Red Rose Care Community

Red Rose Care Community is a nursing home providing personal and nursing care to up to 65 people. The service provides support to people with dementia and nursing care. At the time of our inspection there were 52 people using the service.

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

Enough staff were available to respond to people’s needs in a timely manner.

Medicines were administered in a safe way, however, monitoring and delivery of medicines in some areas of the home required review. We were not fully assured staff were following current government guidelines for wearing face masks. Systems were in place to manage risk for people. Accident and incidents were investigated, and measures were in place to prevent recurrence. People were cared for by staff that protected them from avoidable harm.

All staff completed an induction, received relevant training and supervision support for their roles. People’s needs were assessed, and people were involved in their care planning. People’s choices and preferences were adhered to. People were supported to have sufficient to eat and drink and they had a calm and enjoyable dining experience. The service worked well with agencies and other professionals to help provide effective care. The provider adapted the service to meet people’s changing needs. The provider was working in line with the principles of the mental capacity act.

People were supported, respected and well cared for. People were involved in making decisions about their life choices. The provider promoted equality and diversity, which was also reflected in people’s care plans.

The service had systems in place to monitor and share continuous learning. Where necessary relevant changes were made. However, the auditing tool used to identify shortfalls did not always identify issues and concerns we identified during the inspection. Management showed positive and motivated leadership and were clear about their role and responsibilities. We received positive feedback about the management of the service from people, families and staff. There was a positive culture throughout the service. Management were open and honest, encouraged people and families to be involved and worked well with healthcare professionals

We have made a recommendation about the providers auditing tool.

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 the service was Requires Improvement, published on. 19 November 2020.

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

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, Caring and Well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Red Rose Care Community on our website at www.cqc.org.uk.

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.

Red Rose Care Community is a care home that provides nursing and personal care for up to 65 people. The home is split into three areas, Serenity which support people with health and nursing needs, Memory which supports people who are living with dementia, and, Castle which support people who have needs associated with growing older. At the time of the inspection 54 people lived at the home. Due to concerns identified at our June 2019 inspection, we took action to restrict admissions to the home. We have now removed this restriction.

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

At the last inspection the provider failed to ensure staff had the skills and knowledge to support people safely. At this inspection we found not enough improvements have been made. Not all new staff had received formal induction in to the service and completed their mandatory training.

We received a mixed feedback about staffing levels from relatives. However, during the inspection we observed enough staff were on duty to respond to people's needs in a timely manner. Staff rotas which showed there were enough staff employed to provide safe care to people.

At the last inspection the provider failed to have effective systems in place to monitor the quality of the service. At this inspection we found improvements had been made. The registered manager and provider undertook a range of audits and checks to ensure quality of care offered to people. The registered manager used information from accidents and incidents to learn lessons and to reduce the risk of them happening again.

We found the service to be warm and welcoming. We received positive feedback from relatives about the quality of care their family members had received. Staff had supported people to remain in contact with their relatives during the COVID-19 pandemic and activities had been arranged within the care home to reduce the risk of isolation, including celebrating cultural events. One relative told us “I certainly would recommend this home. Can talk to any of the staff about anything”.

Infection control measures were in place to prevent cross infection. The service held good stocks of Personal Protective Equipment (PPE) and staff had been trained on how to use it correctly. Regular testing for people and staff had been implemented in accordance with Public Health England guidance. At the time of this inspection all people and staff had tested negative for COVID-19 infection.

People's care and support needs were assessed and reflected people's current needs. Medicines were managed safely and there were close links with health and social care professionals to ensure people's health needs were met and changes responded to quickly.

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 and update

The last rating for this service was requires improvement (published 27 July 2020). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been made however the provider was still in breach of regulation.

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 covers our findings in relation to the key questions Safe, Responsive and Well-led only.

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 were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. 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 Red Rose Care Community on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to staff induction and training at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were placed at risk of harm as risks associated with their care and support were not always managed safely. Opportunities to learn from incidents had been missed which meant people may have been exposed to the risk of harm. Although people told us they felt safe, action had not always been taken to protect people from improper treatment and abuse. The home was clean and hygienic; however, infection control procedures were not followed by all staff. Overall there were enough staff and safe recruitment practices were followed.

