We carried out a review of the data available to us about Rosewood Lodge 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 Rosewood Lodge, you can give feedback on this service.
Rosewood Lodge is a residential care home. It provides accommodation and personal care for up to 20 older people. At the time of the inspection there were 19 people living at the service.
People’s experience of using this service and what we found
People were safe and well supported. Recruitment of staff followed the provider's policies and there was enough staff to meet people’s needs. The service was clean and well maintained. Infection control procedures were in place.
Medicines were administered and managed safely. Assessments were in place to identify and reduce risks to people.
The service was well-led. We received positive feedback about how the service was managed. There was a positive staff team and culture. Systems were in place to monitor and review the quality of the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 requires improvement (published 14 December 2019), there was one breach of regulation. 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 improvements had been made and the provider was no longer in breach of regulation.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 7 November 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in regard to Regulation 19; Fit and proper persons employed.
We undertook this focused inspection to check they 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 which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosewood Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Rosewood Lodge is a residential care home. It provides accommodation and personal care for up to 20 older people. At the time of the inspection there were 19 people living.
People’s experience of using this service and what we found
Changes had been made at the service to ensure there was more effective leadership. This had resulted in positive improvements. Staff knew their roles and responsibilities and told us they were well supported. Communication systems were professional and efficient. There was a welcoming and friendly atmosphere.
Further improvements were still required in the recruitment of staff to ensure safe systems were fully followed. Medicines management and administration had improved so that people got their medicines as prescribed.
Care plans and risk assessments were person centred and gave clear guidance about how people preferred to be supported in a way that maintained their independence. This included accurate information about people’s health conditions.
People were cared for by staff who were kind, caring and respectful. People were happy and relaxed in the company of staff. Staff were responsive to people’s needs and also spent time sitting and speaking with people. Staff knew people likes and dislikes well.
The environment was homely, clean and well maintained. People’s rooms were personalised. People told us they enjoyed the meals provided. Mealtimes were sociable and relaxed. People were asked for their feedback in meetings.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 Inadequate (published 3 July 2019). At the last inspection breaches were identified in Regulation 12; Safe care and treatment, Regulation 19: Fit and proper persons employed and Regulation 17; Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A recommendation had been made in January 2019 about guidance for specific health conditions.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12 and 17. However, there was a continuing breach of regulation 19. The recommendation had been met.
This service has been in Special Measures since 3 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Rosewood Lodge is a residential care home. It provides accommodation and personal care for up to 20 older people. At the time of the inspection there were 18 people living at the service.
People’s experience of using this service:
There was ineffective leadership and oversight of the service. Provider quality assurance systems did not identify and rectify previously identified breaches of regulation, ensure the quality of service provision and mitigate the risks to people. Senior staff’s job roles and responsibilities were unclear.
The provider failed to recruit staff safely. Relevant legislation, guidance and the provider’s own policies and procedures had not been followed.
The service was clean, tidy and well maintained. Staff were caring and responsive to people’s needs.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection:
Requires Improvement (9 April 2019). This service has been rated as requires improvement at the previous three inspections (9 April 2019, 7 April 2018 and 30 November 2016). Following this inspection, we imposed conditions on the provider’s registration. These required the provider to carry out specified audits and report on the outcomes of these audits to CQC each month.
Why we inspected:
We received concerns in relation to the management of staff recruitment. As a result, we undertook a focused inspection to review the Key Questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
Enforcement:
We found three repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
People’s experience of using this service: People were supported for by a consistent staff team who were kind and caring. Staff had good relationships with people and knew them well. People were encouraged and supported to maintain their independence.
Care plans and risk assessments did not always contain accurate and complete information, particularly in relations to people’s specific health conditions. There was a lack of guidance in how risks should be managed safely. Recruitment procedures did not ensure all relevant checks were completed before new staff began work. Audits had not always identified these shortfalls.
Activities were provided which people enjoyed and engaged with if they wished. People spoke positively about the food provided at the service. Relationships were supported both within and outside the service. Visitors were welcomed. The service was clean and tidy.
