Rosebery House

Rosebery House is a residential care home providing accommodation and personal care for up to 30 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 29 people using the service.

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

There were enough staff working to provide the care and support people needed. However, we made a recommendation that the provider reviews deployment of staff at peak times during the day.

People were protected from the risk of harm of abuse because staff knew what actions to take if they identified concerns. Staff received regular training and competency assessments which helped to ensure they had the knowledge and skills to look after people. The home was clean and tidy throughout with no unpleasant odours.

Staff knew people well and understood the risks associated with their support. Care plans and risk assessments provided guidance about risks. People received their medicines safely, when they needed them. Recruitment procedures ensured only suitable staff worked at the home.

The culture of the home was positive and staff worked hard to ensure people lived happy lives. The quality of the service was regularly monitored through audits, discussions and feedback surveys. Improvements were made where needed and there was an ongoing improvement program for the home. They worked well with other organisations. Visiting health and social care professionals spoke highly of the registered manager and staff.

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.

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

We undertook an infection prevention and control inspection (published 24 March 2022). This was a targeted inspection therefore we did not re-rate the service at this inspection.

The last rating for this service was requires improvement (published 28 July 2021). The provider completed an action plan after this 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.

At our last inspection we recommended that the provider seek appropriate guidance in relation to the storage of prescribed topical creams. At this inspection we found topical creams were stored appropriately.

Why we inspected

We looked at infection prevention and control measures (IPC) 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.

The inspection was prompted in part due to concerns received about the care people received, this included continence care, staff training and IPC. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

At our inspection, published 28 July 2021 a breach of legal requirements was found which related to IPC. At this focused inspection we also checked they had followed their action plan and to confirm they now met legal requirements

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider was following current government guidance to ensure people were able to visit the home safely. There were safe and appropriate measures in place in relation to visiting at the home. This included temperature checks and lateral flow testing before visitors were admitted to the home. The provider had an allocated visiting room which was accessed at the rear of the building. People were able to use this for visiting or they could enter the home if they wished, once appropriate checks had been completed.

Families had been kept updated throughout the pandemic to ensure they were aware of visiting and testing requirements. Relatives had also been informed when an outbreak had occurred at the home.

People were being supported to go out and to attend appointments.

The home had designated housekeeping staff, with further cleaning tasks shared by care staff. Daily cleaning and cleaning of high touch areas was recorded.

A testing regime was in place for all staff in line with government guidance.

Staff had received training in relation to infection prevention and control and COVID-19. This had been supported with further staff meetings and information sharing as changes had occurred.

Rosebery House is a residential care home providing care and accommodation for up to 30 older people living with dementia or dementia type illness. There were 24 people living there at the time of the inspection.

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

The home had experienced a significant outbreak of COVID-19 during the pandemic. A number of staff including the registered manager and provider had been off sick, shielding or isolating. This had impacted on the service and although the home was now COVID-19 free, the registered manager and provider were still trying to catch up in relation to a number of quality assurance processes and documentation

Infection Prevention Control processes needed to be improved to ensure that staff were consistently following government guidance. Staff had not sought confirmation a visiting health professional had completed COVID-19 testing before entering the home. Another had been allowed to wait inside the home until they had their result rather than being asked to wait in the designated area outside until a negative result was confirmed. Although it was difficult to ensure people were socially distanced due to living with dementia, staff needed to mitigate risk as much as possible by supporting people and other staff to remain socially distanced when possible.

Some areas of documentation including care plans and risk assessments needed to be improved to ensure they consistently included relevant information about people. For example, triggers for anxiety and actions for staff to follow. Improvements were needed to ensure all risks were identified and assessments completed to demonstrate how risk was to be mitigated. For example, people who may not be able to socially distance and environmental risk assessments.

The registered manager was working with the provider and external health professionals to make improvements and ensure people received appropriate care. An action plan had been completed to identify which areas needed to be prioritised. We were told this was a ‘live’ document and further areas would be added once the essential improvements had been implemented. Newly implemented quality assurance systems needed time to become embedded into practice.

Staff giving medicines were appropriately trained and their competencies assessed to ensure medicines were given safely. People told us they received their medicines correctly. We have made a recommendation regarding medicines and the storage of topical creams.

Staff had received safeguarding training and knew what to do if they suspected anyone was at risk of abuse. Accidents and incidents were documented and referred to the local authority and CQC completed when required.

People and relatives told us they were happy with the care provided. We received positive feedback regarding staff and the registered manager. One told us, “They would rather be at home, but they now even says the girls are lovely, they have company with the staff, even if they are not able to talk to many of the other residents.” And, “The manager is very understanding and kind and has put me at ease.’

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 27 July 2019).