Staff required more effective training and support to enable them to provide high quality care. Although people were supported to have maximum choice and control of their lives, staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Mealtimes were positive experiences; however, more work was needed to ensure risks were managed safely. People had access to a range of health care professionals. The home was adapted to meet people’s needs.

People’s right to privacy and to be treated with dignity were not always upheld. People told us staff were kind and caring. However, staff did not all read care plans which placed people at risk of inconsistent support. There was an inconsistent approach to involving people in decisions about their care and support. People were supported to be as independent as possible.

People did not always receive personalised care that met their needs. People were not consistently provided with opportunity for meaningful activity. People were supported to raise issues and concerns and there were systems in place to respond to complaints. People and their families were given an opportunity to discuss their wishes for the end of their lives and they were provided with compassionate care in their last days of life.

Systems to ensure the safety and quality of the service were not fully effective. This failure to identify and address issues had a negative impact on the quality of the service provided. The management team were responsive to feedback and took action to address issues identified. Feedback from people, families and staff was used to drive improvement. There was positive partnership working with health professionals.

The service met the characteristics of Requires Improvement in all areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Inadequate (report published on 8 January 2019). At the last inspection in August 2018, we asked the provider to take action to make improvements in relation to promoting dignity and respect, providing person centred care, risk management, staffing and governance and leadership. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since our inspection in August 2018. During this inspection the provider demonstrated that some improvements had 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: This was a planned inspection based on the rating at the last inspection.

Enforcement: We have identified breaches in relation to person centred care, safeguarding, safe care and treatment, staffing and leadership at this inspection. 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.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

After our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report . In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk.

We inspected the home on 28 August and 3 September 2018. The first day of our inspection was unannounced. On the first day of our inspection there were 37 people living in the home. This was because in January 2018 the then registered provider placed a voluntary embargo on new admissions to the home. Additionally, following our inspection of May 2018 the local authority also placed an embargo on new admissions. The home is divided into three separate units (two on the ground floor and one on the first floor). However, at the time of our inspection the registered provider had closed the first floor unit to reflect the reduced occupancy level in the home and to facilitate the refurbishment of the unit.

We last inspected the home in May 2018 when we rated it as Inadequate and placed it into ‘special measures’. In June 2018 we re-registered the home to reflect a change in ownership. This was our first inspection of the re-registered home. We were disappointed to find that the new owners had made no significant improvement in service quality. As a result, the overall rating of the re-registered home is also Inadequate and the home 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.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of shortfalls in organisational governance; a failure to properly assess and mitigate risks to people's safety; a failure to ensure sufficient staffing to meet people’s needs and to keep them safe; a failure to protect people’s rights under the Mental Capacity Act 2005; a failure to ensure staff had the skills and knowledge to support people safely and effectively; a failure to promote people’s privacy and dignity and a failure to support people in a consistently person-centred way and to meet their needs for mental and physical stimulation. We also found the registered provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 due to a failure to notify us of allegations of abuse of service users.

In other areas, the registered provider was also failing to provide people with the effective, caring and responsive service they were entitled to expect. Some care provision was task-centred and lacking in warmth. People’s hydration requirements were not always met effectively. Staff did not always contact external healthcare providers in a timely way and the provider’s response to people’s concerns and complaints was inconsistent. Further work was required to establish a healthy organisational culture and more effective lines of management control.

We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see what action we told the registered provider to take at the back of the full version of this report.

In some areas the registered provider was meeting people’s needs.

Staff received regular supervision and told us they worked well together in a mutually supportive way. People were satisfied with the food they received and staff encouraged people to maintain their independence. Staff were aware of adult safeguarding procedures and there was some evidence of organisational learning from significant incidents. Staff recruitment was safe. Senior staff had recently taken action to give people and their relatives more opportunities to provide feedback about service provision.

There was no registered manager in post at the time of our inspection. However, the provider had appointed a new manager who was due to commence her role shortly after our inspection. In the meantime, the management of the home was being undertaken jointly by the provider’s chief operating officer and quality director. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.