Rosedale Centre Also known as javascript:void(0)

Rosedale Centre accommodates up to 44 people across four separate units, each of which have separate adapted facilities. Currently 3 of the 4 units were being used. People do not generally stay at Rosedale for more than six weeks although there are, on occasion, exceptions to this. People are admitted following discharge from hospital or from the community in an attempt to prevent hospital admission. At the time of our inspection there were 31 people living at Rosedale Centre.

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

People and relatives told us they felt the service was safe. The home was clean and safety checks were carried out. There were enough staff to meet people’s needs quickly. Any incident or accidents in the home were responded to and learning shared.

Risks to people’s health, safety and well-being were effectively managed. Medicines were administered safely. The provider had effective infection prevention and control systems in place.

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.

The home had a registered manager who had good knowledge of people’s needs and clear oversight of processes in the home. There were systems to assess the quality of the service, which were closely monitored. People, relatives and staff gave us positive feedback and told us they had opportunity to comment on the service. Staff sought us out to tell us how the culture of the service had improved under the management team and staff felt valued and listened to.

For more details, please see the full report which is 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 (published 14 July 2021).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 7 June 2021. 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 they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 changed from requires improvement to 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 Rosedale Centre 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.

Rosedale Centre accommodates up to 44 people across four separate units, each of which have separate adapted facilities. Two of the units, Willows and Poplars, are assessment units where people's ongoing care needs are established. The other two units, Oaks and Laurels provide tailored rehabilitation support to people in order to prepare them for a return to their own home. People do not generally stay at Rosedale for more than six weeks although there are, on occasion, exceptions to this. People are admitted following discharge from hospital or from the community in an attempt to prevent hospital admission. At the time of our inspection there were 34 people living at Rosedale Centre.

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

Risks to people’s health and wellbeing were not all in place. Staff were not following the providers policy in relation to administering people’s medicines. Fire drills had not taken place since 2019. Records to evidence the service's safety such as gas boiler servicing were unable to be located.

We were not fully assured the service was following safe infection control guidelines in relation to COVID-19.

Records were not always fully completed or in place. Audits that took place did not highlight the concerns found on the day of the inspection.

Accidents and incidents were reviewed monthly for any learning outcomes. Staff felt more staff were needed, especially on a night. The service manager said there was funding in place to set up another team to support this.

The providers recruitment process was robust and followed safe practices.

Staff understood safeguarding procedures and how to report concerns.

Staff felt supported by the management team. People and their relatives were very complimentary about how the service was run.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (published 22 December 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We carried out a focused inspection of this service on 7 June 2021. This report only covers our findings in relation to the key questions safe and well-led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.

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.

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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvement. 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 Rosedale Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

Rosedale Centre is a short term residential care home providing rehabilitation and assessment of people’s ongoing care needs. The home is registered to accommodate up to 44 people across four separate units, each of which have separate adapted facilities. People are generally admitted following discharge from hospital or from the community in an attempt to prevent hospital admission. On this occasion we inspected the Willows unit. There were two people living on the unit at the time of our inspection and a maximum capacity of ten. We found the following examples of good practice.

¿ The systems in place allowed people to be admitted to the home safely. There was a separate entrance which allowed direct access to the Willows unit for staff and ambulance admissions. This reduced the risk of cross infection. There was no movement of staff or residents between units.

¿ People isolating in Willows unit had their own dedicated staff who met all of their support needs.

¿ National guidance was followed on the use of personal protective equipment (PPE). There was clear signage on the correct use of PPE and handwashing techniques and staff had received appropriate infection control and prevention training.

¿ All non-essential visits into the home had been suspended at the time of the inspection so alternative measures such as video calls and window visits were being used to maintain contact with family members.

¿ The environment was very clean. Additional cleaning was taking place particularly of frequently touched surfaces such as light switches and door handles.

¿ There were detailed risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

¿ Staff had been consulted with about their specific risks or concerns and the provider was taking all possible steps to keep them and people using the service safe.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Our previous inspection of the service took place on 9 and 11 May and 18 July 2016 and at that time we found breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were related to failure to obtain consent, lack of robust risk assessments, poor record keeping and ineffective quality assurance systems.

