Rosewood House

Updated 13 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Rosewood House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Rosewood House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection, a registered manager was in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

People could not easily share their views of the service so we observed how people spent their time and interacted with staff. We spoke to 2 people, 4 relatives, 10 staff members, including the registered manager, and 2 professionals.

We spoke to 5 relatives by phone. We reviewed 3 people’s care records and medicines administration records (MARs). We also reviewed a range of information related to the management of the service, such as audits and checks and meeting minutes.

Updated 13 September 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Rosewood House is a residential care home providing personal and nursing care to up to 16 people. The service provides support to people with a learning disability. At the time of our inspection, there were 15 people using the service, some of whom had complex nursing needs.

The service is adapted to meet the needs of people with physical disabilities. It is on a site outside of the local village, along with three further residential care homes run by the same provider. There is a swimming pool and restaurant on the same site.

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

Right Support:

The model of care and setting did not consistently maximise people’s choice and independence. The service did not ensure people had a fulfilling and meaningful everyday life. There was little evidence of people’s aspirations and goals or what support they needed from staff to achieve them.

People did not have the same level of contact with their local community as any other citizen.

People received their medicines as prescribed, but medicines were not always managed safely.

People were not supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service were in line with the Mental Capacity Act.

People’s care and support was provided in a safe, clean, well equipped, well-furnished, and well-maintained environment. A new kitchen had been installed which increased people’s opportunities to participate in choosing and preparing some meals. People had a choice about their living environment and could personalise their rooms.

Relatives and staff told us people were safe living at Rosewood House. People could access specialist health and social care support in the community and were supported by staff who understood how and when to highlight concerns they had about people’s health.

Right Care:

People’s care plans were not holistic and did not consistently promote people’s wellbeing and enjoyment of life. The support people received did not always focus on their quality of life or enable them to undertake activities or interests that were tailored to them.

Opportunities to increase people’s skills and independence were not always used.

People had access to good quality nutritious food but were not as involved as possible in planning their menu, buying food or cooking.

People were able to communicate with staff who understood peoples’ communication needs.

People were protected from abuse. Staff understood how to raise any concerns and said they were listened to.

New staff were recruited safely and completed an induction.

Right Culture:

The provider had not ensured best practices for people with a learning disability had been embedded in the way the service operated.

Staff knew people well but there was a lack of guidance to enable staff to support people to achieve their aspirations and to live a quality life of their choosing.

The service’s governance arrangements had not identified all the areas for improvement highlighted during the inspection.

Staff received regular updates to their training. They told us they also attended team meetings and one to one supervision.

Relatives gave positive feedback about the service.

Staff turnover was low, which meant people received care from staff who knew them well.

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 10 October 2022). We found breaches relating to the governance of the service and treating people with dignity and respect.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 4 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance and how they treated people with dignity and respect.

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, Effective and Well-led which contain those requirements.

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 the same.

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

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.

Enforcement and Recommendations

At this inspection we found the provider remained in breach of regulations. We found ongoing breaches in relation to the governance of the service and treating people with dignity and respect.

Please see the action we have told the provider to take at the end of this report.

At our last inspection we recommended that the provider followed national guidance when recording the administration of medicines and sought advice and guidance about each of the steps outlined in the duty of candour. At this inspection we found further concerns about medicines management but found the provider had made improvements in relation to how they followed the steps to meet their obligations regarding their duty of candour.

At this inspection we made a recommendation about the emergency evacuation information held in the service.

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