Rosedene Nursing Home

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location was supporting 5 people with a learning disability or autism. We therefore assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Rosedene Nursing Home is a residential care home providing personal and nursing care to up to 67 people. The service provides support to both younger and older adults with complex mental health care needs. Some people residing at the service were also living with dementia or as described above have a learning disability or autistic spectrum disorder. At the time of our inspection there were 42 people living at the care home. The care home accommodates people in 1 adapted building comprising of 2 floors, each with their own separate facilities.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

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 kept safe and were confident any concerns they raised would be listened to. Staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and knew how to apply this knowledge. Enough staff were deployed to meet peoples assessed needs whose suitability and fitness to work at the care home has been thoroughly assessed. The premises was kept clean, and tidy, and staff followed current best practice guidelines regarding the prevention and control of infection. People received their prescribed medicines as and when they should. The provider worked well with external health and social care agencies and professionals to plan and deliver people’s packages of care.

Right Care

The care and support provided by staff was person-centred. Staff knew and understood people, and responded well to people’s individual needs. Risks to people and staff were assessed, monitored, and reviewed. Staff were aware of how to manage risks people they supported might face and how to keep them safe.

Right culture

The care home’s culture was positive, open, and honest, with leadership and management that was clearly identifiable and transparent. The provider sought the views of people living in the care home, their relatives, and staff working there. Staff were aware of and followed the provider’s vision and values which were clearly defined. Staff knew their responsibilities, accountability and were happy to take responsibility and report any concerns they may have. Complaints, concerns, accidents, incidents, and safeguarding issues were appropriately reported, investigated, and recorded. The service quality was reviewed regularly, and appropriate changes made to improve people’s care and support if required.

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 this service was good (published 11 May 2022).

Why we inspected

We received concerns in relation to how the care home was being managed, specifically relating to an increase in the number of incidents involving people living at the care home being harmed. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We did not inspect the key questions of effective, caring and responsive. 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 and for both key questions safe and well-led remains good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedene Nursing Home 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. If we receive any concerning information, we may inspect sooner.

Rosedene Nursing Home is a care home registered to provide accommodation and personal care for up to 67 people although a maximum of 45 people are usually accommodated. The service provides care and support to people living with complex mental health needs and /or dementia. At the time of our inspection there were 41 people using the service.

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

Family of people using the service were positive about the service provided at Rosedene Nursing Home. They told us that a consistent team of staff, some of whom had worked at the service for a long time, supported their relative and ensured their health and welfare. They said staff were kind, caring and respectful towards people using the service.

Staff were recruited safely, had appropriate training and were well supported by the longstanding registered manager. Safe staffing levels were maintained.

The management and administration of medicines was safe. People received their medicines as prescribed.

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 benefitted from effective leadership of the service. The registered manager ensured the home had a caring and accepting culture. People using the service knew her and staff told us they could talk to her if they had any concerns or for advice and support.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 3 August 2021).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm.

We also 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedene Nursing Home 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.

We found the following examples of good practice:

The staff and managers of the home had worked hard to ensure that people understood the risks associated with COVID-19 and followed appropriate government guidance. People who found it difficult to isolate when necessary were provided with one-to-one support, as were people who were required to isolate as they had recently moved into the home.

Staff supported people to maintain contact with their loved ones through video and phone calls when the home was closed to general visitors. When restrictions were lifted, the home made use of a summer house to ensure people were able to see their loved ones safely without having to enter the main building of the home.

Staff took into account people’s social and emotional needs and ensured people were able to participate in regular activities safely, with one-to-one support and in small groups. The layout of the home had been adapted to provide additional space to encourage people to maintain appropriate distance during meals and small group activities.

Staff and people who lived at the home participated in regular testing programmes and were required to isolate should they return a positive test. The home made use of exclusive agency staff who were also required to participate in regular testing. Visitors for people who use the service were also subject to rapid testing before their visit to reduce risks.

