Rochester Care Home

Rochester Care Home is a residential care home providing personal care and support for up to 56 older people. The Napier Unit provides respite care for up to eight people with complex physical and learning disabilities. At the time of the inspection there were 53 people living in Rochester Care Home and six people on respite stays in Napier Unit. Rochester Care Home is divided into four separate wings, Bishop Obo, Bishop Gundulf, King John and King Henry.

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

People, relatives and staff told us the service was exceptionally well-led. The registered manager led by example and promoted an open, inclusive culture where people, their relatives and staff were all valued for their individuality. Since the last inspection they had built, developed and sustained a caring and committed staff team. The registered manager and staff were dedicated to making sure people were empowered to remain independent for as long as possible. Visions and values were promoted and shared throughout the staff team who worked cohesively to provide high-quality care and support. There was a strong emphasis on continuous improvement and views of people and their relatives were highly valued.

People felt safe. They were supported by staff who understood how to keep people safe, how to report concerns and how to reduce risk. People were protected from discrimination and their life-choices were respected. There were enough staff in each area of the service and people told us staff spent quality time chatting with them. The staff had been recruited safely. People had their medicines when they needed them, and medicines were managed safely.

People’s physical, mental health, emotional and social needs were regularly assessed and reviewed. Care plans were kept up to date with people’s changing needs and preferences. People told us they were involved in planning their care and support. People were supported by a staff team who were skilled and knowledgeable. Staff were supported to complete regular training and additional qualifications to keep up to date with best practice. Staff felt valued and supported by the registered manager and the provider.

People were offered choices of home-made meals and plenty to drink to make sure they ate a balanced, healthy diet and stayed hydrated. People really enjoyed their meals which were social occasions. People were involved in setting tables and washing up when they wanted to be.

People had access to health care professionals when needed. Staff worked closely with GPs, community nurses and the local dementia team to ensure people stayed as healthy as possible. 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.

People were treated with kindness and compassion. People said, “This is the place I always wanted to come to and I am very happy here” and, “This is a very good home. Staff get on well together and help each other out. They are always laughing and joking with us”. People’s privacy and dignity were respected and promoted.

People and their relatives did not have any complaints. They knew how to raise a complaint if needed. They had confidence the registered manager would resolve any concerns quickly if necessary. The registered manager actively sought feedback from people, relatives, health care professionals and staff to monitor the quality of 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 (report published 28 February 2017).

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.

Rochester Care Home is divided into two distinct service provisions. One area provides care and support for up to 56 older people who require accommodation and personal care. This area for older people was further sub divided into four separate wings namely, Bishop Obo, Bishop Gundulf, King John and King Henry. The other area of the service called The Napier Unit provides respite care for up to eight people with physical and learning disabilities combined with additional complex needs. People who use Napier Unit service are aged 16+. The service is provided during evenings, weekends and bank holidays. The bedrooms in the Napier Unit are equipped with modern aids and adaptations. Rochester Care Home is a large service with ample communal space and gardens. At the time of our inspection, 53 people lived in Rochester Care Home for older people.

There was a registered manager for Rochester Care Home. 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 the previous inspection on 8 and 10 June 2016, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in relation to the provider failing to adequately implement healthcare professional’s guidance in response to peoples’ changing needs. The provider sent us an action plan telling us what steps they would be taking to remedy the breach in Regulations we had identified.

We also made three recommendations to assist the provider to make improvements to the service provided. These recommendations were in relation to the provider seeking further guidance on how to put together a risk assessment that would meets people’s needs; the provider to seek further guidance on the deployment of staff in order to adequately meet people’s needs, and the provider to seek guidance from a reputable source about Dementia Care practice in care homes.

At this inspection we found improvements had been made.

People’s care plans contained information about their personal preferences and focussed on individual needs. Care plans had been reviewed and updated. Risk assessments were in place to identify and reduce risks that may be involved when meeting people’s needs such as physical disabilities, and behaviours that challenge.

People were provided with a nutritious and a variety of food and drinks. The cook prepared meals to meet people's specialist dietary needs. We found staff recorded what people had to eat and drink in the daily records.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the service complied with these requirements.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Staff supported people with health care appointments and visits from health care professionals. The staff recorded the outcome of these visits. Care plans were being amended to show any changes and staff spoken with knew what care and support people were having.

