing].

This service has been in Special Measures since June 2020. 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions 'Safe', ‘Effective’, ‘Responsive’ and 'Well- Led' which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rose Martha Court 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Rose Martha Court Care Home is a residential care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service can support up to 76 people.

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

The delivery of care for people was not always safe. Information relating to people’s individual risks was not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The staffing levels and the deployment of staff was not suitable to meet people’s care and support needs. Lessons were not learned, and improvements made when things went wrong. People were protected by the prevention and control of infection, but people were not routinely given the opportunity to wash their hands or for antibacterial wipes to be used prior to and after mealtimes. Staff had a good understanding of what to do to make sure people were protected from harm or abuse. Recruitment checks were satisfactory.

Staffs’ training was not embedded in their everyday practice. Though staff had completed an orientation induction, not all staff had received an induction when promoted to a different role. Not all staff felt supported or valued by the management team. People at risk of poor nutrition and hydration were not properly and accurately assessed and people did not always have their nutritional and hydration needs met. The premises did not meet people’s needs, particularly for people living with dementia. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed.

People and their relatives told us they were treated with care and kindness. However, care provided was not always caring or person-centred. This was attributed to inadequate staffing levels and poor deployment of staff, high agency staff usage and the impact this placed on the quality of care people received. Many interactions by staff remained task and routine led. People were not always treated with dignity and respect.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people’s needs and preferences. Where information was recorded this was not always accurate or up-to-date. Palliative and end of life care plans were in place but provided limited information to guide staff on how to provide care to a person who required palliative care and at the end stages of their life. People were not supported or enabled to take part in regular social activities that met their needs.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using 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 Good. [Published 21 August 2018].

Why we inspected

The inspection was prompted in part due to concerns received about a person receiving poor care and treatment. A decision was made for us to inspect and examine those risks. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident. The information we received about the incident indicated concerns about safeguarding and protecting people, effective care and support, nutrition and hydration, dignity and respect, personalised care and end of life care.

We have found evidence that the provider needs to make significant improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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.

Rose Martha Court 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. The care home accommodates up to 76 older people and people living with dementia in one adapted building.

Rose Martha Court is a large purpose built building situated in a residential area in Leigh on Sea and close to all amenities. The premises is set out on two floors and is unitised [Lavender, Sweet Pea, Forget Me Not and Primrose], with each person using the service having their own individual bedroom and adequate communal facilities available for people to make use of within the service.

At the last inspection on the 10 and 11 August 2017, the service was rated ‘Requires Improvement’. Four breaches of regulatory requirements were identified pertaining to Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. 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 of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-Led’ to at least good. At this inspection, we found the service had improved their rating to ‘Good’.

A registered manager was 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.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs to ensure theirs’ and others’ safety. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines. This meant people received their prescribed medicines as they should and in a safe way.

Staff received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction based on their level of experience in a care setting and competencies. Staff felt supported and received appropriate formal supervision at regular intervals and an appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect, dignity and to maintain their independence.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Care plans accurately reflected people’s care and support needs and people received support to have their social care needs met. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions. People had their nutritional and hydration needs met. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

Quality assurance arrangements were in place and completed at regular intervals in line with the registered provider’s schedule of completion. The registered provider and the registered manager were able to demonstrate an understanding and awareness of the importance of having good effective quality assurance processes in place. Feedback from people using the service, those acting on their behalf and staff were positive about the care and support provided.

Rose Martha Court provides accommodation and personal care for up to 76 older people and people living with dementia.

This inspection was completed on 10 and 11 August 2017 and there were 60 people living at the service.

A registered manager was 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.

Whilst improvements were noted since our last inspection in relation to some aspects of care provision, care planning arrangements, people’s nutritional and hydration needs and complaints management; quality assurance checks and audits carried out at service level were not as robust or effective as they should be. The registered manager had not recognised the issues we identified during our inspection including where people were put at risk of harm or where their health and wellbeing was compromised. The registered manager was unable in some instances to demonstrate how they identified where improvements to the service were needed and lessons learned.

Suitable measures were not always in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Significant improvements were required in relation to medicines management so as to ensure the supply, administration and recording of medication was appropriate. Robust procedures and processes that make sure people are protected from abuse and improper treatment had not at all times been considered and followed by the registered manager of Rose Martha Court.

Where staff’s care practices and performance required improvement, suitable arrangements were not always in place to ensure staff received refresher updated training. Improvements were needed to ensure where appropriate newly employed staff completed the ‘Care Certificate’ or an equivalent robust induction, particularly where newly employed staff had limited experience within a care setting or had not attained a National Vocational Qualification. Suitable arrangements were not in place to ensure staff received regular supervision and an appraisal of their overall performance.

Although people’s comments about staffing levels were variable, our observations showed that the deployment of staff was suitable to meet people’s needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected.

The dining experience for people was generally positive and people were complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions. People told us that their healthcare needs were well managed; however improvements were required to ensure staff followed advice provided by healthcare professionals.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon. People using the service and those acting on their behalf told us that staff were kind, caring and the care provided was appropriate.