Improvements had been made to how people’s medicines were managed and administered. Feedback was sought from people, relatives and staff through meetings and questionnaires. Relatives said the service communicated well with them. People felt comfortable in raising any concerns or issues.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection: Requires Improvement (April 2018). This service has been rated as requires improvement at the previous two inspections (November 2016 and April 2018).
Why we inspected: This was a planned inspection based on the previous rating.
Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we made one recommendation into guidance for specific health conditions. Please see the ‘action we have told the provider to take’ section towards the end of the report
Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.
The service has single and shared accommodation for a maximum of 20 older people, some of whom may be living with dementia. On the day of the inspection there were 17 people living at the service. The service had a registered manager in post. 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.
At the last inspection the service was rated 'Requires Improvement' overall. We issued one requirement notice for a breach in Regulation 12, safe care and treatment. People’s risk assessments and support plans were not always up to date and reflective of people care needs. They were not being followed to prevent people receiving unsafe care. You can read the report from our last inspection, by selecting the ‘All reports’ link for Rosewood lodge, on our website at www.cqc.org.uk.
The provider completed an action plan to show what they would do to meet the requirement of the regulation they had breached. They had prioritised some areas that needed immediate attention including: updating care plans and risk assessments and quality assurance systems. During this inspection, we saw evidence to confirm that the service had improved.
The registered manager and staff had worked to introduce new systems and procedures. Systems had been reviewed and changed; infection control practices had been improved; care plans and associated risk assessments had been updated; quality monitoring of the service had been developed. The registered manager told us this work was on going and during this inspection, we found this was the case.
Whilst improvements had been made with risk assessments and the guidance for staff to support people was now in place, we still found some shortfalls in the recording and storage of medicines and the associated audits.
Staff we spoke with knew how to provide the care and support that people needed.
People, their relatives and staff told us that the service had improved and that the registered manager, head of care and deputy manager were supportive and approachable. The registered manager had begun to seek feedback from people and their relatives. We saw people being encouraged to share their views about the service each day.
We found improvements had been made and people now had the opportunity to take part in a range of activities in-house.
We saw some improvement had been made to the environment to support people living with dementia.
People told us they were happy with the care they received.
Staff were observed to be kind and attentive and demonstrated a caring approach to people.
Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.
There were sufficient numbers of staff to meet people's needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.
People's capacity to consent to care was considered and the service worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Throughout our inspection, we saw that people who used the service were able to express their views and make decisions about their care and support. We observed staff seeking consent to help people with their needs.
People's health care needs were assessed, monitored and recorded. Referrals for assessment were made when needed and people received regular health checks.
There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. The registered manager told us, and we reviewed records, that demonstrated they had acted promptly when concerns were raised.
We found one 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 this report.
Rosewood Lodge residential home provides care and accommodation for up to 20 people. On the days of the inspection 19 people were living at the home. The home was over three floors, with access to all floors either via stairs or the lift. Some bedrooms had an en-suite toilet. There were shared bathrooms, shower facilities and toilets throughout the home. Communal areas included two lounges, one dining area, a front garden and courtyard and hair dressers room.
The service had a registered manager at the time of the 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 2008 and associated Regulations about how the service is run.
People did not always have up to date risk assessments and guidelines that identified how staff should support them with their specific care needs. Where one person was at risk of choking we found staff were not following the support plan so the person received safe care and treatment. Those people at risk did not always have records completed that confirmed what care and support staff had provided relating to their skin care and modified diets.
People felt safe and all but two people had a personal evacuation plans that identified what support they should require in an emergency. Fire checks were undertaken regularly but the building had no fire plan so staff were able to tell the area which would need evacuating in an emergency situation.
People had their medicines administered safely by staff who had received training. People who required their blood sugar levels monitoring did not have their checks undertaken with test equipment that had been calibrated in line with the manufactures guidelines.
