Archived: Rosebank House

We rated Rosebank House as requires improvement because:

• There were blind spots that undermined staff’s ability to undertake effective observations.
• Staff were not undertaking or recording the minimum level of observation of patients.
• There were numerous ligature points, no ligature cutters nor a ligature risk assessment.
• The hospital did not fully comply with same sex accommodation guidance.
• Temporary staff had not received an adequate induction.
• There was no system in place to check the competence of staff to administer medicines safely.
• Staff did not always follow medicines management policies.
• Clinical nursing staff were not involved in clinical audits.
• There were no clear recovery pathways in patients care plans.
• The service did not use outcome measures when supporting people.
• Care plans did not reflect patients’ specialist needs.
• There were no audits or plans to review the hospitals effectiveness in meeting the needs of patients who may have autism or a learning disability.
• There was an absence of internal monitoring to improve services.
• When an audit did identify gaps, no robust action plan was put in place.
• The provider was not adequately monitoring the risks around staff skill mix to meet considerable variances in patients’ needs and risks.
• The provider had not taken steps to assure itself about patients’ safety.

However:

• There were sufficient numbers of staff on duty to meet people’s needs.
• The hospital was clean and well maintained.
• There was emergency equipment available in the event of a health crisis and this was checked daily.
• Medication was prescribed within National Institute for Health and Care Excellence (NICE) guidelines.
• There was good monitoring of patients physical health needs, and treatment was sought promptly, when required.
• Staff received regular supervision.
• We observed consistent supportive and caring interactions between staff and patient.s
• Patients were treated with dignity and respect.
• A recent patient satisfaction survey was positive about the service, 100% of patients felt listened to.
• The hospital had suitable furniture and equipment to meet people’s needs.
• There was an interpreting service available if required.
• There was good access for people who may be wheelchair dependent.
• Patients had access to an art therapy room, computer room and meeting space.
• Locally staff reported feeling well supported and enjoyed working in the service.