The home was clean throughout. Cleaning schedules had been increased to ensure that specific areas identified as high risk of transmission of COVID-19, such as light switches and other touch points, were cleaned several times per day. The home had added domestic shifts throughout each day to ensure there was enough staff to undertake the additional cleaning.

The home had adequate supplies of personal protective equipment (PPE) and we observed that most staff wore these according to government guidance. Staff had been trained in infection prevention and control specifically relating to the risks associated with COVID-19.

The provider, registered manager and clinical lead had worked hard throughout the pandemic to ensure staff felt supported and their well-being was prioritised. They told us they had received excellent support from the GP, local authority, clinical commissioning group and especially from the local Behaviour and Communication Support Service, who had run one-to-one and small group counselling sessions for staff throughout.

Rosedene Nursing Home accommodates up to 63 people in one adapted building. At the time of our inspection 42 people were living at the home.

People’s experience of using this service

People received care in a safe environment, that had effective infection control measures in place. Medicines were well managed and potential risks to people were appropriately assessed. Although it required an aesthetic update, the environment was safe. Staffing levels were assessed and maintained in line with people's needs. Staff were recruited safely.

Management took appropriate steps to ensure people, relatives and staff were supported. Quality assurance measures were in place to review the quality of care delivery. A new clinical lead supported developments and improvements across the service. The provider worked effectively with other partnership agencies to ensure they could meet people's needs.

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 this service was good (published 16 June 2018).

Why we inspected

We received concerns in relation to the management of staffing, infection control and the competency of management. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

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.

At our last inspection on 20 and 22 February 2017 we found the provider had made some improvements to the service following the completion of an action plan. At this inspection we found that further improvements had been made to develop the service, and we were able to assess the effectiveness of these as the improvements had been in place over a sustained period of time.

Rosedene 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.

Rosedene Nursing Home accommodates up to 67 people in one adapted building. At the time of our inspection 43 people were living at the home. The home was split into three floors with a mix of people with varying needs on each floor.

A registered manager was in place at the time of our inspection. 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.

Improvements were needed to ensure medicines were handled as safely as they could be. We have made a recommendation about the management of medicines. Guidance was not always sought from the pharmacist in the administration of covert medicines and appropriate records were not always used to ensure that medicines were accurately recorded. Following the inspection the provider contacted the pharmacist and implemented the appropriate records. We will check on their progress with this at the next inspection.

People told us they felt safe living at the home and staff were aware of how to report and manage any safeguarding concerns. Infection control procedures were in place to maintain hygiene across the home.

Risks to people were assessed to ensure that appropriate action was taken to mitigate risks and keep people as safe as possible. We found that there were appropriate staffing levels to meet people’s needs and keep them safe.

Accidents and incidents were investigated when they occurred and improvements made to prevent future events. People were protected through safe recruitment processes.

Staff received appropriate training, supervision and appraisal to support them in delivering their duties. Effective handovers took place to ensure continuity of care when there were changes in shifts.

People were supported to maintain a balanced diet and received enough to eat and drink. Where required people were supported to access a range of healthcare professionals to meet their needs.

People’s consent was sought in line with the Mental Capacity Act 2005 (MCA), including best interests decisions and applications were made to the local authority where people were deprived of their liberty.

People felt cared for by staff at the home, and staff we spoke with knew the needs of individuals well. People were treated with kindness and compassion and were supported to express their views.

A complaints policy was in place that was accessible to people, and they knew how to raise any concerns. People received stimulation through a range of activities on offer and were supported to access local events of their choosing. Where necessary people’s records evidenced their preferences in relation to end of life care.

People, their relatives and staff spoke positively about the management of the home. Efforts were made to improve engagement with community agencies to ensure people were engaged and involved. Regular quality checks were carried out to drive improvement across the service.

At our last comprehensive inspection on 14, 16 and 20 June 2016 we found breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance, staffing and submitting notifications to the CQC. We issued warning notices in respect of the breaches relating to person centred care and dignity and respect. Following receipt of an action plan from the provider we returned to complete a focused inspection on 19 September 2016 to check that the provider had met the requirements in relation to person centred care and dignity and respect. We found that some improvements had been made but these improvements were ongoing and had not been fully implemented at the time of the inspection. During this inspection we checked that the provider had fully implemented their action plan to make the required improvements to the service.