People were supported by staff who were happy in the home and who felt supported by the manager. Staff had received regular supervision and training and staff meetings were an opportunity for staff to raise any changes or concerns. Staff had adequate checks completed prior to working with vulnerable people.
People and relatives were happy with the care they received and felt staff were kind and caring. One person who was supported with their lunch did not receive their meal in an inclusive, supportive manner. There was a lack of engagement and one to one support to provide this person with a positive meal experience. People were supported to maintain relationships with people who were important to them.
People’s consent to care and treatment was obtained and care plans reflected if people had capacity to make their own decisions. People were involved in their care planning and referrals were made to health care professionals when required.
The environment was not always enabling a dignified environment for people living at Rosewood Lodge. People had access to activities and people told us they enjoyed the meals.
People, relative’s, health professionals and staff views were sought. People and relatives felt able to raise any concerns and there was a complaints policy in place. The provider had quality assurance systems in place that monitored the quality and safety of the service and identified areas for improvement, although some areas of concern had not been identified prior to this inspection.
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.
We looked at three care plans in detail and saw that people had signed consent forms in their care plans and the care documentation was written using the expressed words of the people using the service where possible.
We observed staff speaking with people who used the service and saw that they spoke to the people at eye level and offered assistance to them before carrying out tasks.
We spoke to a district nurse visiting the home who told us that the staff working at Rosewood Lodge were quick to highlight changes in care needs of the people living there. They also told us that the staff responded promptly to their advice and provided a high standard of care.
We saw there was information for people in the reception area of the home so that people were aware of the activities available.
One visitor told us they had always been welcomed in the home and staff members were always polite and caring. They told us the 'the staff are very good, you couldn't wish for a better place.'
People we spoke with told us they were happy and safe at Rosewood Lodge. One person commenting on the home told us, 'I cannot think of anywhere better than here.'
The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw people were treated with respect and dignity, for example, staff were observed to make good eye contact and used touch to reassure people.
Staff told us they were aware of the home's policies on recognising and reporting abuse and would not hesitate to report any concerns to the manager.
We observed the atmosphere and general ambiance of the home to be friendly, calm and relaxed.
We saw staff speaking to the people in the home and observed how they treated them in a calm reassuring manner and were aware of those people with dementia care needs.
One person who lived in the home told us 'my future daughter in-law can visit at any time. She came yesterday and nobody bothers. We can stay in the lounge or go to my room. We are free to go any where we want'.
We saw staff speaking to the people in the home and observed how they treated them in a calm reassuring manner and were aware of those people with dementia care needs.
We saw that staff do receive mandatory training and are competent to do their job, but we noted that there are some gaps in training that the manager and staff have received which would help them to further understand and respect the cultural, social values and beliefs of people they support and enable them to challenge anti- discriminatory behaviour. This training would also help them to ensure people's best interests and to recognise when people are being deprived of their liberty and what to do about it.
We spoke to an advocate of a person who lives in the home who told us 'I cannot be more pleased with care provided to the person I visit. They look better than they have done for years'. We were told how the home had supported this person to make choices and decisions about their care, including moving to a different room to help them feel less isolated and nearer to he People who use the service are encouraged to be involved in decisions about their care and support and are encouraged to express their views. There are no records in peoples care plans to show that they, or their representatives, have been involved in their care planning.
People are supported to have coordinated care from other care professionals and services, but we found there had been a significant delay in the service referring one person to health care professionals when their needs had changed.
One visitor told us that they had lived in the home three years ago and they now come in to eat lunch at the home twice a week, as they enjoy the food and the company. This person was very complimentary about the home. They said the staff would do anything for you.
One visitor told us that there was always enough staff on duty when they visited. They said there were usually four or five staff.
People receive appropriate attention and treatment but they cannot be completely confident that important events that affect their welfare, health and safety are reported to the Care Quality Commission.
The people who live in the home, a visitor and the staff that we met and talked with at Rosewood were complimentary about the staff and the manager
One person spoken with said 'the girls are brilliant and the manager, but we do not see her much'.