Rose Villa Nursing Home

Rose Villa Nursing Home is a residential care home providing personal and nursing care up to a maximum of 36 people. The service provides support to people with dementia, older people and people with a physical disability. At the time of our inspection there were 25 people using the service.

Rose Villa Nursing home is a large Victorian house and has three floors serviced by a passenger lift. There are bedrooms for single and shared occupancy on each floor, with communal and dining space on the ground floor.

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

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.

Staff supervision and appraisals were not consistent and did not support staff to maintain knowledge of best practice. Training was inconsistent and did not support staff to meet the needs of people in their care.

The service did not have effective safeguarding systems in place and there was not a consistent approach to safeguarding matters. Staff were not up to date with safeguarding training.

Information about risks and safety was not always comprehensive or up to date and full information about risks to people’s safety was not always communicated to the staff. People and their families or carers were not always involved in decisions about their care and treatment.

People received the care and support they required to be safe, however, staff did not always have time to respond to people’s changing needs. Staff regularly felt stretched and focused on tasks rather than person-centred care.

Governance systems were not reliable or effective. Investigations were not always completed and there was little evidence of learning from accidents and incidents.

Information to support staff to safely administer medicines was not always available. We have made a recommendation about the management of some medicines.

People were not always supported to engage in person-centred activities to help them maintain hobbies and interests. One relative told us “Activities are an issue, [person] would benefit from some activities that suited them”. We recommend the provider reviews accessibility of activities.

The provider did not always engage with people who use the service, their families and/or carers, ensuring their views were acted on to shape the service and culture. Relatives told us there had never been any invitations to attend carers meetings. We have made a recommendation around how the provider obtains the views of all stakeholders including people and their families.

Staff have access to and followed clear policies and procedures on infection, prevention and control that met current and relevant national guidance.

People had access to an outside space and a quiet area to see their visitors. People had choice and access to enough food and drink throughout the day.

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

The last rating for this service was good (published 20 March 2018).

At our last inspection we recommended that improvements continue with the recording of care plans and monitoring charts to ensure up to date information guides staff in meeting people’s needs. At this inspection we found improvements had not been made in the recordings of care plans, and care plans did not contain up to date relevant information.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective responsive and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

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 and will take further action if needed.

We have identified breaches in relation to person-centred care, safe care and treatment, the Mental Capacity Act 2005, safeguarding, staffing and the overall leadership and management of the service.

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

Rose Villa is registered to provide care for 36 people who need nursing care and who may be living with dementia. Fifteen of the 36 placements are allocated as an interim care service for those people who may need support to prevent hospital admission or rehabilitation following discharge from hospital. The building is two large Victorian houses and has three floors serviced by a passenger lift. There are bedrooms for single and shared occupancy on each floor, and a large communal space divided into two lounges and a dining space on the ground floor.

Rose Villa 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 service had a registered manager 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.

Governance of the service had improved. The quality assurance system consisted of audits, checks, observation of staff practice, meetings and surveys. The audits were completed on a range of topics and shortfalls identified from them and from the meetings and surveys were addressed in action plans. The provider’s representative completed visits and spot checks of the service; they spoke to people and completed a check of the environment. This helped to ensure the provider had oversight of the service.

We saw risk management had improved. A range of risk assessments were completed and these were checked more frequently and kept up to date. A new heating system had been installed which had removed the risk of cold bedrooms and the need for electric heaters.

We found the registered manager and staff had a much improved understanding of mental capacity legislation and the need for consent. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had improved. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision.

At the last inspection, we made a recommendation about ensuring care plans were more person-centred and monitoring charts were accurate. Whilst this had improved in several of the care plans we assessed, there remained some shortfalls and we have made a recommendation that these improvements continue.

Staff knew how to safeguard people from the risk of abuse and harm. They had completed safeguarding training and had policies and procedures to guide them. They were clear about the alerting procedures to the local safeguarding team.

Staff were recruited safely and in sufficient numbers to meet people’s needs. A health professional told us some people had mentioned they had various waiting times when they used the call bell. This was discussed with the registered manager to address.

People told us staff were kind and caring and respected their privacy and dignity. People could remain at Rose Villa Nursing Home for end of life care. The service had recently become part of a project to improve end of life care for people, which included additional training for the registered manager, nurses and care staff.

People’s health and nutritional needs were met. We saw people had access to a range of community health care professionals and contact was made by staff in a timely way. People liked the meals provided and there were choices and alternatives on the menus. Staff provided support to people at mealtimes in a patient and sensitive way.

People's medicines were managed in a safe way and they received them as prescribed.

Activities provided for people had improved since the last inspection with the addition of two activity coordinators. There was a range of activities which people saw as meaningful and helped to provide social stimulation.

Staff had access to a range of training, supervision, appraisal and support. This helped them to feel confident when providing support to people. Staff said they could approach the registered manager and nurses if they had concerns about people’s needs.

There was a complaints procedure and people felt able to raise concerns.

Rose Villa has a mixture of shared bedrooms and those for single occupancy; there is a passenger lift to the three floors. There is a large sitting room divided into separate areas to facilitate seated areas, a small dining area and a quieter space in the conservatory at one end. The service has a range of bathrooms, showers and toilets on each floor. At the time of the inspection, there were 13 people living in Rose Villa and 19 people receiving an intermediate care service.

