We carried out a review of the data available to us about Rosedale House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Rosedale House, you can give feedback on this service.
People's experience of using this service and what we found
There had been significant improvements following the inspection of 10 February 2020. Positive changes had been made with a legionella risk assessment now in place. Risk assessments had been put into place to mitigate the risks of burning from the use of hot surface temperature portable radiators. The risks associated with people’s medical conditions were fully recorded within people’s care records and risk assessments.
Relatives told us they felt their family members were safe living at the home. Staff understood their responsibility to protect people from avoidable harm and abuse. Staff confirmed they had received safeguarding training. Risks to people's health and safety were assessed with guidance for staff to follow. Staff were recruited safely and there were enough staff to provide safe and effective care. Medicines were stored and administered safely in line with people's prescriptions. Accidents and incidents were reported and recorded with audits in place to help identify any trends or patterns.
The home had a clear management and staffing structure in place. Staff were enthusiastic and happy in their work. Staff described working together as a team, they provided person-centred care and helped people to achieve their potential. The registered manager had effective quality assurance systems in place to monitor the quality and safety of the home. Staff worked well with external social and health care professionals.
Rating at last inspection
The last rating for this service was Good (published 21 May 2020). At our last inspection we found there were shortfalls in the safety of the premises. These related to management and control of legionella. There was a lack of risk management for the use of hot surface temperature portable radiators. Improvements were needed to ensure staff were safely recruited. At this inspection we found improvements had been made.
Why we inspected
We carried out an inspection of this service on 10 February 2020. We rated the service requires improvement in Safe due to the shortfalls, which we identified. 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.
We undertook this focused inspection to check the provider 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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The key question safe has not been rated Good. The overall rating for the service remains Good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale House on our website at www.cqc.org.uk.
People’s experience of using this service and what we found
We observed staff and the deputy manager wore PPE in accordance with guidance. We received information of concern prior to the inspection that the management team did not always wear masks whilst sat in the office. We spoke to the registered manager during feedback about the importance of wearing masks whilst sat in the office with others.
We found the following examples of good practice.
The home had designated entrance with posters displayed which explained the safety procedures in place. At the time of our inspection due to the outbreak of COVID-19 the only visitors to the home were professionals. They were asked to adhere to the home’s infection control procedures. Temperature checks were being undertaken.
People were able to communicate with loved ones by phone, and video call.
Increased cleaning of the home was taking place. This included regular cleaning of high touch areas such as door handles and light switches and deep cleaning of communal rooms and chairs.
The home had an adequate supply of personal protective equipment (PPE) to meet current and future demand. Staff were using this correctly and in accordance with current guidance. Staff had received training in relation to Covid-19 which included, infection control and use and donning and doffing of PPE.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale House on our website at www.cqc.org.uk
We found the following examples of good practice.
• Staff greeted visitors at a designated entrance to the home and explained the safety procedures in place. Access into the care home varied, depending on the area of the home being visited. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route. Visitors had their temperature checked on arrival and were provided with personal protective equipment (PPE) that included gloves, aprons and facemasks.
• People had been supported to maintain contact with their loved ones, through video and phone calls, when they were unable to visit. There was a wide range of daily activities organised by the staff team, and entertainers performed outside on the small paved area.
• Access to the garden was limited because extension building works were being undertaken. However, structured and planned internal and window visits were facilitated. Visitors were able to sit at the entrance to the home, with the person using the service sitting on a bench inside the reception area. The registered manager told us how well these visits had been received and enjoyed by everyone.
• When people were admitted to the home, risk assessments were completed, and people were isolated for 14 days. To enable this to happen, the registered manager told us they allocated staff on a one to one basis, to provide personal care and additional support, for newly admitted people. Most people in the home were living with dementia, and unable to understand the need for social distancing. For example, some people were used to sitting or moving close to others in communal areas during the day. Staff were aware of the need to mitigate the risks associated with people being in close contact with one another. There was enhanced cleaning of frequently touched surfaces and people were supported to wash and sanitise their hands regularly.
• Regular testing for COVID-19 was being undertaken. Staff were tested weekly, and people using the service were tested monthly.
• Rosedale House had policies, procedures and contingency plans in place. Staff had received training and regular updates. A ‘Covid’ file with updated information, was available for staff to read. The registered manager and deputy manager told us they completed daily ‘spot checks’ to make sure staff understanding and compliance with use of PPE and infection prevention and control practices.
