Archived: Rosewood House

Rosewood House is a residential nursing care home providing personal and nursing care to up to 90 people. The service provides support to people aged 65 and over, including people living with dementia. At the time of our inspection there were 72 people using the service.

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

The registered manager assessed and mitigated risks to people’s health and safety. People had personalised risk assessments in place for different areas of risk, and clear care plans which contained advice for care workers in how to mitigate those risks. The provider followed good infection prevention and control practises and managed people’s medicines safely.

The registered manager conducted a range of audits and lessons were learned when things went wrong. Notifications of significant events were sent to the CQC as required.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA). The provider ensured there were enough staff on duty to support people and conducted appropriate pre-employment checks before hiring new staff.

Staff gave positive feedback about the service and people and their relatives were complimentaryabout the service overall.

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 and update

The last rating for this service was requires improvement (16 May 2023).

At our last inspection we found breaches of the regulations in relation to safe care and treatment as risk assessments were not always clear and good governance, as the provider had not always picked up on concerns through their auditing systems. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 28 November and returned announced, on 7 December 2023. We undertook this focused inspection to check they had followed their action plan and to confirm if they 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 is now 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 Rosewood House 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.

Rosewood House is a residential care home providing personal and nursing care to up to 90 people. The service provides support to people aged 65 and over, including people living with dementia. At the time of our inspection there were 67 people using the service.

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

The provider was still not consistently mitigating risks to people’s health and safety. People had personalised risk assessments in place for different areas of risk, but risk management guidelines did not always contain complete information and we saw some errors about the care people were supposed to receive in care documentation.

The provider was managing people’s medicines safely. People were getting their medicines as required and accurate records were being kept of medicines administration. Although medicines were stored safely, we found there was a risk to refrigerated medicines as not all staff knew how to reset fridge temperature gauges. We made a recommendation in this area.

The provider conducted a range of audits, but these did not Identify the issues we found. The provider was now meeting the requirements of the Mental Capacity Act 2005 (MCA). The provider ensured there were enough staff on duty to support people and conducted appropriate pre-employment checks before hiring new staff.

The provider followed good infection prevention and control practises and ensured lessons were learned when things went wrong. Notifications of significant events were sent to the CQC as required.

Staff gave good feedback about their experiences working for the service and people and their relatives gave good feedback about the service overall.

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 and update

The last rating for this service was requires improvement (27 January 2023). This is the fifth consecutive time we have rated the service requires improvement.

At our last inspection we found breaches of the regulations in relation to Safe care and treatment, Good Governance and Consent. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found although the provider had made some improvements, they remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 27 October 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 and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm if they 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 remains requires improvement. 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 Rosewood House on our website at www.cqc.org.uk

Enforcement and recommendations

We have found breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Rosewood House is a residential care home providing personal and nursing care to up to 90 people. The service provides support to people aged 65 and over, including people living with dementia. At the time of our inspection there were 62 people using the service.

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

The provider was not consistently assessing and mitigating risks to people’s health and safety. People did not have risk assessments in place for areas of risk that were unique to them. People’s wound care was not always being appropriately managed as records associated with wound care treatment were was not being fully completed.

The provider did not consistently meet the requirements of the Mental Capacity Act 2005 (MCA). We identified two examples of people who appeared to have fluctuating capacity, but there were no assessments completed of their capacity to make decisions. The provider ensured there were enough staff on duty to support people and conducted appropriate pre-employment checks before hiring new staff.

The provider did not manage people’s medicines safely. We found discrepancies in the provider’s medicines records and temperature checks were not being completed consistently.

The provider followed good infection prevention and control practises and ensured lessons were learned when things went wrong. Notifications of significant events were sent to the CQC as required.

The provider conducted a range of audits, but these did not identify the issues we found. Staff gave mixed feedback about their experiences working for the service. The provider confirmed they were addressing issues with staff morale and they were taking adequate steps in order to do so.

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 and update

The last rating for this service was requires improvement (4 July 2022). This is the fourth consecutive time we have rated the service requires improvement.

