Rosedale Retirement Home

Rosedale Retirement Home is a residential care home providing personal care for up to 24 people aged 65 and over in one adapted building. There were 15 people living in the home at the time of our inspection.

People’s experience of using this service and what we found

Rosedale Retirement Home had been through a period of significant management changes over the past two years, which had had a negative impact to the service provision. The recent management team had put systems into place to respond to the significant concerns that were identified at the last inspection. Improvements had been made, and the standard of care had improved. In addition to this more time was needed for these new systems and process to become established, embedded into practice and sustained.

Aspects of the environment required further improvement to promote people’s privacy and dignity.

People told us they felt safe and were supported by staff. Relatives felt their family member was safe and cared for in the right way. Staff recognised different types of abuse and how to report it. The provider understood their safeguarding responsibilities and how to protect people from abuse. Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient numbers of staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.

People told us staff were kind and treated them well. Relatives felt the staff cared for their family member in a caring and supportive way. Staff treated people as individuals and respected the choices they made. Staff treated people with care and respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported to maintain contact with people who were important to them. People engaged in activities that were individualised to them. People had access to information about how to raise a complaint. Where complaints had been raised these had been responded to in line with the provider’s policy. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

People and relatives told us the service had improved since our last inspection. Staff told us there had been improvements which was working much better. People, relatives and staff felt the nominated individual (NI) was visible within the home and listened to people's and staff's views about the way the service was run. The nominated individual (NI) is responsible for supervising the management of the service on behalf of the provider.

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 11 March 2022).

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 regulations.

This service has been in Special Measures since 28 January 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale Retirement Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rosedale Retirement Home is a residential care home providing personal care for up to 24 people aged 65 and over in one adapted building. At the beginning of the inspection there were 20 people who lived in the home, by our final inspection there were 17 people living in the home.

People’s experience of using this service and what we found

Staff did not recognise different types of abuse and how to report it. The previous manager had not understood their safeguarding responsibilities and how to protect people from abuse. The new manager had a good understanding of their safeguarding responsibilities. Potential risks to people's health and wellbeing had not been identified to ensure these were managed safely. People had not been involved with decisions in how to reduce risk associated with people’s care and people told us they did not feel listened to. There were not sufficient staff on duty to keep people safe and meet their needs. People's medicines were not managed and stored in a safe way. Safe practice was not consistently carried out to reduce the risk of infection.

People's care needs had been assessed and reviews had not taken place with the person and where appropriate their relative. Staff had not received the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff did not work with external healthcare professionals to follow their guidance and advice about how to support people following best practice. The new nominated individual and manager were working to improve these external professional working relationship links. People had not been supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported by staff who treated them with kindness, however, there were not enough staff to support people which compromised people’s dignity. The environment of the home did not promote people’s independence or privacy.

The provider could not be assured people's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. There were actions being taken to improve staff communication, so management had a clear understanding of people’s experiences of care and whether additional input was required. People were not supported or encouraged to maintain their hobbies and interests that were individual to them. People did not have access to information about how to raise a complaint and did not feel listened to. The providers system for receiving complaints to enable them to respond to these was ineffective. The provider could not be assured people's end of life care needs had been met in line with their preferences in a respectful and dignified way.

Significant management changes had taken place during the period of this inspection. We received mixed reviews about the management of the service, However, the provider could not demonstrate they had always listened to people and strived to achieve the best possible improvements to the home and the way the service was run. The providers checks to monitor the quality of the service provision were inadequate and had not identified or acted upon the significant concerns we identified on inspection. The provider recognised the seriousness of our concerns and took action to mitigate immediate risk. It was recognised by the provider that time would be needed to return Rosedale to its prior good ratings.

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 27 September 2021) and there were multiple breaches 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The inspection was also prompted in part due to concerns received about people’s care. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report. Where we identified significant concerns, the provider took action to mitigate risk.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale Retirement Home on our website at www.cqc.org.uk.

Enforcement

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 continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s management of risk, staffing, recruitment, infection control, person-centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns can be found at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 6 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.

Rosedale Retirement Home is a residential care home providing personal care for up to 24 people aged 65 and over in one adapted building. At the time of the inspection 18 people lived in the home

People’s experience of using this service and what we found

People's medicines were not always managed, stored or recorded safely. The storage temperatures were not being recorded to ensure they were safe to administer.

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People were not always protected from cross infection Staff did not always wear personal protective equipment correctly.

The provider did not always follow safe recruitment practices. Staff files did not always contain up-to date information as required under Schedule 3 which requires providers to ensure they collected information on staff employed.

People reported staff were kind and treated them well. Although staff reported they felt there were not always enough staff on duty to meet people’s needs especially on weekends.

Quality monitoring systems were in place however, they were ineffective at identifying where improvements were needed and any actions taken to mitigate risks to people.

Staff had understood how to safeguard people. They were confident about reporting any concerns both inside and outside of the organisation.

Why we inspected:

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.

The inspection was prompted in part due to concerns received about the health and safety of people living at the home and the management of the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The last rating for this service was requires improvement (published 02 May 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine administration storage and management, infection control, staffing and governance oversight of the service at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Rosedale Retirement Home is a residential care home providing personal care for up to 24 people aged 65 and over in one adapted building. At the time of the inspection nine people lived in the home.

People’s experience of using this service and what we found

The provider had sought an interim manager to support the home until the new registered manager began work. The interim manager had reviewed associated risks to people's health and wellbeing, and these were being managed. The interim manager supported and guided staff to follow best practice. Competency checks were being implemented to understand if staff were competent in their roles and to identify where they may require additional support and/or training.