You can see what actions we told the provider to take at the back of the full version of the report.

The inspection was completed on 30 June 2016, 1 July 2016 and 4 July 2016 and was unannounced. There were 62 people living at the service when we inspected.

A registered manager was 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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk, pressure mattresses were not correctly set in relation to people’s weight and bedrail assessments had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits.

Although people did not think that there were sufficient numbers of staff available to meet their needs or their relative’s needs, our observations showed that staffing levels were suitable at the time of this inspection. However, staff did not always have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated. People’s comments about the care and support they received were variable. Whilst some staff’s interactions with people were positive and staff had a good rapport with the people they supported, this was in contrast to other observations. These showed that some staffs practice when supporting people living with dementia required further improvement and development.

The implementation of staff training was not as effective as it should be so as to ensure that staff knew how to apply their training and provide safe and effective care to the people they supported. Although staff had received appropriate training relating to manual handling and dementia awareness, staff did not recognise the importance of safe manual handling procedures and the significance of good person centred care for people living with dementia.

The dining experience was not always positive and person focussed. Consideration by staff was not always well-thought-out to ensure that eating and drinking was an important part of people’s daily life or treated as a social occasion. Where instructions recorded that people should be weighed at regular intervals, this had not always been followed. Records of the meals provided and fluids taken had not always been maintained in sufficient detail to establish if people’s dietary needs were being monitored, managed or encouraged where this was required.

Not all of a person’s care and support needs has been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. The needs of people approaching the end of their life and associated records relating to their end of life care needs were either not recorded or contained minimal information. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

The arrangements for the effective management of medicines required improvement. Although these were generally in good order as they provided an account of medicines used and demonstrated that people were given their medicines as prescribed. Although there was a complaints system in place, not all complaints evidenced fully how conclusions had been reached and actions followed up.

Suitable arrangements were in place to ensure that the right staff were employed at the service. Although staff received regular supervision, not all staff felt supported by the registered manager or other members of the management team. Improvements were required to ensure that where subjects and topics were raised by staff, this was followed up and there was a clear audit trail to demonstrate actions taken.

Assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected however these required improvement as some of the information was contradictory. People’s preferences and choices for their end of life care were not robust or as detailed as they should be.

Staff were able to demonstrate an understanding and awareness of the different types of abuse and how to respond appropriately where abuse was suspected.

Where appropriate people were enabled and supported to be independent. People were also treated with dignity and respect.

You can see what actions we told the provider to take at the back of the full version of the report.

At the time of our inspection there were 60 people using the service. As part of this inspection we spoke with ten people using the service, three visiting relatives, six staff and the registered manager. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included six support plans, daily support records, four staff files and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had detailed policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

The staff team were skilled and experienced. Staff we spoke with said they had been properly recruited and trained for their roles. Staff told us that they received good support from the management team.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People's care records showed that care and treatment was planned in a way that was intended to ensure people's safety and welfare. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by cheerful and attentive staff. We saw that care workers showed patience and understanding when supporting people. A person who used the service we spoke with told us, 'The staff are all very good, I'm happy here.' Another person told us, 'I like it here, everything is done for me by the staff who are all nice and always smiling.'

A relative we spoke with told us, 'The staff are very approachable and listen to our views, they are also caring and always busy making sure our relative's needs are being met.'

The responses and views of people who used the service and their relatives were asked for as part of regular quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people's wishes.

Is the service responsive?

Where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the healthcare support they needed. This included seeking support and guidance from care professionals, including doctors and community nurses.

People had the opportunity to enjoy a range of activities and were able to get out and about in the local and wider community.

A person who used the service we spoke with told us, 'There are nearly always staff around, they check if I'm ok and need anything, if I tell them if I'm worried about something they try to help me.'

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times.

A relative we spoke with told us, 'I'm satisfied with the care my relative receives in this home, the staff are good at understanding my relative's needs and the managers and staff are good at keeping me updated about my relative's health.'

People's health and personal care needs were assessed and there were care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. People told us that they liked living at Rose Martha Court and that they found the staff to be kind and caring. Our observations suggested that people living at the service were happy, that they felt safe and were well cared for. It was evident that the people who used the service had a good relationship and rapport with the staff who supported them.

Improvements were required in relation to ensuring that peoples' care records contained all of the information necessary for care staff to follow and that this was easily accessible. We also found that improvements were required to ensure that the home environment was safe for people living at Rose Martha Court.

Throughout our inspection the atmosphere at Rose Martha Court was observed to be calm and relaxed. Staff interactions with people who used the service were noted to be positive and it was evident that staff had a good knowledge and understanding of people's care and support needs.

Each person was noted to have a care plan in place detailing their care needs and how they were to be supported by staff. Records also showed that people who used the service were supported with their healthcare needs. Robust systems were in place to ensure that staff were recruited properly and that they received a comprehensive induction.

Whilst we acknowledge that there were a lot of positives as detailed above, improvements were required in relation to consent to care and treatment, ensuring that people who used the service had an accurate record maintained about their care and support needs; and training, supervision and appraisals for staff.