Rosewood Lodge & Brook House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last inspection the provider was in breach of the legal regulations in relation to risk management, infection prevention and control, premises and equipment and recruitment. At this assessment improvements had been made, and the provider was no longer in breach of regulations.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a proactive and positive culture of safety based on openness and honesty. Lessons were learnt to continually identify and embed good practice. There was a process in place to record accidents and incidents, with audits of themes and trends completed monthly.

Staff told us they had a learning culture. One staff member told us, “We have discussions about the situation, and it all gets handed over, we make everyone aware, so it doesn’t happen again, we have a learning culture.” The registered manager gave examples of how they shared learning from incidents with staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. One professional told us, “I have been given a full handover of any events that are important and any increasing risks that are of concern.” Another professional gave an example of a person who moved to the home suddenly without a lot of time to plan. The professional told us, “All staff understood the issues involved and were so responsive in communication, facilitating visits and helping locate a new GP. [Name of person] settled so smoothly, as to almost disguise what a lot of work had to go into making it look quite easy.”

Records of individuals' care needs were maintained for sharing with other professionals when necessary. A process was in place to ensure relevant information was communicated when individuals were admitted to hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they were safe. One person told us, “I feel safe here.” Another person commented, “Yes, sure I feel safe.”

Staff understood their responsibility to report abuse and neglect and felt confident to do this. One staff member told us, “We know people well and would recognise any changes. I would report it straight away to the managers, I am aware of whistleblowing. [Name of registered manager] is constantly notifying safeguarding of incidents; we are quite open here.” A health professional told us staff worked collaboratively with them, and they were confident the service alerted safeguarding with any concerns regarding the safety and wellbeing of the people they supported.

The registered manager was aware of their responsibility to ensure appropriate applications were completed where required to authorise a person being deprived of their liberty.

The provider worked well with people to manage risks. There were improvements to people’s risk assessments. Professionals confirmed risks to people were managed well. One professional told us, “They work really well with us to mitigate risks.” Another professional commented that risks and incidents were, “Managed in a person centred and supportive way to prevent impact and keep all involved as safe as possible.”

Risks to people were identified in their care plans and there were control measures in place to mitigate the risks. Areas covered included deterioration in mental health, anxiety, emotional wellbeing, smoking and people’s Personal Emergency Evacuation Plans (PEEPS).

The provider did not always address potential risks in the care environment. They did not make sure that equipment and facilities supported the delivery of safe care.

Although the overall environment had improved and areas of the home had been redecorated and refurbished since our last inspection, there was an environmental action plan in place detailing further works required. This included some shortfalls in relation to fire safety. There were fire checks completed by external contractors. Some of the issues found during these checks were not always acted upon in a timely way. We discussed this with the registered manager who demonstrated actions had been taken. For example, work had been completed on some the fire doors and there were still some that needed work. This work was completed during the assessment. The registered manager had been raising the outstanding work with the provider. During the assessment the registered manager gave us assurances the work was being completed. They were liaising with the fire service to discuss any ongoing work required.

The service had a system in place to carry out environmental checks. Regular checks were carried out on areas of the home such as the water, fire, gas and electric.

The provider ensured there were enough qualified, skilled and experienced staff and ensured staff received effective support, supervision and development. However, records did not demonstrate staff were always recruited safely. Although there had been some improvements since the last inspection, for example, photos were now on staff files, there were still some gaps in recruitment records. For example, 1 staff member only had 1 employment reference on file and 2 staff members had gaps in their employment history. During the assessment the registered manager confirmed these documents had been placed on staff files.

Staff received training in mandatory subjects and subjects specific to people’s needs. Areas included, mental health, health conditions and supporting people when they were anxious. The registered manager had oversight of staff training, and they gave us assurances where staff training had expired, dates were booked. The registered manager was arranging for professionals to deliver training in specific subjects, and they were planning for a person with lived experience to share their recovery journey with people and staff.

Staff were positive about the training they received. One staff member told us, “It’s pretty good, they are constantly refreshing us, it’s enough and if we want extra it would be available, I’ve had new training recently.” A health professional commented, “They are happy to promote training for their staff and encourage input from other professionals.” Staff worked together to make sure people received their care and support safely.

Staff told us they felt supported and received supervision. Staff felt able to request supervisions if needed. One staff member told us, “We do have supervision, I had 1 last month, [name of staff member] does them well, I feel listened to and can raise anything.”

The provider assessed and managed the risk of infection. There were improvements to infection prevention and control procedures since our last inspection. They detected and controlled the risk of it spreading. The home was observed to be clean. Cleaning schedules were in place, including regular deep cleans. Infection, prevention and control risk assessments were in place and spot checks and audits were carried out. Staff had access to the necessary personal protective equipment (PPE) and were seen wearing it throughout our visits.

The provider did not always make sure all areas of medicines management were safe.

Where people required medicines ‘as required’ (PRN) there was some guidance available in people’s care plans for when these medicines should be administered. However, there were not always clear PRN protocols in place. Staff knew people well and described how and when they would administer PRN medicines. We discussed this with the registered manager who addressed this during the assessment.

One person’s medicines were ‘secondary dispensed’ at times, meaning staff placed them in a dosset box ready for the person to take. Although this had improved outcomes for the person receiving their medicines, there was not a risk assessment in place to mitigate any risks. We discussed this with the registered manager who confirmed they would complete a risk assessment.

Medicines were administered as prescribed. A health professional told us, “Medication adjustments from our side have been implemented effectively and without delay, which speaks to good communication and safe practices in medication management.”

People were involved in their medicines planning. Fire risk assessments for flammable emollients were in place. Regular medicines audits were completed. Staff received training and storage of medicines was appropriate and secure.