The provider was working with the interim manager to put more efficient processes and systems in place to assure themselves staff had understood the training and were consistently following safe and best practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 02 May 2020)

Why we inspected

We undertook this targeted inspection to check on concerns we had about people’s safety and care needs being met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale Retirement Home on our website at www.cqc.org.uk.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosedale Retirement Home is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

People’s experience of using this service and what we found

Improvement was required with the way people’s medicines were managed.

Staff recruitment procedures in the home were not always robust, personal employment histories was not always available.

Staff had received training in Infection control however, infection control procedures were not always followed by staff putting people at risk of cross infection.

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.

People's safety was protected from abuse by staff who knew what procedures to follow to keep people safe from harm.

The provider’s quality assurance systems and audits required improvements as they had failed to identify the shortfalls in medicine management, recruitment and infection control measures within the home.

For more details, please see the report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was Good published (27 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about a reported safeguarding incident, which was being investigated by the police and the Local Authority. As a result, this inspection did not examine the circumstances of the incident.

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 good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosedale Retirement Home on our website at www.cqc.org.uk.

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.

Rosedale Retirement Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide accommodation and personal care for a maximum of 24 older people, some of whom are living with dementia, within one large adapted building. At the time of our inspection there were 16 people living at the home.

At the time of our inspection, the registered manager had been away from the home for about one month. In their absence, we met with the directors, one of whom was overseeing the day-to-day management of the service, with the support of a registered manager from an associated home. 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.

Staff did not always handle and administer people’s medicines in line with good practice. Medicine expiry dates were not consistently monitored. Staff did not always follow the provider’s risk assessments to minimise risks associated with people's access to the home's laundry. The provider completed pre-employment checks on prospective staff to ensure they were safe to work with people. However, they had not carried out a risk assessment in relation to the renewal of staff members’ DBS checks.

The provider had assessed, reviewed and put plans in place to manage the risks associated with people’s individual care and support needs, including the risk of falls or skin breakdown. People felt safe living at the home, and understood how to raise any concerns about their own or others’ safety with staff and management. Staff recognised their individual responsibilities to protect people from abuse and discrimination. They understood the different forms and potential signs of abuse to look out for. The provider monitored staffing levels in line with people’s care and support needs. The provider had taken steps to protect people, staff and visitors from the risk of infections. This included providing staff with appropriate personal protective equipment for their use.

Prior to people moving into the home, the registered manager or a senior care staff member met with them to assess their individual care and support needs. Staff had received training in, and understood, the need to avoid any form of discrimination when assessing or meeting people's care needs. Staff and management worked with a range of community health and social care professionals to promote people’s health and wellbeing. On starting work for the provider, staff completed the provider's induction training to help them settle into their new roles and understand people’s individual needs. After their induction, staff received further training to give them the skills and knowledge needed to succeed in their roles.

Staff supported people to have a balanced diet, and helped them choose what they wanted to eat and drink each day. Any specific needs or risks associated with people’s eating and drinking were assessed, reviewed and plans put in place to manage these. Staff and management helped people access professional medical advice and treatment when they were unwell. The home environment provided people with sufficient communal space to eat in comfort, participate in activities and receive visitors. The provider had plans in place to create a more dementia-friendly environment. Staff understood the need to respect people’s rights under the Mental Capacity Act 2005, and to support their day-to-day decision-making.

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.

Staff treated people in a kind and caring manner, and took the time to get to know them as individuals. They supported people in an unrushed manner and listened to what they had to say. People were encouraged to participate in decision-making that affected them with appropriate support. Staff understood and promoted people’s right to privacy and dignity, and addressed them in a polite, professional manner.

People received person-centred care and support that took into account their individual needs and requirements. They had individualised care plans which were kept under regular review. People’s communication and information needs had been assessed to promote effective communication. People had support to participate in recreational activities, and the provider had plans in place to improve activities provision. People knew how to complain about the care and support they received. The provider had a complaints procedure in place to ensure complaints were dealt with fairly. The provider had processes in place to establish people's wishes and choices for their end-of-life care.

People’s relatives benefitted from open communication with staff and management, who kept them up to date with any changes in their loved ones’ health or wellbeing. Staff felt well-supported by the registered manager, and could seek advice from senior colleagues and the directors in her absence. The provider had developed quality assurance processes to enable them to assess, monitor and improve the service provided.

The inspection took place on 13 May 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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’s individual needs and risks were known and managed by staff. Staff's attitudes and behaviours towards people were monitored by the registered manager and disciplinary action taken where necessary. Staff knew when to refer concerns regarding people’s safety to the local authority. People received their medicines from trained and competent staff, and as prescribed by their GP.

People’s privacy was respected and staff knew the importance of maintaining people’s dignity. People enjoyed positive and caring interactions with staff. People and their relatives were involved in the planning of their care.

People had access to a range of health professionals and staff knew when to request specialist input. People’s nutritional needs were known by staff, and people benefited from flexibility in how their meals were provided. People were provided with choices about how they received their care, and their consent was sought before assisting with personal care or giving medicines.

People's individual needs, interests and preferences were known by staff. Staff were alert to people's changing needs and these were responded to. People were involved in decisions about their care and in the running of their home. People knew how to complain if they were unhappy with the care they received.

People knew who the registered manager and provider were and were encouraged to give feedback on the service. Where people had made suggestions, these had been acted upon. The registered manager and provided monitored the quality of care provided to people and carried out monthly checks to ensure people were being cared for safely and that their needs were being met.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were asked about their preferences about their care so they felt involved in their care and treatment.

Staff had been recruited in an appropriate way. We found that thorough checks had been undertaken before staff started work at the home to ensure they were suitable to care for vulnerable people.

The provider had a system of audits in place to enable them to monitor the quality of the service provided and ensure that people received appropriate care and treatment.