The Rosary Nursing Home

The Rosary Nursing Home is a residential care home providing personal and nursing care for up to 102 people. At the time of our inspection there were 67 people using the service. The home was split into two buildings both with two floors. One was for people requiring nursing and the other was for people with dementia. At the time of the inspection only the ground floor of the dementia unit was being used.

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

People were supported by staff who knew them well and how to keep them safe. One person said, “You do not have to worry about me. It is all lovely. Staff are smiley.” Care records, including risk assessments, did not always reflect this knowledge. The provider had recognised this prior to our inspection and plans were in place to rectify it. Relatives had more mixed feelings about whether their family members were safe. No examples of unsafe care and support were seen during the inspection. People were comfortable in the presence of staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible considering their best interests; the policies and systems in the service supported this practice. However, records did not always reflect the discussions and decisions which had taken place. The provider’s systems had already identified this and had action plans to rectify it.

Medicines were managed safely, and people were able to see other health and social care professionals. People were positive about the food and being consulted about the direction of the home. Relatives felt they were kept informed of any changes or accidents and incidents. Systems were in place to manage accidents and incidents. However, analysis around development of pressure ulcers had not always occurred. Following the inspection, the registered manager had updated these systems.

Staff felt there was a clear line of accountability and were positive about the support provided to them. There were gaps in training which already had planned completion dates and some staff had access to bespoke training related to their roles. People were supported in a home that promoted a positive culture that treated everyone as equals.

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 good, published on 17 March 2018.

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We received concerns in relation to risks related to pressure ulcers, eating and drinking, management of safeguarding and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

The Rosary Nursing Home 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 Rosary Nursing Home provides accommodation and nursing care to up to 102 people. At the time of the inspection there were 76 people living at the home. The Rosary specialises in the care of older people including older people living with dementia.

The home is made up of two main buildings. One part of the home, known as Primrose, provides general nursing care to people. The other building, called Snowdrop, provides care to people living with dementia.

At the last inspection in January 2017 we found that improvements were needed to ensure staff were effectively deployed so people received safe care which met their needs in a timely manner. We found improvements were needed to make sure everyone’s care was person centred and to ensure people were aware they were able to make choices about the care they received. We also found the providers’ quality assurance systems were not always effective in identifying shortfalls in the service provided to people.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. We also met with the provider to confirm the action being taken. At this inspection we found that improvements had been made in all areas and there was a commitment to on-going improvements.

There is 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.

There had been a change in the culture of the home which ensured staff worked in a way that respected people as individuals and took account of their needs and wishes. This led to a happy and relaxed place for people to live.

People were cared for by staff who were observant and ensured people were comfortable. People told us, and we saw, that staff were always kind and caring. . Comments from people included, “The staff look after me,” “I love it here. They [staff] are all so kind” and “The staff are pleasant and helpful.”

People felt safe at the home and with the staff who supported them. One person told us, “I feel safe here.” Staff were effectively deployed to make sure people’s needs were met and they had opportunities for social stimulation. Where people requested help this was provided in a timely manner.

People received their medicines safely from trained staff. The provider made sure that people at the end of their lives had the medicines they required to maintain their comfort and dignity. People who were being cared for in bed were regularly seen by staff to make sure they remained comfortable.

People received effective care from staff who had taken part in training which gave them the skills and knowledge they needed. One person pointed to staff and said, “Them [staff] know exactly what they are doing.” One visiting professional told us, “The staff are on the ball.”

People had access to a range of activities and care staff spent time socialising with people. There was a happy atmosphere in the home and most people were relaxed and animated.

The management team at the home had a commitment to continual improvement and seeking people’s views. They learned from things that did not go well and acted on suggestions where practicable. One visiting healthcare professional said they had been involved with the home for six years and told us, “It is much improved over the last six months.”

The Rosary Nursing Home provides accommodation and nursing care to up to 102 people. At the time of the inspection there were 96 people living at the home. The Rosary specialises in the care of older people including older people living with dementia.