Rosedene Nursing Home provides care and support for up to 67 people who require nursing and personal care. There were 42 people using the service when we visited. There are three floors within the building and people of different genders, mobility and mental health diagnosis were placed on each floor.

There was a registered manager at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or sooner if the person’s care needs had changed.

Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty authorisations to ensure this was lawful.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision, however, not all staff who had been working at the service for over a year had received an annual appraisal of their performance. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice from the dietitian was followed by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals.

People using the service felt able to speak with the registered manager and provide feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave good feedback about the registered manager.

People were encouraged to participate in activities they enjoyed and people’s participation in activities was monitored. People’s feedback was obtained to determine whether they found activities or events enjoyable or useful and these were used to further develop the activities programme on offer. The activities programme included a mixture of one to one sessions and group activities.

The organisation had implemented improved systems to monitor the quality of the service. Feedback was obtained from people through quarterly residents and relatives meetings as well as bi annual questionnaires and we saw feedback was actioned as appropriate. There was evidence of auditing in many areas of care provided. However, we were unable to fully assess the effectiveness of these as they had not been in operation for a sufficient amount of time.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rosedene Nursing Home is a nursing home that provides care for up to 67 people with a broad range of health needs, with the majority having a diagnosis of a mental health condition. There are three floors to the building and people of different genders, mobility and mental health diagnosis were placed on each floor. At the time of our inspection there were 43 people using the service.

There was no registered manager at the service although the manager was in the process of registering with the CQC. 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.

At our previous inspection we found that care records did not contain consistently up to date information about people’s current healthcare needs. At this inspection we found that whilst some improvements had been made, these improvements were ongoing and there were still some gaps in care records.

At our previous inspection we found that whilst people were encouraged to eat a healthy and balanced diet care records contained incomplete information for care workers about how to meet people’s nutritional needs. At this inspection we whilst found some improvements had been made in this area, these were not consistent and care plans still contained some gaps.

At our previous inspection we found that people’s dignity was not respected. Some areas of improvement were noted during this inspection and we saw positive interactions between staff and people using the service. It was noted that people’s personal preferences were not always considered in relation to the drinkware that was used.

At our previous inspection we did not see evidence of activities being conducted to aid people in their recovery or rehabilitation and there people’s involvement with activities was not consistently recorded. At this inspection we found people provided good feedback on the activities on offer. However, there was still little evidence of appropriate activities that provided therapeutic benefit to people and there were still issues with regard to the consistent recording of activities.

Rosedene Nursing Home is a nursing home that provides care to up to 67 people with a broad range of health needs, with the majority having a diagnosis of a mental health condition. There are three floors to the building and people of different genders, mobility and mental health diagnosis were placed on each floor. At the time of our inspection there were 46 people using the service.

There was no registered manager at the service although the manager was in the process of registering with the CQC. 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities. However, staff were not recording the site at which they were giving people their injections creating the risk of causing people unnecessary pain by potentially injecting them in the same place and the date of opening on some topical medicines was not marked.

When questioned, staff appeared to be clear about safeguarding procedures and when to report an incident. However, we became aware of two safeguarding incidents which had not been reported or investigated and potential safeguarding concerns were not always addressed.

Staff told us they had received training in what to do in the event of an accident or incident, but most staff told us they had not received training in how to manage instances of violent aggression from people and the training records supported this. We observed one incident where a care worker did not manage a potential incident appropriately.

Information in care records and risk assessments was inconsistent and confusing. We found some examples of known risks not being fully explored through specific risk assessments and care planning as a result. We also found that staff did not always respond to risks appropriately to ensure that people were protected from avoidable harm.

Care staff gave us mixed feedback about whether they felt there were enough of them on duty to do their jobs properly. The manager was unable to provide us with evidence of how they determined safe staffing numbers or ensured that people with the right skills were on duty.