Safe medicines management processes were in place and people received their medicines as prescribed.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully. The records of activities that people took part in did not always reflect all activities the person had participated in. We made a recommendation about this.

There were sufficient staff with a mix of skills on duty to support people with their needs. Staff were recruited using procedures designed to protect people from unsuitable staff. Staff had the knowledge and skills to meet people's needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People's feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider's complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. Where there were shortfalls, the registered manager had immediately put plans in place to rectify these. The registered manager understood the requirements of their registration with the Commission.

Rochester Care Home is divided into two distinct service provisions. One area provides care and support for up to 56 older people who require accommodation and personal care. This area for older people was further sub divided into four separate wings namely, Bishop Olbo, Bishop Gundulf, King John and King Henry. The other area of the service provides respite care for up to eight people with physical and learning disabilities combined with additional complex needs. People who use Napier Unit service are aged 16+. The service is provided during evenings, weekends and bank holidays. The bedrooms in the Napier Unit are equipped with modern aids and adaptations. Rochester Care Home is a large service with ample communal space and gardens. At the time of our inspection, 51 people lived in Rochester Care Home for older people.

There was a registered manager for Rochester Care Home. 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. Napier Unit also had a manager who is currently undergoing registration with the commission.

People’s care plans contained information about their personal preferences and focussed on individual needs. However, based on our observation and records we looked at, people’s care plans had not been updated with up to date information about their changing needs and staff were not always available to diffuse situations that may occur early.

There were allocated numbers of staff to meet people’s needs in both the residential and respite units. However, on the first day of our inspection, we found that the needs of people at the residential unit of the service had changed along with some people’s dependency levels and therefore the current staffing calculator did not reflect the number of staff required to adequately meet people’s needs. On the second day of our visit, the registered manager provided us with an updated dependency calculator which they said the service was now adequately staffed. We have made a recommendation about this.

The service had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as physical disabilities, behaviour that challenges. However, the risk assessments we looked at were all completed with varying amounts of information and were not all complete. The risk assessments did not all correspond with each other and made it confusing to determine what risks were identified and what remedial action was in place to minimise the risk. We have made a recommendation about this.

People’s care plans contained information about their personal preferences and focussed on individual needs. However, people’s care plans had not been updated with up to date information about their changing needs and staff were not always available to diffuse situations that may occur early. We have made a recommendation about this.

Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Safe medicines management processes were in place and people received their medicines as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the service complied with these requirements.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. Where there were shortfalls, the registered manager had immediately put plans in place to rectify these. The registered manager understood the requirements of their registration with the Commission.

We found a breach 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 this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff showed knowledge of people they supported. For example, we observed staff during breakfast serving one person who had diabetes a special diet as stated in their care plan.

We spoke with relatives and the commented, 'I really feel my grand dad is better living here as they cared for him. They are very friendly and caring' and 'Overall we are quite happy and they do their best for my relative'.

People's preferences, interests and activities had been recorded. We observed that people were involved in activities inside the home and care was provided in accordance with people's wishes.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

People received a consistent and safe level of support.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs. One person said, 'They involve me in what is going on here and in my care. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I feel well looked after here and they help me to do things for myself'. 'Everyone is kind and good with support'. A relative said, 'I visit my dad regularly and the staff are lovely to my dad and I am quite happy with the care'.

People who used the service, their relatives, friends and other professionals involved with the service were recently sent an annual satisfaction survey by the manager to be completed.

There was an advocacy service available if people needed it. We saw Kent & Medway Independent Mental Capacity Act Advocacy Service information leaflet on the notice board.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

People's preferences, interests and activities had not always been recorded. We observed that people were not regularly involved in activities inside and outside the home. Because of this care and support could not always be provided in accordance with people's wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

People told us, that the home does not provide a range of activities both in the home and in the local community. One person told us 'I do not go out for activities because they do not provide activities here.' A relative said, 'They could do more with the residents. Most of the time it's only the TV on. More activities are needed to stimulate them.'

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to provision of meaningful activities to stimulate people who used the service.

People told us they were involved in reviewing their plans of care when their needs changed. One person said, 'They make you involved in your care and it gives you something to do'.

People knew how to make a complaint if they were unhappy. One relative said that they had made a complaint and they were satisfied with the outcomes.

Is the service well-led?

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were kept up to date.