The home is made up of two main buildings. One part of the home, known as Primrose, provides general nursing care to people. The other building, called Snowdrop, provides care to people living with dementia. Primrose is divided into two areas called Chiltern and Polden. Snowdrop is divided into two areas called Quantock and Mendip.

The last inspection of the home was carried out in December 2015. At that inspection the service was rated as Requires Improvement. We found that improvements were needed to make sure the recording of medicines administration, including the application of prescribed creams, was clear and gave an accurate record of what had been administered to people. At this inspection we found that improvements had been made and records gave clear information about medicines which had been administered or refused.

In December 2015 we also found that the leadership within the home was not always clear. Staff were uncertain who was responsible for organising each shift. Some felt it was the senior carers and others thought it was the registered nurse. Feedback from people was that there was a lack of organisation when the registered manager and deputies were not on site. This was a particular issue at night and at weekends. We found that improvements had been made and registered nurses were taking full responsibility for shifts in each unit. A new on-call system for the registered manager and deputies ensured people had access to these people at weekends.

A number of concerns about the service have been raised with us since the last inspection. These have included concerns that there were insufficient staff to meet people’s needs, people waiting an excessively long period of time for staff to support them and general standards of care.

At this inspection we found improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received. The provider had a very comprehensive system in place which included regular audits by the registered manager and senior management within the company. However these systems had not identified all the issues we found through observations within the home.

During this inspection we found improvements were needed to make sure staff were suitably deployed to meet people’s needs in a timely way and ensure their safety. On two occasions we observed people waited for 40 minutes for their requests for assistance to be carried out. We also found that some people in communal lounge areas received very limited support, supervision or social stimulation. At lunch time a number of people waited for long periods of time for their meal and between courses.

Improvements were also needed to make sure everyone received person centred care and had opportunities for social stimulation. This was a particular concern regarding the care of some people living with dementia who were unable to make their day to day needs and wishes known. Care plans contained very limited information about people’s preferred daily routines which meant staff did not always have the information they required to ensure care and support was provided in accordance with people’s wishes and preferences. Although long term staff knew people well the home had a number of new staff and regularly used staff from agencies who would not be expected to have personal knowledge of each individual.

There is 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. The registered manager had only been in post a few months. They were open and approachable and committed to making improvements. In response to our verbal feedback at the inspection they took immediate action to address the issues we raised.

In addition to the areas for improvement we also found areas of good care. Without exception everyone we spoke with praised the staff who supported them. People told us staff were always kind and caring and they named a number of staff who they thought were exceptional at their jobs. One member of staff was described as outstanding and one person said “Some staff here are really excellent. [Staff description] will do anything for you they just seem to know what will make things alright.” Throughout the inspection we observed that staff were kind and patient when they assisted people. In one area of the home there was excellent interaction between staff and people living with dementia which created a happy and engaged atmosphere.

People’s healthcare needs were monitored and people told us registered nurses were always happy to discuss any worries with them. A number of people were being nursed in bed and we saw these people were warm and clean. Records showed that people in their rooms were seen regularly by staff to ensure their comfort.

Risks of abuse to people were minimised because there was a robust recruitment process which ensured new staff were checked before they commenced work at the home. Staff knew how to recognise and report abuse. The registered manager worked with appropriate authorities to make sure any concerns were fully investigated and their legal rights were respected.

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.

The Rosary Nursing Home provides accommodation and nursing care to up to 102 people. At the time of the inspection there were 97 people living at the home. The Rosary specialises in the care of older people including older people living with dementia.

The home is made up of two main buildings. One part of the home, known as Primrose provides general nursing care to people. The other building, called Snowdrop, provides care to people living with dementia. Primrose is divided into two areas called Chiltern and Polden. Snowdrop is divided into two areas called Quantock and Mendip.

There is 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.

The last inspection of the home was carried out in February 2015. At that inspection the service was rated ‘Requires Improvement’ and two requirements were made. We found improvements were needed to ensure there were enough staff available to assist people with meals and social stimulation. We also found some people were not receiving their prescribed medicines at the correct times and there were some gaps in the recording of medicines.

