About the service
Rosewood House is a residential care home providing nursing and personal care for up to 90 people aged 65 and over, including people living with dementia. They also had a unit dedicated to providing neurological care. There were 55 people living in the home at the time of the inspection.
Rosewood House has three separate floors that each consist of two units, able to support 15 people within each unit. The units have separate adapted facilities. At the time of our inspection, one unit on the first floor was not open as it had just completed renovation works.
The home changed its name from Hawthorn Green Residential and Nursing Home to Rosewood House in September 2021.
People’s experience of using this service and what we found
People and their relatives were positive about the kind and caring attitude of the staff team. One person said, “I have built up a good rapport with the staff and feel they give me good care.” All the relatives we spoke with felt the home had a welcoming environment.
People’s medicines were not always managed safely. Issues we identified at the last inspection had not been fully addressed.
Infection prevention and control practices did not always ensure people were fully protected from COVID-19. Although the home was clean and hygienic and staff were reminded about safe practices, we observed regular poor compliance of staff wearing masks properly throughout the inspection.
Staffing levels were not always consistent across the units to be able to meet people’s needs. People told us this impacted the care they received. Staff told us they regularly raised their concerns about how staffing levels increased the risk to people’s care or being able to support people in a timely way.
Risks to people's safety and guidance for staff to follow to manage these risks were not always recorded or in place for staff to understand how to support people safely.
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.
People and their relatives felt they had been well supported during the COVID-19 pandemic and had been kept updated when needed. One relative said, “The manager is brilliant, they will always try and sort out any problems.”
Monitoring and auditing systems did not always identify and remedy any issues with the quality of the service. Feedback from staff was mixed about the working environment and the support they received. Some staff told us they did not feel their issues were listened to.
The provider had failed to notify us about all the incidents that had occurred across the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inspected but not rated (published 30 March 2021), which meant the rating at the time of the inspection did not change from requires improvement.
This is because we carried out a targeted inspection. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
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 the provider remained in breach of regulations.
Why we inspected
We received anonymous concerns in relation to staffing levels, the safety of people’s care and support and general concerns about the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 remained as requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. 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.
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 have identified a continued breach in relation to the management of medicines. We have identified breaches in relation to staffing and good governance.
We have sent a Regulation 17(3) Letter to the provider in relation to their failure to effectively operate systems and processes to assess, monitor and improve the quality and safety of the services provided in carrying on the regulated activities. A Regulation 17(3) Letter stipulates the improvements needed to meet breaches of regulation, seeks an action plan and requires a provider to regularly report to CQC on their progress with meeting their action plan.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.