We found the following examples of good practice.
Social distancing was in place and promoted were appropriate. Separate areas were available to enable effective zoning and cohorting of staff when people were COVID positive
The service had sufficient supply of Personal Protective Equipment (PPE) which was stored safely. Staff had received training and wore PPE in line with government guideline.
Rockliffe Court limited is a residential care home providing care for up to 35 people some of whom may be living with dementia or have a sensory impairment. At the time of inspection there were 29 people living at the service.
People’s experience of using this service and what we found
Medicines were managed safely although improvements were needed to improve the standards of medicine processes and record keeping. We have made a recommendation about this.
Since the last inspection, the provider had improved safety and risk management within the service. Improvements had been made to ensure good standards of cleanliness of the environment were maintained. Old furniture had been removed and bedrooms redecorated. Fire safety issues had been addressed and regular fire drills carried out.
The quality of record keeping in relation to people’s care and safety had improved. Care records contained up to date information about people’s needs and risks.
The improvements made since the last inspection has supported people to feel safe. Staff demonstrated knowledge and understanding of safeguarding systems and the provider liaised with the local safeguarding teams to keep people safe.
Staff were recruited safely and received the training and support they needed to undertake their role.
People, relatives and staff spoke positively about the management team and felt able to raise concerns and felt confident these would be addressed. People and their relatives said they felt the service had improved since the last inspection. Meetings were held with people and feedback sought from their relatives to exchange information and gather feedback.
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; policies and systems in the service supported this practice.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection and update.
The last rating for this service was inadequate (published 9 October 2020) 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 9 October 2020. 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
This inspection was carried out to follow up on action we told the provider to take at the last 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 Inadequate to requires improvement. This is based on the findings at this inspection.
The provider has taken action to effectively mitigate the risks identified in the previous inspection
You can read the last comprehensive inspection, by selecting the ‘all reports’ link for Rockliffe Court limited on our website at www.cqc.org.uk
Follow up
We will continue to monitor information we receive about the service until we visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Rockliffe Court Limited is a residential care home providing personal care to 33 people at the time of inspection. The service can support up to 35 people, some of whom may be living with dementia or have a sensory impairment.
People’s experience of using this service and what we found
People at Rockcliffe Court Limited did not receive a safe, responsive or well-led service.
At the last inspection, we found concerns relating to the safety and cleanliness of the premises, management of medicines and quality assurance systems were not effective.
At this inspection we found minimal changes had been made to the quality assurance systems and necessary improvements to the service had not taken place or been sustained. Risks to people were not always identified and safely managed. Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people. There were several incidents that should have been notified to the local safeguarding team and to the Care Quality Commission (CQC), but this had not been done.
There were concerns relating to people’s safety which included poor oversight of fire safety issues, a lack of training and guidance for staff on how to support people in the event of a fire which put people at significant risk of harm.
The service did not have sufficient infection prevention measures in places. Areas of the premises were unclean and furniture was worn and in need of replacement.
Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as and when’ required medicines to people safely. Medicines were not always stored safely and stock levels of controlled medicines were not accurately recorded.
There was little provision for activities within the home and there was no clear record of how people were supported to interact and engage in activities. We have made a recommendation about this.
End of life care plans lacked detail, they did not explore peoples wishes or needs in their last days of life and did not consider pain relief and families wishes. We have made a recommendation about this.
Systems were in place to recruit staff safely. However these were not always completed effectively. The provider failed to complete inductions with newly recruited staff to ensure they were fully prepared to support people using the service in a safe and effective manner. We have made a recommendation about the induction of staff.
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. However, despite this staff were kind, caring and respectful to people using the service.
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 requires improvement (published 10 July 2019) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations relating to the premises safety, governance systems and managing risks. The service has been rated as requires improvement for the last two inspections and has now been rated inadequate.
Why we inspected
This was a planned inspection based on the previous rating.
We carried out a focused inspection to review the key questions Safe, Responsive and Well- Led.
We have found evidence that the provider needs to make improvements. Please see Safe, 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.
You can read the report from our last comprehensive inspection, by selecting the all reports link for Rockliffe Court Limited on our website www.cqc.org.uk
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of exceptional circumstances arising as a result of 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to fire safety and managing risks, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor record keeping, notification of incidents and safeguarding people from risk of harm or abuse.
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 for 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.
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 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.
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, 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 the registration.
People's experience of using this service and what we found
At the last inspection, we found concerns relating to the safety and cleanliness of the premises, a lack of understanding of the Mental Capacity Act 2005 (MCA) and quality assurance systems not being effective. During this inspection, we found improvements had been made regarding knowledge and application of the MCA; we found the service to be compliant in this area.