At our last inspection we found breaches of the regulations in relation to Safe care and treatment, Good Governance and Staffing. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing and pressure area care. 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 not changed following this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe 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 Rosewood House on our website at www.cqc.org.uk

Enforcement and recommendations

We have found breaches in relation to safe care and treatment and good governance at this inspection.

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.

We have made a recommendation in relation to consent. We will check if the provider has acted on any recommendations at our next comprehensive inspection.

Follow up

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

Rosewood House is a residential care home providing nursing and personal care for up to 90 people aged 65 and over, including people living with dementia. They also had a unit dedicated to providing neurological care. There were 55 people living in the home at the time of the inspection.

Rosewood House has three separate floors that each consist of two units, able to support 15 people within each unit. The units have separate adapted facilities. At the time of our inspection, one unit on the first floor was not open as it had just completed renovation works.

The home changed its name from Hawthorn Green Residential and Nursing Home to Rosewood House in September 2021.

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

People and their relatives were positive about the kind and caring attitude of the staff team. One person said, “I have built up a good rapport with the staff and feel they give me good care.” All the relatives we spoke with felt the home had a welcoming environment.

People’s medicines were not always managed safely. Issues we identified at the last inspection had not been fully addressed.

Infection prevention and control practices did not always ensure people were fully protected from COVID-19. Although the home was clean and hygienic and staff were reminded about safe practices, we observed regular poor compliance of staff wearing masks properly throughout the inspection.

Staffing levels were not always consistent across the units to be able to meet people’s needs. People told us this impacted the care they received. Staff told us they regularly raised their concerns about how staffing levels increased the risk to people’s care or being able to support people in a timely way.

Risks to people's safety and guidance for staff to follow to manage these risks were not always recorded or in place for staff to understand how to support people safely.

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 practice.

People and their relatives felt they had been well supported during the COVID-19 pandemic and had been kept updated when needed. One relative said, “The manager is brilliant, they will always try and sort out any problems.”

Monitoring and auditing systems did not always identify and remedy any issues with the quality of the service. Feedback from staff was mixed about the working environment and the support they received. Some staff told us they did not feel their issues were listened to.

The provider had failed to notify us about all the incidents that had occurred across 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 inspected but not rated (published 30 March 2021), which meant the rating at the time of the inspection did not change from requires improvement.

This is because we carried out a targeted inspection. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 the provider remained in breach of regulations.

Why we inspected

We received anonymous concerns in relation to staffing levels, the safety of people’s care and support and general concerns about the management of the service. 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 remained as requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

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.

Enforcement

We have identified a continued breach in relation to the management of medicines. We have identified breaches in relation to staffing and good governance.

We have sent a Regulation 17(3) Letter to the provider in relation to their failure to effectively operate systems and processes to assess, monitor and improve the quality and safety of the services provided in carrying on the regulated activities. A Regulation 17(3) Letter stipulates the improvements needed to meet breaches of regulation, seeks an action plan and requires a provider to regularly report to CQC on their progress with meeting their action plan.

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.

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

Hawthorn Green Residential and Nursing Home is a residential care home providing nursing and personal care for up to 90 people aged under and over 65, including people living with dementia. There were 45 people living in the home at the time of the inspection.

Hawthorn Green has three separate floors that each consist of two units, able to support 15 people within each unit. The units have separate adapted facilities. At the time of our inspection, the first floor was closed due to refurbishment works.

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

People were positive about the caring attitude of the staff team and how they supported them to stay safe. One person said, “The staff are the best thing. They help me with my medicine, they come and check on me and respond quickly. They look after me and I feel safe in the home.”

Health and social care professionals felt improvements had been made since the last inspection and had observed many examples of positive interactions when staff were supporting people in the home. There was particular praise for the wellbeing team and their level of engagement.

People told us they had been well supported during COVID-19 and staff had helped them to stay in touch with their relatives due to visiting restrictions. One person said, “They do wear their PPE when they are helping me. They wear it all the time.”

