Rosemount Care 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

The service has been rated inadequate. We found a breach in relation to assessment of risk and consent to care and treatment. People’s rights were not protected as the principles of the Mental Capacity Action (2005) were not being followed. People’s care had not been planned with them and care plans were not sufficiently detailed to enable staff to provide safe, appropriate care which met people’s needs and preferences.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their families told us they were not always involved in, or aware of care planning arrangements. One family member told us, “They went in with a care plan, not involved in any changes.” Another told us, “[Family member] had a care plan at home, not got one now but there is a folder telling what he’s eaten.”

Some staff told us that, prior to the appointment of the new manager, they had been involved in writing the nursing people’s care plans, but they explained they did not feel they always had the knowledge around nursing areas. The new manager explained that she had already identified this and nurses were now writing nursing care plans.

An effective system was not fully in place to ensure best practice guidance was followed when assessing and providing care. We identified shortfalls in relation to medicines management, the assessment of risk, Mental Capacity Act (MCA) procedures and care planning. People’s needs were assessed and reviewed however, where needs had been identified, the care records didn’t always contain sufficient information to help staff meet them.

We received mixed feedback about the delivery of people’s care. Some people told us they were happy with their care, others felt improvements could be made, particularly the timeliness of care.

Although staff told us they had all the necessary information about the person from the care plan as well as the handover information, the new manager acknowledged care plans were a work in progress. There was a ‘resident of the day’ system in place. Resident of the day is an initiative when a particular person’s care is reviewed with them and their relatives on a regular and recurring basis. The new manager told us they had started to implement a new electronic care planning system and all care plans were being reviewed and updated as part of this process.

An effective system was not fully in place to ensure care was delivered in line with best practice guidance and the regulations. We identified shortfalls in relation to aspects of people’s care and these issues had not always been highlighted by the providers quality monitoring system. Records did not always document that care was carried out as planned. For example, in relation to diabetes care, one person’s care plan stated that their blood sugar levels needed to be monitored four times a day. However, records did not always evidence this.

People gave us mixed feedback about how staff and teams worked together at Rosemount. One person told us, “There is enough staff, always someone there, you don’t have to go hunting. When an alarm goes off they respond quickly.” However, relatives expressed concerns about the number of staff, the consistency of staff and use of agency staff in the home, leading to concerns about how well the team knew their family members. Feedback via organisational safeguarding meetings had highlighted concerns with regards to staffing, their skills and ability to provide safe care. The home had been in organisational safeguarding where issues of concern had been resolved, and the process had been concluded.

Staff told us that, historically, working collaboratively had been difficult and they had felt unsupported. The new manager told they were working on improving this. They had recently met with the GP to strengthen working relationships. During our site visits we observed effective communication between staff and the NHS frailty nurse who was based there.

At the beginning of the assessment, partners and health care professionals involved in supporting the home told us they had significant concerns about staff culture within the home, a lack of effective information sharing between team members, and poor care plan recording. There were concerns that staff had not raised concerns about poor practice or safeguarding in the home. There had previously been a reliance on health care professionals to support the staff with meeting care needs but they told us that they had seen some improvement in this recently. This left people at risk due to a lack of staff knowledge and awareness. We received a further update from the local authority that there were signs of improvement but further work was still required.

Processes were being strengthened to support effective partnership working. Several communication and assessment tools were being used to correspond with the wider healthcare team. The new manager recognised that further staff training was needed in relation to these tools.

We received mixed feedback from people and relatives about how staff supported people to live healthier lives. Some people told us they were not offered support to brush their teeth and whilst another person did not raise any concerns about the management of their weight, we found that this had an impact upon their health and wellbeing.

Staff did not always demonstrate the actions they had taken to support people to live healthier lives.

Processes had not been fully implemented to support people to manage their health and wellbeing. The new manager told us that she was completing oral hygiene checks as part of her walk around audits. Records did not always demonstrate how staff were supporting one person with their weight management and there was no evidence of a referral to the dietitian.

People and relatives gave us mixed feedback about monitoring and improving outcomes. Some people told us they had experienced positive outcomes. For example, one person was in the process of transitioning out of Rosemount and into Independent Supported Living following a period of rehabilitation in the home. However, others told us that they did not always experience positive outcomes.

Staff told us they worked hard to achieve good outcomes for people but this was not always possible due to processes and resources available in the home. The new manager told us she was aware of these issues and was working towards more effective ways of meeting outcomes.

Processes to ensure people who use the service consistently experience positive outcomes were not fully implemented. They did not always meet agreed expectations as set out in legislation, standards and evidence-based clinical guidance. Effective approaches to monitor people’s care and treatment and their outcomes were not always utilised and recorded in peoples records. This meant that continuous improvements were not always made to people’s care and treatment.

People’s experience was impacted by a lack of evidence to demonstrate how staff followed the principles of the Mental Capacity Act 2005 (MCA) in relation to capacity assessments and best interests decision making. For example, information relating to consent and best interests decisions around areas such as sensor alarms, being cared for in bed or certain clinical procedures was not always available. This meant there was a risk of people’s rights not being upheld, or respected.

Staff told us they understood the importance of ensuring that people fully understand what they are consenting to and the importance of obtaining consent before they deliver care or treatment. However, records did not always demonstrate that staff were following the principles of the MCA and that people were asked for consent to care.

Systems and practices to ensure that people understand the care and treatment being offered or recommended were not fully implemented. People’s views and wishes are taken into account when their care is planned. Where necessary, documentation relating to people, such as carers, family members or advocates, with legal authority or responsibility to make decisions within the requirements of the Mental Capacity Act 2005 were not always recorded. .This includes the duty to consult others such as carers, families and/or advocates, where appropriate. Audits relating to care files and care plans identified the need for consent or capacity assessments however, these actions were not implemented.