Rosedene 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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s medicines and the safety of the care home environment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider encouraged a learning culture that promoted people’s safety. The registered manager and clinical lead reviewed accidents, incidents, near misses and adverse events. This was done to identify causes and take action to prevent reoccurrence. The lessons learnt were shared with staff to improve people’s safety.

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.

The provider ensured pathways to the service were safe. Prior to resettling to the nursing home, leaders reviewed the assessments undertaken by social workers. This was to confirm the service could meet people’s needs. The provider then undertook their own initial assessment with people and their relatives to confirm their preferences for care and support. In partnership with people, their relatives and healthcare professionals, the provider developed care plans detailing how people’s assessed needs should be met. 6 weeks after people moved into the service, the provider coordinated a review meeting to assess people’s needs, and evaluate their resettlement. Care records were then updated to reflect people’s changing needs.

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 were protected from improper treatment. The provider had a safeguarding policy in place and staff received safeguarding training. Staff we spoke with understood the signs of abuse to be alert to, and told us they would report any concerns about people’s safety to the registered manager.

The registered manager understood their responsibility to report any safeguarding concerns to the local authority and the regulator. When concerns had arisen, the provider participated in investigations and relayed the findings to people and their relatives. This meant the provider was transparent and worked in partnership with professionals.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the provider had DoLS policies and procedures in place. Where people were subject to restrictions to keep them safe, details of the deprivation, the assessments supporting it and the duration it applied for were stated in care records. Where the outcome of further DoLS applications were awaited, the service retained copies of correspondence with the local authority team responsible.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were protected from avoidable harm. Staff assessed people’s risks. These included people’s mobility, skin integrity, swallow and behaviour. Where risks were identified risk management plans were in place to mitigate them. For example, where people were at risk of falling, falls risk assessments were in place.

When required, staff made referrals to healthcare professionals to carry out specialist assessments. For example, referrals were made to tissue viability nurses when people were identified to be at risk of pressure sores. Staff followed their guidance to protect people’s skin. Staff actions included using pressure relieving equipment, turning people regularly and maintaining optimal hydration and nutrition.

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

The provider did not carry out and record continuous and robust safety checks. For example, the provider was not able to show us any records in relation to the regular testing of the fire call bells or water temperature checks. No emergency lighting tests were recorded as having been completed during the 3 months before our inspection This meant that the provider had not assured themselves that the fire alarm system was working properly or that water temperatures were safe.

The décor and furnishings in the care home were dated, tired and worn. Carpets along corridors were old and damaged. Doors, doorframes, handrails and skirting boards were chipped and scuffed. Tiles in bathrooms were chipped. One member of staff told us, “We talk about this all the time. We need new carpets throughout. We really need updating. Toilets need reflooring. It really needs improving. It’s embarrassing when we have visitors.” Another member of staff said, “The home is safe but we’re not the best looking. We need to update for sure.” A third member of staff told us,” We need a refurbishment as soon as possible. Furniture needs updating. A lick of paint and new carpets to start with.” At the time of our inspection one bedroom had recently been redecorated and refurbished.

The environment of the nursing home was not dementia friendly. The walls were painted magnolia and the doors and door frames were white. This meant people living with failing vision had no colour contrasts to support their depth perception. There was a lack of large, colour, pictorial imagery indicating the purpose of rooms. This meant that the orientation of people living with dementia was not supported within the environment.

Notwithstanding the above, the provider ensured that a range of checks to maintain the safety of the environment were carried out. For example, hoists and equipment, gas safety, legionella and portable electrical appliances were tested and certified. We also found action to resolve shortfalls. For example, when checks identified the need to replace some existing fire doors, this was completed and recorded.

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.

People received their care and support from trained and supervised staff. One healthcare professional told us, “The staff are confident, knowledgeable, and demonstrate a good understanding of their clients’ needs.” Another healthcare professional told us, “The staff are eager to learn and have participated in all our training programmes.” Nurses, care staff, kitchen staff and domestic staff received on-going training to keep their skills up-to-date and people safe.

At the time of our inspection 18 care staff and 2 nurses were present and providing direct support to 44 people. There were also kitchen, admin and domestic teams. Supernumerary managers were on-site providing leadership. These included the registered manager and clinical lead. This meant the provider deployed enough staff to deliver care and support safely.

The provider followed robust processes when recruiting staff. The vetting of new staff included taking up references, confirming addresses and identities, and criminal records checks. New staff were inducted and were required to perform satisfactorily through a probationary period. This meant that staff were safe and suitable to provide care and support.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The care home was kept free of obstacles and hazards which enabled people to move safely around the home. Cleaning staff were a visible presence in the care home, maintaining the environment to a good standard of hygiene. Domestic staff followed structured cleaning schedules. They told us, “We have a checklist that we complete as we go along” and “Once a month, we do a deep clean.” However, the worn carpets, and damaged handrails, bathroom tiles, doors and skirting boards meant that regular cleaning could not optimise effective infection prevention and control.

People received their food safely. Kitchen staff ensured that the kitchen environment was cleaned regularly and followed best practice around food storage, preparation and serving. Opened food was labelled with the date of opening. Kitchen staff ensured food was cooked to the appropriate temperature before serving and recorded these. The service had a recent food hygiene rating of 5, which reflected good practices around food handling, cleanliness and food safety.

Staff that we spoke with told us there were adequate supplies of Personal Protective Equipment (PPE) which we observed them wearing during the inspection. One member of staff told us, “We have all the cleaning materials we need.” Hand sanitisers and soap were available throughout the service for effective hand washing. This helped to minimize the risk in relation to poor hand hygiene. Cleaning chemicals which could cause harm were locked away to prevent people accidentally coming into contact with them. These substances were routinely audited to ensure people’s safety.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Healthcare professionals assessed that it was proportionate, necessary and in some people’s best interests for them to receive their medicines covertly. However, we found instances where medicines records did not state how convert medicines should be administered. We also found instances where medicines were crushed to administer them, when pharmaceutical instructions stated that the medicines should not to be crushed. Additionally, we found that one person’s agreed list of covert medicines was out of date and did not correspond with the current medicines the person was taking. This meant that there were shortfalls in the provider’s management of covert medicines processes.

To support some people’s health needs healthcare professionals prescribed ‘controlled medicines.’ These are medicines with a higher risk profile, for which the service has additional safety and monitoring responsibilities. We found instances where controlled medicines were not labelled by staff to state the date they were opened. In one instance, a person’s prescription stated the bottle was to be labelled with the date of opening and discarded after 3 months. Staff were not able to tell us when the medicine been opened. Although we found no evidence that people were harmed, there was a risk that the 3-month period had lapsed.

Notwithstanding the above, people had medicines care plans in place which were updated regularly and medicines administering records were completed by staff. Leaders carried out audits of medicines records, stocks and storage.