At this inspection we found that improvements had been made in staffing levels and the safe handling of medicines. However we found further improvements were required to make sure medicines were correctly recorded. We also found improvements were needed to ensure the home was well led at all times.

Since the last inspection staff had been recruited but there were still some occasions when the home was short staffed when staff were absent at short notice. There was always a registered nurse on duty in each part of the home. This meant there was always a trained and experienced member of staff to monitor people’s care and well-being. In addition to the registered nurse there were also senior carers. There was some confusion about who organised each shift and made sure everyone received care to meet their needs. One visiting relative said “When there are no managers here there is definitely a lack of leadership.” Another visitor said “The biggest problem is the nurses don’t have the leadership skills they need.”

There had been improvements in the lunchtime experience for people. The provider had implemented a two sitting option. This meant that people who wished to eat in their rooms were served first and received the support they needed. There was a later sitting for people who choose to eat in the dining rooms and staff were able to support people to eat in a relaxed and unhurried manner. One visiting relative told us “Big improvements at lunchtime. There’s enough staff to do the job properly.”

People felt safe at the home and with the staff who supported them. The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff knew how to report any concerns and the registered manager worked in partnership with appropriate organisations to make sure any concerns were fully investigated.

People told us staff were kind and caring and we saw many examples of this during this inspection. Staff took time to talk with people and offer reassurance where necessary. When people refused support they respected people’s choices. When they assisted people with care they made sure people’s dignity was protected.

Staff received adequate training to make sure they had the skills and knowledge needed to safely support people. One person told us “The staff are very good.” Another person said “I’m not in the best of health but the staff look after me well.”

Each person had a care plan which gave clear information to staff about how to meet people’s individual needs. People, or their representatives, were involved in the creation and review of their care plans to ensure their views were recorded. People’s likes and dislikes were written down to make sure staff were able to provide personalised care to people.

There were ways for people to make suggestions and share concerns with the registered manager. These included individual conversations, relatives and residents meetings and a formal complaints procedure. People said they would be comfortable to make a complaint or suggestion to the registered manager. One person said “You can talk to [registered manager’s name] and they do listen.”

There was a calm and friendly atmosphere in all areas of the home. We observed that people appeared very comfortable and relaxed with the staff who supported them. Throughout the day we observed, and heard, pleasant and caring interactions between staff and the people who lived at the home.

Some people who lived at the home were unable to fully express themselves verbally due to frailty or dementia. Staff we spoke with demonstrated a very good knowledge of the people they cared for and how they expressed their views. People who lived at the home and visitors that we spoke with were all very happy with the care and support provided. One person told us 'I like it very much here. I feel well looked after.'

We observed that staff were well motivated and acted in a professional manner. Staff told us they were confident they had the skills and experience to meet the needs of the people who lived at the home. One visitor commented 'The staff take a pride in their work. There is always great respect for people and that means so much.'

The recruitment procedure minimised the risks of abuse to people by making sure that all staff were thoroughly checked before beginning work.

There were effective systems to monitor the quality of care.

Some people were unable to fully express their views due to their frailty or dementia. We therefore spent time observing care practices and talking with staff, in addition to speaking with people who lived at the home and visitors.

People said that staff involved them in planning their care. One person told us 'They went through everything with me when I moved in and I was able to say how I wanted things done.'

People were very happy with the care that they received. Comments included; 'I feel well looked after' and 'Nothing is ever too much trouble for the staff. I get everything I need.' We saw that people who were unable to express their views appeared relaxed and content.

The home was fitted with hand rails throughout to assist people to move around independently if able to. Other adaptations and equipment included raised toilets, profiling beds and assisted bathing and shower facilities.

People said that they thought there was usually enough staff on duty to meet their needs. One person said 'There is enough staff if nobody goes off sick.' Another person said 'The staff are always busy but I get all the help I need.'

People who lived at the home, and visitors, said they would be comfortable to speak with a member of staff if they were unhappy about any aspect of the service provided.