Rose Hill Nursing Home

We found the following examples of good practice.

People’s needs were reviewed to ensure appropriate support was provided in case they were diagnosed with COVID-19. For example, where people required increase in care this was provided in the home. People could host visitors and were supported to maintain contact with their loved ones when they could not see each other in person.

The registered manger implemented clear plans on management of any infection outbreaks in the home. Staff told us they had ongoing access to all required resources, including personal protective equipment (PPE), COVID-19 testing and vaccines. They had also received individual support from the registered manager. Staff commented they felt supported, received COVID-19 related training and could freely approach the registered manager with any queries.

We saw staff using PPE appropriately and cleaning was undertaken on the day of the inspection. There were clear plans and a risk assessment on how the home would adhere to the COVID-19 national guidance. Where required, staff were allocated to work in cohorts to minimise the risk of the infection spread.

Rose Hill is a care home providing personal and nursing care for up to 35 older people, including people living with dementia. At the time of the inspection there were 26 people living at the home.

The accommodation is an older style, large residential house, which was converted into a care home. There are two floors and a lift to provide access to the first floor. Rooms are single occupancy, and some have en-suite facilities. There is a large garden to the side and rear of the house.

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

The provider had tackled the issues we had reported on at the last inspection. Improvement had been made but more could be done to ensure that good quality care was monitored and maintained. We made a recommendation about having a more robust quality assurance system and frequent checks in place to keep standards high and to ensure improvement plans covered all aspects of the service.

People were kept safe and safeguarded from harm. Improvements had been made since the last inspection to address safety risks in the environment. People were also protected from the spread of infection. There were enough staff at the home to meet people’s needs and the recruitment of staff was done safely.

People’s living environment had been improved and further work was planned to enhance physical standards in the home.

People received effective care based on an assessment of their needs. Nutritional needs were known and met. People’s health and wellbeing was prioritised, and referrals made in a timely way for specialist health advise. Staff were trained and supervised appropriately.

Staff had been trained in the principles of the mental capacity act since the last inspection. 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 were treated with dignity and experienced care from staff who were respectful and kind. However, we raised with the provider that staff needed to remember to talk with and engage people when undertaking any care task.

People’s wishes were known and sought. Visitors were welcomed and, where possible, people were enabled to be independent. There was a range of social and one to one activity on offer during the day. People’s communication needs were known and met wherever possible.

The service had a complaints process, and this had been used effectively to make improvements with a person’s care. The service responded openly and honestly to complaints and suggestions, using the opportunity to improve.

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 2 August 2018). There had been three 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 regulation. There were some improvements which needed to be made and sustained, and we made one recommendation. The overall rating for the service has changed from Requires Improvement 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 Rose Hill Nursing Home on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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.

Rose Hill is a care home, registered to provide nursing care and accommodation for up to 35 people. One the day of our inspection there were 24 people at the service, including some people on short term or respite care.

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.

At Rose Hill, the accommodation is arranged over two floors. A passenger lift provides access to the first floor. Rooms are single occupancy and some have en-suite facilities. There is a large garden to the side and rear of the service.

At our last inspection, in November 2015, the service was then rated as “Good”. However, at this inspection we found there were some aspects of the service that needed to be improved.

The premises needed to be made safer for people living with dementia. In particular, all windows were required to be risk assessed and made secure with restrictors that comply with Health and Safety regulations.

There were also parts of the building where cleanliness needed to be addressed, for example in the laundry and sluice rooms that staff used. The physical environment was not decorated to a consistent standard, and in some bedrooms the bedding and carpets looked stained.

Staffing levels were adequate and people’s needs were met. However, we were told that staffing levels were based on the numbers of people living at the home. We have made a recommendation to the registered provider to also take into account the needs of people to ensure there are always sufficient staff.

Medicines practice was safe and well administered. We noted a gap in recording and protocols that affected a small number of people. These have been corrected since the inspection.

Whilst people were involved in decisions about their care, staff understanding of the legal basis for consent was limited. We could not find sufficient evidence that the service was acting in line with the legal requirements of the Mental Capacity Act 2005 (MCA). There were gaps in people’s records on mental capacity assessments and where decisions were taken in a person’s best interests.

People’s needs had been assessed to provide effective health and social care. Information about people was stored on a relatively new care management system. People’s personalities and needs were known by staff, but some individual care records needed to be updated.

We heard positive feedback about the way the service was managed from staff and relatives, but there were aspects of service governance that needed improvement. The quality assurance system was not effective in reviewing the quality of the service provided. Audits did not identify any actions to mitigate the risks or address the shortfalls we found. Learning from accidents and falls across the service was not developed.

People were looked after by staff who were kind and caring. We heard from relatives who praised the kindness and attention that was shown. However, some staff did not communicate as well as others and appeared task focused. We have made a recommendation to the registered provider that all staff are supported to communicate to a required standard of English.

Staff were trained (apart from in the Mental Capacity Act), supervised and supported to undertake their caring role. The provider had carried out appropriate checks on staff to ensure that they were suitable for their roles.

People were looked after by staff who knew about keeping people safe from abuse. There was evidence that risks to people were assessed. Staff knew people well enough to ensure they took actions based on risks and needs. Staff practiced infection control measures when caring for people. There was a plan in place to deal with emergencies.

People had enough to eat and drink throughout the day and their nutritional needs were being met. Meal time was positive with people enjoying their food. The cook was responsive to individual needs and knew about any dietary risks.

Healthcare professionals and specialists were involved in people’s care to monitor and to meet their health needs.

People were supported to undertake daily activities of their choice. There was also a clear programme of events and good use was made of the attractive garden for the benefit of people living at the home.

People could find their way in the building and the premises met the needs of those who lived there. People were enabled to be as independent as possible and their privacy and dignity was maintained by staff.

A complaints process was in place and this was followed. Where concerns by relatives had been raised, these were responded to and changes had been made. The management was accessible and responsive to people.

There was an end of life care plan in place for everyone. The service had established a link with the hospice and had experience of caring for people at the end of their lives.

We received positive feedback about how the service was managed from relatives, staff and visiting professionals. The staff and managers demonstrated they worked well together and were committed to the people in their care.

People and their relatives were encouraged to give feedback on the care and the service.

The service had some good partnerships with local services in order to support people’s healthcare. The registered manager attended local provider forums and was exploring ways the service could improve.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made five recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of this report.

People's needs were assessed and care and treatment was planned and delivered according to people's individual care plans. One person and their relative who had recently moved into the home praised the staff for their help and support during the transition.

People who used the service told us they they liked living in the home and that the staff were kind and caring.

We saw that people who used the service were involved in the planning of their care as much as possible. One person told us that their family was also considered in this process.

The home was clean and hygienic and staff were aware of their responsibilities regarding infection control. Individual bedrooms were cleaned daily and all communal areas of the home were clean and well maintained.

Staff told us they liked working in the home. They said they had received the training and supervision necessary to undertake their roles.

We looked at at the provider's quality assurance and complaints procedures in place. We found there was a good range of monitoring systems used to audit the quality of the service being provided.