Why we inspected

This inspection was prompted by our previous Infection Prevention Control inspection in January 2021 and the last comprehensive inspection in July 2019. We were also prompted by our data insight which assesses potential risks at services, concerns received in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to review the previous ratings. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 have identified a breach in relation to safe care and treatment.

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

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

Follow up

We will request an action plan from 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.

We found the following examples of good practice.

The home was currently closed to admissions and non-essential visitors. Measures had been implemented to ensure people and staff entering the home did so safely. This included temperatures being taken on arrival and personal protective equipment (PPE) being used.

People and staff had individual COVID-19 risk assessments completed where appropriate. This considered people’s associated risks, including long term and underlying health conditions and ethnicity.

The home had experienced a high number of positive COVID-19 people and staff. During the outbreak staff monitored people’s physical health and recorded this on a monitoring form, this included people’s temperatures and general symptoms.

Rosebery House is a residential care home providing personal and nursing care to up to 30 older people. There were 22 people living there at the time of the inspection. Most people were living with dementia and needed additional assistance due to frailties of old age; such as support to move around the home safely. Some people had more complex needs, which included Parkinson’s disease and diabetes.

The manager had been responsible for the day to day management of the home for two months prior to the inspection. They had applied to register with CQC and their application was being progressed. During this time the provider had supported the manager and a number or improvements had been made since they started. For example, the layout of the furniture in the lounge had been changed so people could sit together in small groups if they wished and the decoration had been improved to brighten the room.

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

People and relatives were positive about the support provided at Rosebery House. People said the manager was very approachable and a relative told us the staff were excellent. Staff knew people very well, they treated them with kindness and respect and demonstrated a good understanding of people’s individual needs. People were assisted to access healthcare services when needed.

Risk assessments and management plans were included in the care plans and, there was guidance for staff to follow to reduce risk as much as possible. The provider had an ongoing training plan, with supervision and support for staff to ensure they were aware of their roles and responsibilities. People received their medicines when they needed them by staff who were trained to give them out safely. People were protected from the risks of harm, abuse or discrimination because staff had completed safeguarding training and knew what actions to take if they identified concerns.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the home.

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.

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 16 November 2016).

Why we inspected - This was a planned inspection based on the previous rating.

Follow up: We will review the service in line with our methodology for 'Good' services.

Rosebery House specialises in providing care for people with dementia and memory loss.

This was an unannounced inspection which took place on 28 July and 1 August 2016.

At the last inspection undertaken on the 1 and 2 June 2015 we asked the provider to make improvements in relation to the safe storage and administration of medicines, safe staffing levels in relation to evacuation procedures and peoples preferences and needs not being met. The provider sent us an action plan stating they would have addressed all of these concerns by August 2015. At this inspection we found the provider was meeting these regulations.

Rosebery House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager was in day to day charge of the home, supported by a deputy manager. People spoke highly of the home and the way it was run. And staff told us that they felt supported.

Staff felt that training provided was effective and ensured they were able to provide the best care for people. Staff were encouraged to attend further training, with a number having achieved National Vocational Qualifications (NVQ) or similar. New staff received an induction and staff received regular supervision annual appraisals and had regular staff meetings. This meant that staff were supported to develop skills, knowledge and training.

Staff demonstrated an understanding around safeguarding and were able to tell us how they would report any suspected abuse. People were involved in day-to-day choices. All staff and management had a good knowledge and understanding of Mental Capacity Assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). This meant that any decisions made had followed this process to ensure they were made in peoples best interest and supported by health professionals and Next of Kin (NoK).

Staff recruitment systems were in place and staffing levels were reviewed to ensure people’s needs could be met. A training programme was on going to ensure staff were appropriately trained to support people’s needs.

The home had a designated maintenance employee who was available at the home. Systems were in place to ensure emergency procedures were in place. And equipment and services were well maintained and checked regularly. There were systems in place to assess and monitor the service. This included auditing and feedback from people. All findings were analysed and used to make improvements to the day to day running of the home.

Staff provided care and support for people with kindness and patience. People’s dignity and privacy were respected and people were involved in decisions about how they received care and spent their time throughout the day.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure good standards were maintained.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and the registered manager was developing photographs of meals to enable people to have a better understanding around meal choices available.

Referrals were made appropriately to outside agencies when required. For example GP visits, community mental health teams and community nurses. Notifications had been completed to inform CQC and other outside organisations when events occurred.

During our inspection we found that consent was sought before care was given. People were involved in choices and decisions throughout the day.

Care plans were personalised and documented the needs of people.

The home appeared clean and tidy. Appropriate infection control measures were in place.

A complaints policy was displayed in the reception area. Evidence was seen that comments and complaints were listened to and resolved in a timely and appropriate manner.