• There was regular communication from the owner to the registered manager who spoke positively about the support they received. The registered manager told us they were also well supported by the local GP and the nurse practitioner, with weekly support visits and video calls.
Rosedale House is a care home that provides personal care for up to 23 older people. The service is provided in five areas, Baker Street, Penny Lane, Route 66, Graceland and Westminster Abbey, and located over three floors. At the time of the inspection, 23 people were living at the home. Most people were living with dementia.
What life is like for people using this service:
People who used the service and relatives spoke positively and told us they felt safe in the home.
There were shortfalls in the safety of the premises. These related mainly to management and control of legionella and the lack of risk management for the use of portable hot surface temperature radiators. Prompt actions were taken to address the shortfalls we identified.
Improvements were needed to make sure staff were safely recruited. Staff were well supported and had received sufficient training to carry out their roles. They were all incredibly proud to work at Rosedale House. They worked well as a team and felt extremely well supported by their management team.
Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.
People were supported to access health care services and regular visits were undertaken by their GP.
People, where able, were involved in food preparation and people were offered choices at mealtimes. People received the support they needed with food and fluids.
People and relatives were asked for feedback and knew how to complain. No-one was receiving end of life care at the time of our inspection visit.
People received care that was exceptionally kind, loving, thoughtful and respectful. Care plans reflected people’s personal, emotional and social needs. Everyone we spoke with, and received feedback from, spoke in glowing terms about the service provided.
We have made a recommendation that the provider’s quality assurance systems needed strengthening. This was to ensure shortfalls were identified and actions taken to mitigate risks and make improvements to the safety of the service.
The service met the characteristics of Good in the key questions Effective, Caring, Responsive and Well-led and Requires Improvement in the key question Safe. Therefore, our overall rating for the service after this inspection has remained Good.
More information is in detailed findings below.
Rating at last inspection:
The service was rated Good (Inspection report published July 2017).
Why we inspected:
This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people receive.
Follow up:
We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.
The inspection took place on 12 May 2017 and was unannounced. The inspection was carried out by one inspector. This was the first inspection of the service since a registration change to the legal status of the provider.
Rosedale House provides accommodation with personal care for up to 23 older people many of whom are living with dementia type illnesses. The home is located in a suburb of the city of Bristol.
There was a registered manager for the service. 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.
The registered manager and staff team demonstrated their commitment to providing a very caring service. They cared for people with dignity, to further improve and to follow best practice for the care of people living with dementia. The home had a good reputation within the local community and with health and social care professionals.
People were supported to stay safe because any risks to their health and welfare were well managed. The premises were properly maintained and staff were trained in how to support people safely. A full range of pre-employment checks on new staff were completed. These helped ensure that unsuitable staff did not gain employment at the home. The management of medicines was safe and in line with good practice.
People received a highly personalised care which was unique to their individual needs. Care records set out how to provide person centred care for each person. Daily lives for people included activities and hobbies that interested them. People were involved in things they liked and they told us they really enjoyed their days. The environment had been decorated and set out in a way that meant that people living there had their own space that they enjoyed. The home environment was full of unique areas and themes to keep people engaged in their surroundings.
People received safe care as staffing levels were reviewed and adjusted regularly according to the needs of the people who lived at the home. The staffing numbers fully took account of the number of people being looked after and their level of care and support needs. The staff were properly trained and this meant they were able to carry out their roles and responsibilities. It also meant they were able to provide care that was effective. Staff were being well supervised and supported by the registered manager, deputy manager and other senior staff.
People received care and support that met their individual needs. People were encouraged whenever possible to make their own choices and decisions in relation to their daily life. When people did not have full capacity to make decisions for them staff understood what to do to ensure that decisions made on behalf of the person were in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Risks to the safety of people were minimised as the staff had attended safeguarding adults training, and knew how to identify the different types of abuse. Staff also understood the procedure for reporting concerns. Risk assessments were in place that identified the areas where the safety of people may have been at risk.
There was enough suitably qualified staff on duty at any time of the day or night to provide safe care. Staff were recruited by safe procedures being followed. Accidents and incidents were investigated and health and safety risk assessments of the home environment were completed. There were safe practices and procedures for the management of medicines in the home. People were assisted with their needs by staff who were properly inducted into their role. Staff were well trained and received regular support and supervision to support them in their work.
