This inspection took place on 25 September, 4 and 9 October 2018. The inspection was unannounced. At our last inspection in June 2018 we rated each key question of safe, effective, caring, responsive and well led as requires improvement. We found breaches of regulations 11, 12 and 17. These breaches concerned issues of consent, safe care and treatment and good governance. We asked the provider to send us an action plan. They told us they would have completed all the required actions by 16 August 2018. We also met with the provider to discuss with them how they intended to improve each key question to a rating of at least ‘good’.
Following receipt of concerning information we undertook an unannounced focused inspection on 25 September 2018 and 4 October 2018 to look at the key questions of safe and well-led. This inspection was also done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in June 2018 inspection had been made. Due to the concerns identified during our focussed inspection we returned to the service on 9 October 2018 to complete a comprehensive inspection and look at the additional key questions of effective, caring and responsive. We found continued breaches of regulations 11, 12 and 17 and further regulatory breaches of regulations 13, 14 and 19.
Rowlandson House 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 home provided accommodation across three floors for up to 27 people who require assistance with their personal care. The home does not provide nursing care. The registered manager told us 21 people were using the service at the time of our inspection. Most people using the service were living with dementia.
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 a registered manager in post. Due to staff shortages the registered manager had supported people as a member of the staff team. This took her away from her management duties.
People were at risk of the maladministration of medicines as there were no stock checks carried out in the service. This resulted in inspectors finding people’s medicines missing. Clear guidance to support staff in their application of topical medicines was not in place.
Records required updating and contradictions in people’s records needed to be addressed to give staff clear information about people’s care needs.
The service had failed to follow the requirements of the Mental Capacity Act 2005 and the Mental Capacity Act Code of Practice. This put people at risk of not being involved in decisions which affected them.
Fire evacuation procedures and equipment needed to be reviewed to enable staff to support people to evacuate people at their nearest exit.
The risks of cross infection were not reduced. The laundry was in a dirty state. Arrangements were put in place during our inspection to secure radiator covers to the wall to reduce the risk to people of accidental burning.
The small lift and the number of hoists available to staff made the movement and handling of people challenging. The operations manager told us they were planning to invest in the home.
Personal emergency evacuation plans were in place. However, we found the plans required support from more staff than was on duty to support people to evacuate. The registered manager showed us their dependency tool and they were providing more hours than required. We made a recommendation about this.
Improvements were required to ensure staff were meeting people’s nutrition and hydration needs. Electronic fluid charts failed to provide accurate information about people’s intake. Advice from dieticians had been sought and incorporated into people’s care plans. People did not have the support they needed to eat in a safe manner.
Staff had received training and were supported using supervision meetings with their line manager. They presented as kind and caring during our inspection. They protected people’s privacy by knocking on doors. They knew people’s likes and dislikes and provided explanations to people about meal times.
The provider had a complaints policy in place. The operations manager showed us a complaint they had responded to via email. Complaints had not been documented in line with the policy. We made a recommendation about this.
People were not supported with stimulating activities to keep them active. Only those people who were able to occupy themselves with, for example, knitting had things to do.
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.
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.