People were supported by a dedicated staff team that were very positive about the support and reassurance they received, especially at challenging times during the peak of the pandemic. Staff told us they would get daily updates and reminders about following infection control procedures. Health and social care professionals who had been able to visit the home did not highlight any concerns about infection prevention and control practices.

People and staff told us the registered manager was available, always listened and responded to any concerns. One person praised the whole staff team and said, “They have managed with great courage to come to work and carry out their work as almost as normal as possible. They have been my lifeline.”

Although we saw improvements had been made since the previous inspection, there were still some areas of improvement needed in the management of people’s medicines. The management team acknowledged this and had started to address the issues we found.

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 January 2020) and there were two breaches of regulations. We issued a Warning Notice after the last inspection and the provider completed an action plan to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. It was also carried out to check if the provider had met Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which they were also in breach of at the last inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Hawthorn Green Residential and Nursing Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

The inspection was also prompted in part due to anonymous concerns received about infection and prevention control, medicines, a data breach and general concerns about the management of the service. These concerns had also been shared with the local authority and had resulted in a safeguarding enquiry that was concluded in November 2020. The majority of allegations were not substantiated and a decision was made for us to follow up the recommendations from the local authority safeguarding enquiry.

Although improvements were found and the provider was working towards making further improvements across the service, not enough improvement had been made regarding the management of people’s medicines and further improvements were still in the process of being implemented. Please see the safe section of this full report.

Enforcement

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.

Whilst the warning notice for Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, we identified a continuing breach in relation to the management of medicines. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request 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 commissioning authorities to monitor progress. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Measures were in place to minimise the risk of visitors catching or spreading illness. The service was closed to non- essential visitors at the time of our inspection but was building a bespoke visitors room with a separate entry for visitors and people using the service and a Perspex screen dividing both parties in order to minimise the risk of transmission of illness. Face masks and other Personal Protective Equipment (PPE) was available for visitors upon completion of the room to ensure there was no transmission of illness from visitors to staff. The internal environment was arranged to accommodate social distancing and there were electronic tablets within the home for conducting virtual meetings.

The provider had full access to Personal Protective Equipment (PPE) and care staff confirmed this. Staff had received appropriate training in infection control procedures both internally and from external providers and had explained the need for PPE to be worn to people using the service.

The provider had implemented a programme of testing for both people using the service and staff. However, at the time of our inspection, not all staff were participating in the testing programme. We have signposted the provider to resources to help develop their approach with regard to this issue.

At the time of our inspection, nobody using or working at the service had tested positive for Covid 19. Staff were restricted to work in the same area of the building to minimise the risk of spreading illness.

Hawthorn Green is a residential care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 90 people.

The care home accommodates 90 people across three separate floors that each consist of two units. The units have separate adapted facilities. At the time of our inspection, the ground floor was closed due to refurbishment and people had therefore been moved to the first and second floor of the building.

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

The provider was not managing people’s medicines safely. There were numerous issues with record- keeping that created a risk to people using the service. The provider was not always assessing the risks to people’s health and safety and appropriately mitigating these. The provider had not assessed night- time staffing numbers to ensure they had enough staff in place to meet people’s needs. Audits were conducted into the quality of care, but these did not fully identify the issues we found.

The provider conducted appropriate pre- employment checks before staff started work. Appropriate investigations were conducted into accidents and incidents and lessons were learned as a result of these. The provider had appropriate safeguarding procedures in place and staff were aware of their responsibilities to safeguard people from abuse.

People and staff gave positive feedback about the service and told us improvements were being made. The provider was open and honest about their performance and improvements that were required. The management team and care workers understood their responsibilities. People and staff were engaged by the provider to give feedback through meetings. The provider worked closely with multi- disciplinary professionals to deliver care.

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 20 February 2019). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

This service has been rated requires improvement for the last seven consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines and the care for people at risk of pressure ulcers and at risk of falling. 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 is Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well- led sections of this full report.

We have made a recommendation about staffing numbers.

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

Enforcement

We have identified breaches in relation to Safe Care and Treatment and Good Governance.

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.