We took action by asking the provider to send us an action plan stating how they would achieve compliance with the regulations. During this inspection we found there had been improvements made in line with this action plan and the service was no longer in breach of the regulations detailed above.

Rosedale Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rosedale Centre accommodates up to 44 people across four separate units, each of which have separate adapted facilities. Two of the units, Willows and Poplars, are assessment units where people’s ongoing care needs are established. The other two units, Oaks and Laurels provide tailored rehabilitation support to people in order to prepare them for a return to their own home. People do not generally stay at Rosedale for more than six weeks although there are, on occasion, exceptions to this. People are admitted following discharge from hospital or from the community in an attempt to prevent hospital admission.

The service had a registered manager in place. 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.

People and their relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, whistleblowing and infection control. Staff had received safeguarding training although some refresher training was overdue. Staff we spoke with could describe the types of abuse and how to spot them. They told us they would report any concerns to management and were confident they would be investigated.

Bed sensors were now checked daily to ensure they were in good working condition. People had individual personal emergency evacuation plans in place that reflected their individual support needs. Fire equipment was tested regularly and drills were correctly recorded including information on evacuation times and names of staff involved. People’s weights were monitored on scales that were calibrated regularly. Care records contained detailed risk assessments which addressed each person’s identified areas of risk.

People’s medicines were safely stored, correctly recorded and administered as prescribed by trained staff.

Accident, incident and safeguarding concerns were recorded and investigated to look for trends and prevent any reoccurrence. Regular maintenance checks and repairs were carried out. A business contingency plan was in place that clearly explained the action to take in the event of an emergency. Infection control procedures were followed. The building was clean and free from odour and staff had access to personal protective equipment such as gloves and aprons.

Safe recruitment procedures and pre-employment checks continued to be undertaken and there were sufficient staff members on duty to meet people’s needs.

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.

Evidence of people’s consent to their care and treatment was recorded in their support plans and staff sought verbal consent from people as they provided care throughout the day. Staff supported people to make day to day decisions about their care, giving them choices of what to wear or what to have to eat for example.

People told us they were happy with the food they received and the mealtime experience was calm and relaxed. The kitchen staff and support staff were aware of people’s dietary requirements and catered for them appropriately.

Staff were happy with the training they received and records showed the majority of training was up to date. Action was being taken to address those areas in which refresher training was overdue.

Staff had regular supervision sessions and annual appraisal and told us they felt supported by management.

The provider had an equality and diversity policy in place that outlined their aim to promote equal opportunity for all and to ensure no individual was discriminated against. All staff were to undertake equality and diversity training as part of the provider’s essential training.

People’s health and wellbeing was promoted and monitored in partnership with external health professionals. The service had good links with other agencies and health professionals including the district nurse team and community matron. The service had a team of therapists based at the service and provided physiotherapy in-house. There was dementia friendly signage around the service and further adaptations to the service were planned to accommodate people who needed extra space or specialist equipment because of their condition.

People were treated with dignity and respect by caring staff. Independence was actively encouraged as part of people’s rehabilitation. Positive feedback was received from people using the service and their relatives regarding the standard of care.

We saw that improvements had been made to the information recorded in care plans. This was written to reflect the individual’s personal preferences.

A part-time activities co-ordinator had been employed. They were enthusiastic about their role and worked closely with people to ensure any activity they engaged in was meaningful to them. They also made every effort to ensure hobbies and interests could be maintained once they returned home.

The provider had a complaints policy in place and people were all provided with details of this on admission. Any complaints received were handled in line with the provider’s policy.

The system of audits in place had improved since our last inspection and the checks carried out were more consistent across the four units. Where issues had been identified appropriate action had been taken. Staff were given responsibility for auditing certain areas and the registered manager and the provider’s service manager were both actively involved in the monitoring of the service.

