Roseworth Lodge Care Home

Roseworth Lodge Care Home is a care home providing personal and nursing care for up to 48 people. The home provides support to older people, some of whom are living with a dementia. At the time of our inspection there were 32 people living at the home.

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

The environment was safe. The provider had made extensive improvements to the environment. Equipment and furniture had been replaced and repairs had been completed. Effective infection prevention and control (IPC) measures were in place. Environmental and individual risks had been recognised and managed. The environment had been improved to support people living with a dementia safely navigate and enjoy the home. Brighter lighting, reminiscing images on walls and dementia friendly signage were throughout the home.

The provider had plans to keep people safe in the event of a fire. Personal Emergency Evacuation Plans (PEEPs) were accurate. A new fire alarm system had been installed and fire drills exceeded the required number needed.

People told us they were treated with respect. Staff supported people in line with their care plans.

Improvements had been made to the recording of people's care and support information. A new electronic system had been introduced, which enabled the management team to access ‘live’ information and make quick decisions about people’s care.

The provider had introduced new quality assurance systems, improved documentation and employed additional staff to monitor the quality and safety of all the provider’s services.

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, relatives and staff were regularly asked for feedback. The culture of the home promoted positive outcomes for people.

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

The last rating for this home was inadequate (published 5 December 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last 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.

This service has been in Special Measures since 5 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

We carried out an unannounced focused inspection of this service on 2 and 4 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, risk monitoring and management, dignity and respect and the governance of the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

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

Follow up

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

Roseworth Lodge Care Home is a care home providing personal and nursing care for up to 48 people. The service provides support to older people. At the time of our inspection there were 47 people using the service.

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

Guidance from external health care professionals was not always followed. Equipment to support people was not always used and care plans did not outline how it was to be used. Monitoring of important clinical information was not always recorded.

The provider did not ensure people had a safe environment. Environmental hazards had not always been identified or risk assessed to reduce the danger to people. Infection prevention and control (IPC) was not always safely managed. The home was not well maintained.

Effective plans to keep people safe in the event of a fire were not in place. Personal Emergency Evacuation Plans (PEEPs) were not always in place. Fire drills had not regularly taken place and staff were not confident in the use of the evacuation equipment. People were not always treated with dignity and respect.

The provider did not have effective quality assurance systems in place. The provider failed to ensure the quality and safety of the service was monitored effectively. People’s care and support records were not accurate and complete and were not always held securely.

Systems were in place to investigate safeguarding matters. Staff had completed safeguarding training. The provider was taking action to improve the management of medicines and was working with the local authority.

A safe recruitment procedure was in place. Staffing levels were not always appropriate to meeting people’s needs. We have made a recommendation about this.

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

The last rating for this service was good (published 28 April 2021).

Why we inspected

We received concerns in relation to people’s catheter and diabetes care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

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

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

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

Due to the shortfalls found during the inspection the provider was requested to produce an action plan detailing what action and by when, they would address the issues identified.

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 safe care and treatment, risk monitoring and management, dignity and respect and the governance of the home.

Follow up

We have already requested 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Roseworth Lodge Care Home accommodates 48 people across three separate units, each of which have separate adapted facilities. One unit specialises in providing nursing care, one provides care to people living with a dementia related condition and one provides residential care. At the time of our inspection 46 people were living at the service.

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

We found some medicine stock counts were incorrect. The providers audits had picked up on this, however these were found to still be continuing. Other aspects of medicines management were safe . We have made a recommendation about medicine stock records.

Care records reflected and assessed potential risks to people’s health so staff could support them safely. Staff understood safeguarding procedures and how to report concerns. Accident and incident analysis were in place and appropriate action taken to avoid re-occurrence.

The providers recruitment process was robust and followed safe practices. Enough staff were employed to meet people’s needs.

Staff felt very supported by the management team. People and their relatives were very complimentary about how the service was run.

There was good oversight and management of the service. The provider had a good quality assurance system in place. The registered manager had started to put an action plan in place to correct the concerns with the counts of medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (published 21 November 2017)

Why we inspected

We carried out a focused inspection of this service on 13 April 2021. This report only covers our findings in relation to the key questions safe and well led as we were mindful of the impact and added pressures of COVID-19 pandemic on the 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

Roseworth Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Roseworth Lodge Care Home accommodates 48 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing nursing care, one in providing care to people living with a dementia related condition and the final unit in providing general residential care. At the time of our inspection 42 people were living at the 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.

People and their relatives told us staff at the service kept them safe. Risks to people using the service were assessed and actions taken to reduce the chances of them occurring. The premises and equipment were monitored to ensure they were safe for people to use. The registered manager monitored accidents and incidents. Policies and procedures were in place to safeguard people abuse. Plans were in place to support people in emergency situations. People’s medicines were managed safely. Staffing levels were based on the assessed level of support people needed. The registered provider’s recruitment policy and procedures minimised the risk of unsuitable staff being employed.

People and their relatives all told us they thought staff had the skills and knowledge needed to provide effective support. Staff were supported through regular training, supervisions and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this. People were supported to maintain a healthy diet. People were supported to access external healthcare professionals to monitor and promote their health.

People and their relatives described staff at the service as kind and caring and spoke positively about the support they received. We observed examples of kind and caring support being delivered. Staff clearly knew people and their relatives very well. We saw staff treating people with dignity and respect. Staff promoted people’s independence when delivering care and support and encouraged them to do as much as they could for themselves. The service had received a number of written compliments from relatives of people who used the service. People were supported to access advocacy services where needed.

People received personalised support that met their needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs and preferences. People were supported to access activities they enjoyed. The registered provider had policies and procedures in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service. Staff said they were supported by the registered manager and spoke positively about the leadership of the registered manager and registered provider. The registered manager and registered provider were visible presences around the service. The registered manager had worked to create and improve links with a number of community bodies to help enhance the quality of life of people using the service. The registered manager carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people and their relatives through an annual questionnaire. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.