The staff understood how to support people effectively. The staff team were very caring and extremely attentive in manner towards each person who lived at the home. People were provided with the food and drink they enjoyed and they were able to make a choice. People were given sensitive assistance if they needed support to eat their meals. There were arrangements in place for people to see their GP and other healthcare professionals when they needed to do so for their health.
Feedback from health care professionals was very positive and all said the service worked with them to improve people's lives. People received very flexible care that was responsive to their needs. People were supported by staff in a very person centred way. People where possible had been involved in devising their care plans.
The registered manager continually demonstrated that they were very highly committed to improving the service for people at the home. Their passion and commitment to providing exceptional care for people was evident in many ways. For example how they spoke about what they did for people as well as how they aimed to meet people's individual needs. It was evident from the feedback from people and relatives, staff and health and social care professionals that this was a really well run home.
We carried out this inspection on 26 May 2015 and this was an unannounced inspection. During a previous inspection of this service in January 2014 we had identified concerns that people were not consistently involved in how their care was planned and provided or that care and treatment was not always planned to ensure people’s safety. We further found there were no effective systems to monitor the quality of care provided. During this inspection we found the provider had made the appropriate improvements.
Rosedale House provides personal care for a maximum of 23 people. At the time of the inspection there were 22 people living in the home.
A registered manager was in post at the time of inspection. 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 and associated Regulations about how the service is run.
Medicines were not always stored appropriately and in accordance with legal requirements.
The home was clean, however we identified areas where cross infection risks to people could be reduced. We have made a recommendation to the provider about following nationally published guidance to reduce cross infection risks.
People felt safe and staff could respond to suspected or actual abuse. Staff understood the concept of whistleblowing and were aware of external agencies they could report to.
People and their relatives told us the service met their needs quickly. Staff said there were sufficient numbers of staff on duty to enable them to perform their roles effectively and meet people’s needs.
Staffing levels set by the registered manager had been consistently achieved and staff numbers were increased when required. Safe recruitment procedures were completed when new staff were employed.
People spoke positively of the staff at the home and were happy with the standard of care they received. Staff felt they had the knowledge and skills to carry out their role. Staff received regular training. Appraisals and supervisions were completed to discuss performance.
The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. DoLS applications had been submitted where a need had been identified.
People were provided with sufficient food and drink and positive feedback was received on the standard of food provided. People received support if required and accurate records were maintained when food and fluid intake was being monitored.
Arrangements were made for people to see their GP and other healthcare professionals when required.
Staff had good relationships with people and we observed caring interactions throughout our inspection. People and their relatives spoke highly of the staff at the home.
Where possible, people were involved in making decisions about their care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.
People’s privacy and dignity was respected by staff. People received personalised care and staff knew the needs of the people they were caring for. The provider had a complaints procedure and people felt confident they could complain should the need arise.
Activities were arranged for people within the service and the activities co-ordinator ensured the activities were tailored and designed to stimulate people living with dementia.
People knew who to contact in the service and the registered manager was respected by staff and the people at the home. Staff felt they were able to approach the management of the service with ideas or concerns.
The provider had systems to monitor the quality of service provision and staff incentive schemes had been developed to encourage a high standard of care provision.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
The majority of the people we spoke with who used the service provided positive feedback regarding their experience of the service. Comments included ''I like it here I feel at ease the staff are very good. They ask me how I like things done'. Two people who used the service expressed concerns about not being listened to by staff members.
We viewed four care plans. The planning was centred on the individual and considered all aspects of their individual circumstances. The care plans were detailed and specific to the individual's needs and preferences. Where people were unable to make their own decisions the family members we spoke with told us that they were not involved in regular formal discussions regarding their relatives care.
We found that there was an inconsistent practice regarding reference checks on staff members. The provider was in the process of updating their recruitment policy and staff checks.
Staff we spoke with were knowledgeable about the people they supported and safeguarding procedures. They had received training appropriate to their roles. We found that there was not a consistent support structure in place for staff supervisions.
We found that the provider had inadequate systems in place to regularly assess and monitor the quality of the services provided.
We met with staff who were knowledgeable about people's individual needs. Staff received guidance and training so that they were competent and supported people in a safe way.
People said that they felt safe living at the home. One person told us 'if you have a problem you can go to the manager'. Staff knew what action to take if they had any concerns about people's health or wellbeing. Overall, arrangements were being made to ensure that the service was meeting people's needs.