We continued to find concerns relating to the quality assurance processes; these were not always effective and did not drive improvement within the service. We found concerns relating to the safety and cleanliness of the environment. We also identified a new concern relating to the management of risk and some shortfalls with the management of medicines.
There was some provision for activities, but sometimes this was cancelled and there was no clear record of how people were supported to interact and engage in activities. We have made a recommendation about this.
People felt able to raise complaints, but one person told us they didn't feel their views were listened to regarding how the service was ran.
Systems were in place to recruit staff safely and there were sufficient staff available to meet people’s needs.
Staff felt supported in their role and received training to equip them with the necessary skills for their role. Staff supported people to access healthcare and maintain a nutritious diet.
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.
Staff treated people with respect; they were supported to maintain their independence and their privacy and dignity were maintained.
Staff were aware of people’s needs and supported them in line with their preferences.
People and staff told us the registered manager was approachable. Staff felt there was an improved team morale and positive culture within the service following some staff changes.
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 requires improvement (published 17 July 2018) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulation in regards to consent. However, they continued to be in breach of regulations relating to the premises safety and governance systems. This service has been rated requires improvement for the last two consecutive inspections.
Enforcement
We have also identified a new breach in relation to managing risks.
Since the last inspection we recognised that the provider had failed to display their rating of requires improvement. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Rockliffe House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package 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.
Rockliffe House supports up to 35 older people, some of whom may have sight impairment or be living with dementia. Communal rooms consist of a lounge, a dining room and a conservatory. There is also a small seated area in a walkthrough space near patio doors, which lead out to the garden and an area for people to smoke. Bedrooms, bathrooms and toilets are located over two floors accessed by two passenger lifts. At the time of the inspection, there were 34 people living in Rockliffe House.
The service had a registered manager. A registered manager is a person who has registered with the 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.
During the inspection, we had concerns about areas of the environment and equipment that required cleaning, tidying, repairing and in parts repainting. There were no cleaning schedules for day time domestic staff. Night care workers completed some cleaning tasks but there was no checking system to oversee work had been carried out by either day or night staff. The registered manager and provider were aware of areas in the environment that they wanted to improve; following the inspection, the provider told us these would be completed in the next six to twelve months.
There was a lack of understanding about the Mental Capacity Act 2005. This had impacted on the quality of capacity assessments and applications for deprivations of liberty. There were also shortfalls in the recording of best interest decisions and some people who used the service had signed documents when they were assessed as lacking capacity to understand them. Despite this, staff were clear they had to ask people for consent before carrying out care tasks and people who used the service told us they were able to make their own decisions and choices.
The quality assurance system was not effective in identifying shortfalls in the environment and other areas of service provision. The monitoring and analysis of accidents and incidents had not taken place since the member of staff allocated this task had left the service. This meant that lessons could not be learned in order to reduce accidents and incidents.
The provider and registered manager had not notified CQC of several incidents that affected the safety and welfare of people who used the service. This is a requirement of their registration.
The provider and registered manager had not completed a request for information called a ‘Provider Information Return’. This would have assisted us in planning the inspection. We also noted some policies and procedures and documents were in need of updating.
These issues were breaches of regulations and you can see what action we have told the provider to take at the back of the full version of this report.
Staff knew how to safeguard people from the risk of harm and abuse. There was an inconsistency in how management dealt with incidents that occurred between people who used the service. Sometimes these were referred to the local safeguarding team but we found several instances when they had not contacted the team for advice and to make them aware of incidents.
People had assessments and care plans produced which helped to guide staff when they supported them. The assessments included areas of risk and were held with the care plans so staff could locate them quickly. Some risk assessments for health-related issues could have more information about the signs and symptoms of concerns. The registered manager told us they would address this.
People’s health care needs were met and we saw they had access to a range of health care professionals when required. People were able to remain in the service if their health deteriorated and they needed end of life care.
The menus were varied and provided choices for people. Those people we spoke with told us they liked the meals and had sufficient to eat and drink throughout the day and night.
There were activities arranged for people and staff were designated an activity co-ordinator role each day.
People told us they liked the staff team and they had a caring and respectful approach. Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. Staff reported they were busy in the evenings when care staff numbers dropped to three instead of four. However, a change in the rota was planned, which should help to address this.
Staff received training, supervision, appraisal and support. This helped them to develop their skills and knowledge in order to support people and meet their needs.
The provider had a complaints policy and procedure on display. People who used the service told us they felt able to raise concerns and they would be listened to.
Equipment used had been serviced and maintenance personnel were available to attend to repairs. The environment had been adjusted to meet people’s different needs, for example with grab rails, non-slip cushioned flooring, signage and strategically placed chairs.