The service had a registered manager. 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 last full comprehensive inspection was completed in March 2015 and the service was rated as ‘Good’. We carried out a focussed inspection in July 2016, as there had been some concerns raised with us. We found concerns with cleanliness in parts of the service, management of infection prevention and control and the management of medicines. We found the quality monitoring systems had not picked up these issues. We didn’t change the overall rating of the service as we did not complete a full comprehensive inspection, but we did rate the service as ‘Requires Improvement’ in the three areas we looked at which were Safe, Responsive and Well-led and we planned to re-inspect in six months.

At this full comprehensive inspection, we found improvements had been made regarding cleanliness, infection prevention and control, the management of medicines and aspects of the monitoring system that oversaw these areas. However, when we looked at the full quality monitoring system we found some areas had not been wholly effective in highlighting areas for improvement and there lacked action planning to address issues that had been identified.

We found there was a lack of understanding about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and how these can impact on staff practices in relation to obtaining consent and making decisions in people’s best interest. There was one person whose liberty was deprived but this had not been recognised and actioned appropriately. This meant the registered provider was not acting within the law.

We had some concerns with the management of risk and not all areas of risk had been identified. For example, some people told us their bedrooms were cold; there were portable heaters used and one in the lounge was very hot to touch. The bedroom doors upstairs were wedged open as there were no fire door stops. Some extension leads had multiple plugs in them. Disposable gloves were not always made inaccessible. Some people lacked a current risk assessment with control measures to guide staff in how to minimise risk.

You can see what action we have asked the registered provider to take, regarding the above concerns, at the back of the full version of the report.

We found there were some activities taking place but some people told us they would like to do more. There was no programme of events and we didn’t see any activities during the two days of the inspection. The person designated the role of activity coordinator was new to the role, had limited information and had not completed any training. We made a recommendation about this.

We saw people had assessments of their needs prior to admission and plans of care to guide staff in how to support them. Some assessments and care plans were detailed but others had generic information which made them confusing. We made a recommendation about reviewing the generic sections of the care plans.

We saw staff were recruited safely and there was sufficient staff on duty to meet people’s needs. The registered manager told us they would check out a comment about waiting times for buzzers to ensure people were not waiting excessive amounts of time for staff to attend them.

People received their medicines as prescribed and their health needs were met. Staff referred people to community health care professionals when required and in a timely way.

People liked the meals provided and their nutritional needs were met. There were choices and alternatives on the menus and action was taken to refer people to dieticians or speech and language therapists when required.

We saw staff had a kind approach and there were positive interactions between them and people who used the service. We observed staff promoting privacy and confidentiality.

There was a complaints procedure on display and people told us they felt able to complain.

Rose Villa is located in a residential area, on a main road that leads into the city centre. There is good access to public transport, local facilities and amenities. The service is located over three floors and has a selection of bedrooms for single and shared occupancy. There is a large communal room on the ground floor which is divided into three distinct areas; two sitting room areas and one for dining in. There is a selection of bathrooms and toilets on each floor.

The service had a manager in post as required by a condition of registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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.

We undertook this unannounced inspection on the 27 July 2016 in response to concerns raised by a member of the local safeguarding adult’s team and we focussed on specific areas. At the last inspection in March 2015, the service was rated as ‘Good’ in all five domains of Safe, Effective, Caring, Responsive and Well-led. As we have not completed a full inspection, we have not changed the overall rating for the service. However, we have changed the ratings in the three domains assessed which were Safe, Responsive and Well-led, from ‘Good’ to ‘Requires Improvement’. We will be monitoring the service and completing a further inspection to check on progress with the areas of concern we found on the day.

At the time of the inspection there were a total of 17 people who lived in Rose Villa and 15 people who used the ICS.

We found people had not always received their medicines as prescribed. There was also an issue with recording of medicines which made it difficult to assess if people had been given them or had them applied such as creams and ointments. There was a lack of guidance for staff when people were prescribed medicines ‘as required’.

We found some areas of the environment such as sluice rooms, linen rooms and store cupboards required cleaning and tidying to ensure good infection prevention and control.

The shortfalls in medicines management and infection prevention and control meant we had concerns in these areas. You can see what action we have asked the registered provider to take at the back of the full version of this report.

The CQC had not received all notifications for incidents which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been a misunderstanding by the registered provider and registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

We found there was a quality assurance system in place which consisted of audits and seeking people’s views. However, the shortfalls in quality monitoring and checking that up to date and accurate records were in place for people who used the service, meant we had concerns in these areas. The registered manager told us they would review some of the audits in place to make sure they were more robust and enabled a thorough check of the environment and records. You can see what action we have asked the registered provider to take at the back of the full version of this report.

People gave us positive comments about the care provided to them. Some shortfalls in person-centred care planning and risk assessment documentation, and on some occasions the delivery of individualised care was mentioned to the registered manager to address with staff.

People we spoke with told us they were happy with the meals provided. Comments included, 'The food is superb you can't fault it', 'It's like home cooking' and 'It's always very good and there's plenty of choice.'

People's medication was administered, stored and handled safely. Qualified nursing staff administered people's medication.

There were enough staff on duty to meet people's needs and they had received the appropriate training. People who used the service told us they were happy with the level of care they received and the competency of the staff. Comments included, 'The care staff are brilliant', 'They get me up in the morning and help me throughout the day and they never complain' and 'Yes there are always enough staff on duty both day and night.'

Systems were in place which enabled people to make complaints or raise concerns. People told us 'I would go to the manager he'll sort it out', 'I would see the manager or the owner they are both very approachable' and 'I know I can complain but I don't have any at the moment.'