Staff meetings were held every six months. Staff told us they found the management team approachable and supportive, but some feedback indicated staff felt uncomfortable approaching managers within the busy office environment. The registered manager was taking steps to address this.

People were asked for their feedback via questionnaires and information from these was discussed between the registered manager and provider’s service manager which led to an annual report being produced.

We last inspected the service on 12 June 2013 and found there to be no breach of regulations at that time.

Rosedale Centre provides accommodation and support for up to 44 people to receive short-term intermediate care of up to six weeks. It is a multi-disciplinary integrated re-enablement and assessment service providing both assessment and rehabilitation for adults over the age of 18 including older people. People are referred from local hospitals and from the community via GPs, social workers and therapy staff. The service is situated in a residential area close to local amenities and public transport.

The service was divided into four units. Willows (12 beds) and Poplars (10 beds) were assessment units. Oaks (12 beds) and Laurels (10 beds) were rehabilitation units.

The home had a registered manager in place. 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.

People and their relatives told us they felt that care was delivered safely.

We saw that people had some individual risk assessments within their care files that covered areas specific to the individual’s needs however some identified risks had no corresponding risk assessment in place.

Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing [telling someone] procedures and said they felt confident to report any concerns without fear of recrimination.

At the time of our visit individual personal emergency evacuation plans (PEEPs) were not in place for each person. We have been told by the registered manager that these have been put in place since our visit.

The service had policies and procedures in place to ensure that medicines were ordered, stored and administered safely. People received their medicines as prescribed but one of the records we checked had not been correctly completed.

Accidents and incidents were recorded but there was no procedure in place to analyse this information for trends and patterns.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff received support via one to one supervision and annual appraisal. Staff had not received supervision as often over the past year due to a review of the service being undertaken.

Staff rotas indicated that the service was correctly staffed according to the required levels identified by the registered provider. Some people who used the service felt there were enough staff on duty, others told us they felt staff were over worked and they sometimes had to wait for assistance. Our observations during the inspection indicated there were sufficient staff available to meet people’s needs.

Training was up to date and staff had the required skills and knowledge to provide support to the people they cared for. New staff underwent a structured induction process.

DoLS authorisations were being correctly applied for but not always recorded on support files. Staff had a limited understanding around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care staff had not received training in MCA and we did not see evidence of consent within support files.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. Staff demonstrated knowledge of people’s likes, dislikes, cultural and medical dietary requirements. The service worked with a dietician where necessary. The care records we viewed also showed us that people had appropriate access to health care professionals such as district nurses and chiropodists.

We looked at support plans and found that they were not always correctly completed and did not contain a sufficient level of detail.

We observed that people were encouraged to be as independent as possible and were engaged in therapy sessions to assist their rehabilitation. Although activities outside of the therapy sessions had been scheduled these were not happening on a regular basis and people commented they would like more to do.

The staff had a caring approach. People were treated with respect and their privacy and dignity was protected.

There was a complaints procedure in place and this was given to every person on admission. This had also been produced in an easy read format. There had been one complaint in the current year that was being investigated by the registered provider.

Quality assurance checks were taking place but there were no clear protocols around the level or frequency and different working practices had been adopted by senior staff across the four units. There was no clear management overview of the quality of the service.

Some of the staff we spoke with felt supported by the registered manager and that they were approachable but one staff member felt that it was not currently possible to have their say. The registered manager recognised that the recent review of the service and changes to working patterns had caused some upset to staff.

The home was clean, tidy and free from unpleasant smells. We saw staff using personal protective equipment (PPE), for example gloves and aprons, appropriately.

We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe care and treatment, need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found that people had been fully involved in their care and therapy and saw that they were well documented. People said, “It has been planned in stages, with monitoring and assessment.” “I have been fully aware of my therapy plan and the changes to equipment were discussed along the way.”

We found that the support and treatment plans provided staff with the information they needed to meet people’s needs.

We found that a range of health and care professionals were involved in meeting people's needs.

Staff had received appropriate training and support in respect of their job roles.

People were confident about the care, support and therapy provided within the service and had no concerns, but would raise them if they needed to.