Rose Hill Nursing Home

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 good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the provider had a proactive and positive culture of safety, based on openness and honesty, they did not always learn from previous concerns. For example, at the last 2 inspections, we found that monitoring systems were not always effective. At this inspection, this was still a concern. This meant lessons were not always learnt to continually identify and embed good practice. Further information is included in the well-led section of this report.

Incidents and accidents, safeguarding concerns and complaints were recorded. These were reviewed, discussed and analysed to determine any underlying causes or trends and to identify any actions required to improve the service.

The registered manager understood their responsibility under the Duty of Candour and was able to demonstrate how they had acted on this. There was an open approach to dealing with

concerns and problems. Relatives were kept informed and meetings had been held to address specific concerns or when people's care needs were reviewed.

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.

People told us the staff were available when they needed support and relatives stated they thought their family members’ needs were met. Relatives stated they were informed when their family members required support or treatment from different healthcare services.

The staff team and registered manager told us they worked well with other professionals to ensure continuity of care. Healthcare professionals told us they had a good working relationship with the service and communication was good.

People were assessed prior to them moving into the service and the management team worked with the local authority to introduce people to the service.

Staff told us they received good information about a person before they were admitted to the home, so they could understand and meet their needs and wishes.

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 from harm and abuse. Their comments included, “It is very good. When you call for them, they are very attentive. I have used the call-bell on the odd occasion, and I didn’t have to wait very long” and “There’s always a carer around.” A relative added, “It feels like a safe space to me. [Senior manager] introduced a large emergency button for the outside area. It means that help can be called for while people are in the garden.”

The staff received safeguarding training and regular refresher training to ensure they kept their knowledge up to date. Staff were able to describe how they would recognise signs that someone was being abused, and what actions they would take.

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred.

The provider understood their responsibilities under the Mental Capacity Act 2005 in ensuring Deprivation of Liberty safeguards (DoLS) applications were submitted as required. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

The provider worked well with people to understand and manage risks. Although staff provided safe care to people, risk assessments did not always contain adequate or correct information for staff.

Risks to people’s health and wellbeing were identified and managed well. For example, one person was at high risk of malnutrition. We saw they had been reviewed by a dietician, their weight was checked frequently, and they were being offered fortified food.

Another person was at high risk of developing a pressure ulcer. Their care plan stated how staff could support them to reposition themselves in bed and to check regularly for areas at risk. The person was monitored closely and was supplied with pressure relieving equipment which was regularly checked.

However, there were instances whereby risk assessments had not been put in place or had not been reviewed and updated when people’s needs had changed. This meant there was a risk staff supporting people would not have sufficient information about risk, and may not know how to support people safely, or reduce the risk of avoidable harm. We fed this back to the registered manager who assured us they would take appropriate action to make the necessary improvements.

Incidents and accidents were recorded and contained details such as a description of events leading up to the incident, action and response and post incident analysis. Each report also highlighted what has been put in place to prevent re-occurrence. Following the incident, an action plan was put in place and care plans and risk assessments were reviewed.

Care plans contained details to inform staff how best to support people with complex health conditions such as diabetes or Parkinson’s disease. Care plans contained details on how to recognise signs people were becoming unwell and what action to take. This meant the staff would be able to take appropriate action should they noticed people displaying symptoms.

Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Although people were mostly supported in a safe and well-maintained environment that met their needs, we identified that a water heater in one of the toilets had exposed pipes and taps. This meant there was an increased risk of injury to people. The registered manager agreed to get this boxed and confirmed this had been done following the inspection.

There was an unlocked storage area on the ground floor corridor between the kitchen and laundry which contained some unused items. This posed a risk of harm to people who may have accessed this area. The registered manager assured us they would keep this area locked at all times. Although the provider took immediate steps to rectify these issues, there was a risk that risk would have remained if we had not identified them.

Safety checks were completed daily and weekly in all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment. The provider employed maintenance people to look at any repairs that needed doing.

Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date emergency plan in place to help ensure people were supported in the event of an emergency.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. They used a dependency tool to help ensure there were always enough staff to meet people’s needs.

People’s opinion varied in relation to staffing levels. One person told us, “There’s always a carer around. I think there are enough carers normally – at night too.” Relatives agreed and said, “I think there are enough staff – when I ring the front doorbell someone always answers quickly.” However, one person stated, “Very often you can ring for a long time and they don’t come. All of this nonsense they’re doing today is for your benefit not ours. You can wait for ages for call-bells to be answered. When they get to your room they sometimes ask if you can wait longer as they are busy elsewhere so maybe they could do with more staff. I think there are only six staff on during the day and two at night – that’s definitely not enough.” We fed this back to the registered manager so they could address this.

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

Staff told us they were happy working at the home, felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service.

Staff were permanent and most had been at the service for a long time. The service did not use agency staff. They employed one bank staff who covered the occasional absence.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service. People commented, “I’ve never seen the cleaner but I’m happy with the cleaning. For personal care they usually wear gloves and aprons – not seen them without” and “I will say that they do the laundry well here.” A relative agreed and said, “The home is always clean. They’ve done a lot of decorating recently and that has made a big difference as it was looking a little shabby in places.”

Cleaning staff followed a cleaning schedule and used appropriate personal protective equipment (PPE). Care staff wore PPE when supporting people to help protect people from cross infection.

Appropriate systems were in place in relation to infection control. The provider ensured staff had access to PPE and were trained in the use of this. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The managers and senior staff carried out audits to ensure standards of cleanliness were good.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, we found some minor shortfalls. For example, a pre-filled emergency injection was stocked, but staff did not have the necessary training to administer it if required. This meant there was a risk a person may not receive prompt or effective emergency treatment. We highlighted this to the provider during the inspection, and they took appropriate action.

Medicines administration record (MAR) charts were in place and contained a photograph, date of birth, diagnosis and allergy information for each person. However, there was limited information on how people liked to take their medicines. Two people received medicines via a feeding tube. However, we were not assured that staff had sought appropriate advice on whether these medicines were safe to be given in this way. The MAR chart did not specify that the medicines were to be given via feeding tubes. This placed people at risk of receiving medicines incorrectly. The registered manager took appropriate action to address this.

Protocols to give ‘as required’ (PRN) medicines were in place. Daily bowel charts were completed and PRN medicines for constipation were given appropriately. However, staff did not have access to advice on how to manage any side-effects or what to do if the PRN medicine was not effective. This placed people at risk of uncontrolled symptoms or side effects. For example, one person’s PRN protocol for a medicine for severe anxiety had no information of other options to consider before administering medicines. We fed back these concerns to the registered manager who took appropriate action to rectify these following the inspection.

There was a medicines policy in place. Medicines were stored safely and securely and stocks were managed well. Regular medicines were dispensed in multi-compartment compliance aids (MCAs) in the drug trolley.

Temperature charts for medicines storage areas were completed daily and in the correct temperature range. Staff knew how to always get additional medicines advice. Medicines are considered time critical if a delay could lead to a person becoming unwell. We witnessed a time critical medicine given at the correct time. Where people were prescribed pain relief via skin patches, we saw staff used topical MARs with body maps to show where these were applied. We saw that patches were rotated appropriately.

Medicines were administered with care and compassion. Staff used hand gel before and after medicines administration. Gloves were worn while preparing and administering medicines given via feeding tube. Two tablet crushers were available, one for each person requiring tablets to be crushed.