Archived: Red Rose Nursing Home

Updated 11 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 and 24 May 2018; the first day of inspection was unannounced. The first day of inspection was completed by two inspectors and a specialist professional advisor, whose area of specialism was nursing. The second inspection day was completed by one inspector.

Before the inspection visit we looked at all of the key information we held about the service, this included whether any statutory notifications had been submitted. Notifications are changes, events or incidents that providers must tell us about.

As this was an inspection to follow up on the actions we told the provider to take at our last inspection we did not ask the provider to complete a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took the information from the PIR completed by the provider in 2017 into account when we inspected the service and made the judgements in this report. We also gave the provider the opportunity to update this information during the inspection.

We spoke with the local authority and health clinical commissioning teams. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority or by a health clinical commissioning group. We also checked what information Healthwatch Nottinghamshire had received on the service. Healthwatch Nottinghamshire is an independent organisation that represents people using health and social care services.

In addition, during our inspection we spoke with five people who used the service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with ten relatives. We also spoke with the registered manager, a representative of the provider, three nurses, two senior care staff, three care staff, a maintenance person, two domestic staff and the receptionist.

We looked at the relevant parts of seven people’s care plans and reviewed other records relating to the care people received and how the service was managed. This included risk assessments, quality assurance checks, staff training and policies and procedures.

Updated 11 September 2018

This inspection took place on 22 and 24 May 2018; the first day of inspection was unannounced.

Red Rose Nursing Home is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Red Rose Nursing Home accommodates up to 65 people across three separate units. One unit provides care for people living with dementia, another provides care for people with nursing care needs, and a third provides care for people who have residential care needs. At the time of our inspection 45 people lived at Red Rose Nursing Home. The manager told us, although they had vacancies across all units, they were specifically not accepting any new admissions on to the nursing unit. This was because they wanted to ensure improvements identified at our last inspection had been achieved.

At our comprehensive inspection in December 2017, we rated the service was 'good' overall. In response to further information of concern received, we completed a responsive comprehensive inspection in January 2018 and we rated the service as 'Requires Improvement.' We found four breaches of the Health and Social Care Act (Regulated Activities) Regulation 2014, and issued three requirement notices and a warning notice telling the provider to improve. At this inspection we found the required improvements had not been made. This was the provider's third inspection in 10 months.

Risks associated with people’s care needs, such as those associated with the use of bed rails, and from refusals of personal care were not well managed. Assessments of people’s health and care needs were not consistently in place and care plans were not always up to date and comprehensive. Accidents and incidents, such as falls, were not analysed and used to help identify how to reduce the likelihood and make improvements. People did not always receive timely referrals and reviews of their care when their needs changed or their care and treatment had become ineffective.

Risks associated with the premises, such as the regulation of water temperatures to reduce the risks associated with scalding were not effectively managed. The facilities on the nursing unit did not fully meet people’s needs as people had to use showers on other units within the building.

Infection prevention and control practices did not protect people from the risks associated with infection. Cleaning products and thickening powder were not stored securely.

Guidance for medicines given when people needed them, rather than at set times, did not contain sufficient detail to ensure they were administered consistently. Not all creams had dates of opening recorded and thickening powder prescribed for one person was used for another person.

Staff were not competent to provide care in line with some people’s care plans as they had not been trained to safely hold people. In addition, competency checks on staff were not always completed and many staff had not completed the training identified by the provider as required for their role. Many staff did not have the level of training required to care for people with the assurance that they did so with appropriate levels of skill, knowledge and understanding. This included staff knowledge on how diversity and equality issues may affect the people they cared for. Staff supervisions did not prompt staff to complete their training.

There were not enough staff deployed to meet people’s needs in a timely manner, and to provide people with emotional support when they needed it.

Staff did not always check people’s consent to care before they provided it, and assessments and provision of people’s care had not always followed the Mental Capacity Act 2005 (MCA). Staff knowledge on the MCA and DoLS varied and staff did not always understand how this legislation applied to the people they cared for.

People enjoyed their food, however they did not always receive food that met their preferences. People’s privacy and dignity was not always maintained and promoted. People’s personal care needs and people’s needs associated with their anxiety or behaviours that challenged, had not always been met in a personalised and responsive manner. Staff did not always use language that showed empathy for people and their care needs. There was a lack of meaningful activities for people to enjoy.

People and most relatives were not involved in the development and review of care plans.

Responses to complaints had not been made in line with the timescales in the provider’s complaints policy.

Actions to fully meet the accessible information standard were not always in place to provide assurances people’s communication needs would be met.

People had care plans in place for when they required care at the end of their lives; however, some arrangements were not clear.

Systems and processes designed to assess, monitor and improve the quality and safety of services, and reduce risks were not effective. Records were not always kept securely. A registered manager was not in place; however the manager had taken steps to begin the process of registration with the CQC.

Views gathered from people, relatives and staff did not cover a breadth of issues to help inform the development and improvement of the service. Statutory notifications had not always been submitted as required.

People told us they felt safe with the staff that cared for them, however not all staff were knowledgeable about how to follow procedure in order to safeguard people. Staff recruitment included pre-employment checks that helped the provider make judgements about the staff employed to work at the service. Staff told us about some steps they took to promote people’s dignity and privacy and people’s independence was supported.

Assessments under the deprivation of liberty safeguards (DoLS) had been applied for when identified as required. Referrals to other professionals had been made, however not always consistently. People could access other healthcare services, such as their GP when needed.

The design, adaption and decoration of the dementia and residential unit had been used to help meet people’s needs.

At this inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service 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.

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.