Recruitment records contained the necessary documentation to recruit staff safely.

The service was not compliant with the Mental Capacity Act 2005. We found examples of people being deprived of their liberty without having the necessary authorisations from the local authority.

However, staff told us they had received training in the MCA and were able to demonstrate that they understood the issues surrounding consent.

Care records did not contain consistently up to date information about people’s current healthcare needs.

Care records contained very little detail about people’s life histories and some care staff lacked basic knowledge about the people they were caring for. Some care staff had very limited knowledge about some of the common mental health conditions people had and some staff providing one to one care were unable to explain why the person they were supporting required this level of care from them or what risk they were addressing by doing so.

People were encouraged to eat a healthy and balanced diet. People provided good feedback about the food available and the chefs were clear about what food they were required to prepare to cater for people’s individual health needs.

Staff training records were incomplete so we could not be assured that care staff were receiving the mandatory training required to conduct their roles. Staff told us and records demonstrated that they were not receiving regular supervisions or appraisals of their performance.

We saw some examples of caring interactions between staff and people using the service. However, some of our observations were of a dismissive attitude towards people’s care needs and we observed some instances of unkind treatment. We reported this behaviour to the manager who took appropriate action.

People’s dignity was not protected. We saw some examples of care staff not respecting people’s dignity.

People provided good feedback on the activities on offer. However, there was little evidence of appropriate activities provided for people to aid their therapy or rehabilitation

People and care staff gave mixed feedback about the manager. There was a complaints policy in place, but complaints were not responded to appropriately.

The organisation did not have good systems in place to monitor the quality of the service. There was no evidence of regular auditing being conducted.

During this inspection we found breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance and submitting notifications to the CQC. You can see what action we told the provider to take at the back of the full version of the report. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

A single inspector carried out this inspection. We were supported on this inspection by an expert-by-experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The provider had an effective system in place to report and investigate safeguarding concerns.

Is the service effective?

Care plans were current and reflected people's individual needs and choices. Staff had received relevant training to enable them to carry out their role effectively.

Is the service caring?

We observed staff treating people with respect and offering them choices. They engaged with people and were familiar with the needs of people they were caring for.

Is the service responsive?

Some people using the service had their liberty restricted. The provider had followed appropriate guidance and applied for a Deprivation of Liberty Safeguards (DoLS).

Is the service well-led?

The provider had taken steps to enable learning from incidents. Staff told us they felt well supported and that there was an open culture at the home.

We looked at a number of care plans. Although they had been reviewed and updated recently, they lacked detail to enable care workers to support people using the service appropriately. We saw that staff did not always read the care plans for people, this meant they were not always aware of the risks to people, what mental health illness they had or how best to support them.

People using the service told us they felt safe in the care of staff in the home. One person said 'I have lived here for five years and have never had to make a complaint'. A relative said 'after visiting my aunt I always feel confident that she will not come to any harm'. The safeguarding and whistleblowing policy contained out of date information.

Although staff attended training, there was a lack of staff supervision at the home. Staff felt they were not fully supported.

Records relating to health and safety around the home were accurate and fit for use. However, other records relating to the care and welfare of people were missing key information.

We noted that the home was clean and staff were knowledgeable about the requirements for infection control. Staff said they were happy with the current arrangements and equipment for keeping the home clean and controlling infection. All staff carried hand sanitizers with them.

Staff told us that they were 'never short of the necessary equipment' in order to carry out their jobs. One cleaner told us that 'We are never short of cleaning staff'.

We looked at ten care plans, these included risk assessments. These were reviewed on a regular basis. We observed lunch time at the home; people using the service made positive comments about the food; one person told us "the food is very tasty and just like home".

We looked at staff rotas and we spoke with the manager about staffing levels at the home. The home employed a range of clinical and non clinical staff, including nurses, healthcare assistants, cleaners, kitchen staff and maintenance contractors.

Monthly residents meetings were held at the home and people using the service were encouraged to attend and have their say. The manager told us they tried to implement changes to the homes based on feedback received from surveys that had been conducted recently.