Rose Cottage Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People and their relatives felt the service thoroughly assessed their needs prior to admission and afterwards. One relative told us, “They did a lot of thorough assessments at the previous home with us, and a lot of other health care professionals before they decided they could take [Relative] safely, so that was reassuring in itself.”

Staff told us that assessments were important in helping them understand people’s individual needs and preferences. They felt the information available provided sufficient detail to enable them to deliver care to people based on their assessed needs, wishes and preferences. We observed staff knew people well and demonstrated a good understanding of their needs and how they wished to be supported.

Every relative we spoke with had been involved in regular care planning and risk reviews. We saw assessments were updated when things changed for people

The provider did not always have current evidence-based good practice standards or guidance embedded into their care plans.

We identified gaps in guidance in care plans and risk assessment relating to the safe management of oxygen therapy and the management of choking risks for a person receiving nutrition via a Percutaneous Endoscopic Gastrostomy (PEG) tube. As a result, staff did not always have access to clear, evidence-based information to support safe and effective care. We found no evidence that people had experienced harm because of these omissions and the registered manager acted promptly to update the records following our feedback.

However, people were involved in planning their care and treatment, and care plans and risk assessments were reviewed regularly. People and their relatives spoke positively about the care provided and told us staff knew them well and responded appropriately to their needs. We observed staff providing timely support to people. Staff demonstrated a good understanding of how to support people living with dementia and had received appropriate training in this area.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The registered manager and nursing team demonstrated a good understanding of external health and social care services and made appropriate referrals when people required additional support. We saw evidence that referrals were made promptly to ensure people received specialist input when needed.

Staff told us communication within the service was effective and that information about people’s needs, including any changes in their health and wellbeing, was shared appropriately between colleagues.

Professional feedback was positive for example a comment included, “The handover of information from staff to visiting clinicians is consistently of a good standard. Information shared with the service is communicated effectively amongst the staff team and is reflected in care planning and ongoing practice.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

During the assessment, we observed activities taking place on both days, and people were encouraged to participate. Activities included chair-based exercises, singing and other opportunities for social interaction.

People and their relatives spoke positively about the care and support they received. One relative told us, “It's not all singing and dancing, with cinemas and activities but I cannot tell you how wonderful the staff are, they work very hard.” Staff understood people's individual needs and supported them to make choices about how they spent their time.

The provider recognised the importance of meaningful occupation and was developing opportunities for people to access both indoor and outdoor spaces, including planned visits to local shops and parks. Staff explained that access to outdoor areas had been managed during periods of extreme weather to protect people's health and wellbeing.

People were supported to maintain healthy lifestyles. We saw menu choices offered a variety of meals, and people spoke positively about the quality of food available.

People had access to healthcare services when required. They told us they were supported to attend appointments and receive professional healthcare input. Care records demonstrated that referrals, healthcare interventions and outcomes were clearly documented. This helped to ensure people's health needs were monitored and responded to in a timely way.

Opportunities remained to further enhance the range of individual activities available to people who preferred not to participate in group activities; however, this did not have a significant impact on people's overall experience.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People and their relatives reported positive outcomes since receiving care at the service. One relative told us, “[Person] seems to have settled and though they can’t tell you anymore now, you can see they have more ‘sparkle’ now.”

Relatives of people who had previously lived in other services told us they wished they had moved their family members to Rose Cottage sooner because of the improvements they had seen in people’s wellbeing and the way their clinical needs were met. Relatives also said they felt reassured by the availability of qualified nurses on site to monitor people’s health, respond to concerns and arrange timely intervention when required.

Staff routinely monitored people’s health and care needs, including repositioning, nutrition and hydration. Care records demonstrated that people's outcomes were regularly reviewed and showed evidence of improvements in health and wellbeing following admission to the service.

The provider did not always have systems that appropriately reflected people’s capacity appropriately in line with the Mental Capacity Act 2005.

We found mental capacity assessments (MCAs) were stored in two separate locations. Some assessments were held on the electronic care management system, while others were maintained in paper records. The assessments held on the electronic system differed from the paper versions and were not decision specific. The registered manager explained that limitations within the electronic system prevented multiple assessments from being completed for different decisions. Although the paper assessments were comprehensive and reflected the specific decisions required, the existence of differing records created a risk of staff accessing inconsistent information regarding people's capacity to make decisions. This meant the provider could not be assured that staff were always working from accurate and up-to-date information when supporting people to make decisions about their care and treatment.

The registered manager took immediate action and advised they would remove the electronic assessments and ensure staff were directed to the correct MCA documentation.

However, people told us staff asked for their consent when providing care. One comment included, “The staff help with my personal care, I didn't like it at first, but they were very good about it and let me do what I can. What I can't do they will help with. They always ask for my consent.”