Rockliffe Court is situated in a residential area not far from the city centre of Hull. The service has shared and single bedrooms over two floors. There are various communal areas, a dining area and a large garden. The building is accessible to people with mobility difficulties. Car parking is provided to the rear of the building.
The last inspection was completed on 7 January 2014 and the service was compliant in all areas assessed. This inspection took place on 16 and 19 October and was unannounced.
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.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered provider had not fully understood their responsibilities in relation to DoLS; they had failed to identify who met the criteria for DoLS and to submit applications to the local authority as required. This meant that people who used the service may be unlawfully restricted. These issues meant that the registered provider was not meeting the requirements of the law regarding the need to obtain lawful consent for the people who used the service. We discussed our concerns with the registered manager and registered provider who confirmed they would address this issue without delay.
Meetings were held for people who used the service and relatives which were used as a forum for people to raise concerns, ask questions or make suggestions about the overall running of the service. When suggestions were made for example the addition of more meaningful activities; the registered manager took action without delay.
Medicines were ordered, stored and administered safely. People received their medicines as prescribed from staff who had completed relevant safe handling of medication training.
Staff understood the need to respect people’s privacy and maintain their dignity. During the inspection we observed numerous positive interactions between the people who used the service and the staff who supported them. People were treated with kindness and compassion. It was evident staff were aware of people’s life histories and knew how care and support was to be provided in line with their preferences.
A quality assurance system was in place that consisted of audits, checks and service user feedback. When shortfalls were identified action was taken to improve the level of service.
Staff were recruited safely. Checks were undertaken to ensure prospective staff were suitable to work with vulnerable people. We saw that there was a very low turnover of staff at the service.
We found safeguarding systems were in place at the service. Staff had completed relevant training and knew what action to take if they had any concerns. This helped to ensure the people who used the service were safeguarded from the risk of harm and abuse.
People’s nutritional needs were met. Staff monitored people’s food and fluid intake and took action when concerns were identified. Referrals to healthcare professionals were made in a timely way when people’s needs changed or developed. We saw that people were provided with a freshly prepared, varied and balanced diet of their choosing.
We found that medicines were managed appropriately and people received their medicines as prescribed. The treatment room was clean and tidy and medicines were stored safely.
We found there had been an increase in the staffing numbers. This ensured there was sufficient staff on duty at all times to meet the current needs of people who used the service. Staff confirmed the numbers of staff had increased in the evenings which had made a difference to the support they were able to give to people. Comments from staff included, 'The extra staff has made a big difference. We have more time in the evenings and don't feel rushed' and 'We do have enough staff; a lot of people are independent and don't need a lot of support.'
We found records used in the home had improved. These included care records and those used for managing the service. Comments from staff about records included, 'Recording has improved; the files are set out much better' and 'We have better recording and know more about what is going on. We follow through more and when we do evaluations we go through all the daily reports.'
We have asked the local authority to check out something we noted in one of the records.
There had been improvements in the arrangements for managing people's personal allowance and recording expenditure. Receipts were maintained, which helped to evidence expenditure when staff went to the shops for people. This helped to protect people from the risk of financial abuse.
There were shortfalls in the management of medicines including how they were stored and processes for returning them to the pharmacy. We could not be sure that all the people who used the service had received their medicines as prescribed, as there were some gaps in recording.
We found there was insufficient numbers of staff at specific times to support the needs of people who used the service.
We found there had been improvements in the way personal allowance was recorded and a specific behaviour management plan had been completed since the last inspection. However, we found other records such as staff rotas, personal care entries and medication records had not been completed accurately or consistently.
People told us they were treated with dignity and respect and they could make choices about their lives. Comments included, 'It really is a nice place here and has a pleasant atmosphere. There is not one thing wrong I can say about this place' and 'I get myself washed and dressed and if I can't do anything I just ask. I come and go as I please.'
People told us their health needs were met. Records showed they had access to health professionals for advice and treatment. Comments included, 'We are looked after well and treated kindly.'
We found systems in place for recognising potential financial abuse and the procedure used to manage and record finances did not fully protect people from the possibility of abuse.
We found people received medicines as prescribed, although some minor recording issues were to be addressed.
The service provided people with a safe and homely environment. People told us they were happy with their home and liked the large bedrooms and garden.
We found there were sufficient staff to support people who used the service. Comments included, 'If I can't do something I ask and they come as quick as they can' and 'The staff are excellent and it's a friendly atmosphere.' A relative told us the staff had been very thoughtful and knew their relative's needs well.
We found some of the records used in the service were not accurate and up to date.