CQC report explained · a residential care home
What the CQC found at Rosedale Retirement Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People's risks, medicines, staffing and infection control had improved and were managed safely. However, inspectors said the call bell system did not give enough assurance that staff could always respond promptly.
- Effective?
- Good
- People's needs and choices were assessed before they moved in. Staff had training, worked with healthcare professionals and supported people with food, drink and legal consent processes.
- Caring?
- Good
- People and relatives described staff as kind and caring. Staff respected people's choices and supported their dignity, although some environmental privacy issues remained.
- Responsive?
- Good
- Care plans reflected people's needs and preferences, and changes were reviewed promptly. People had activities, visits, complaint information and end of life care that reflected their wishes.
- Well-led?
- Requires improvement
- New systems had improved care, but they needed more time to become established and sustained. Audits had not identified some continuing problems, including personal possessions in vacant rooms, damaged furniture and the unchanged call bell system.
What inspectors found, October 2022
Rosedale Retirement Home is rated Good overall; inspectors found much better care, but leadership and some privacy and safety systems still need improvement.
Inspectors visited without notice on 27 July 2022. They spoke with people living in the home, relatives, staff and a healthcare professional. They also checked care, medicines, staffing, recruitment, complaints and other records.
The home was rated Good for Safe, Effective, Caring and Responsive care. People said they felt safe, staff were kind, medicines were managed safely, and care plans and activities reflected people's needs and preferences.
Well-led was rated Requires Improvement. The home had gone through major management changes, and its new monitoring systems had not yet been fully established. Inspectors also found continuing concerns about vacant rooms, worn items, privacy and the call bell system.
The previous overall rating was Inadequate and the home had been in Special Measures. Inspectors found enough improvement for the home to leave Special Measures and for all previous breaches to be cleared.
Safer care planning
Staff understood people's individual needs and care records explained their risks and how to reduce them. Reviews took place monthly or when people's wellbeing changed.
“People's care records detailed their individual risks, how these had been minimised and how staff were to support the person in line with best practice.” from the report
Medicines
Inspectors found that medicines were given as prescribed and were safely received, stored and disposed of. Staff knowledge was checked through spot checks and supervision.
“At this inspection we found improvements had been made. People received their medicines as prescribed and in line with their doctor's advice.” from the report
Kind and respectful staff
People and relatives said staff were kind and caring. Inspectors saw staff speaking respectfully and supporting people with dignity.
“We saw staff were kind and supportive in their approach to people and talked to people in a respectful way.” from the report
Personalised support
People and relatives were involved in care planning. Staff knew people's likes and dislikes, and activities included interests such as colouring, knitting and music.
“At this inspection people and where appropriate their relatives, had been supported in developing their care plans.” from the report
Leadership still settling
needs fixingThe new management systems had improved the service but were not yet fully established or proven to last. Staff had also experienced several management changes.
“The systems that were now in place had a positive impact for people and the staff group. However, further time was needed to embed and sustain these systems.” from the report
Call bell system
seriousThe call bell system had not been updated since the previous inspection. Although people said they were not waiting for long periods, inspectors said the provider could not be sure staff would always respond promptly.
“At this inspection we found the call bell system had not been updated.” from the report
Privacy and condition of vacant rooms
needs fixingSome vacant rooms still contained former residents' belongings and information, as well as damaged furniture. One person's window covering remained a privacy concern.
“At this inspection we continued to find in vacant rooms personal items such as clothing, letters and photos.” from the report
Worn towels and face cloths
minorInspectors found that worn and frayed towels and face cloths were still being used during the visit. The nominated individual said new towels had been bought and later confirmed they were in use.
“At this inspection we found frayed and worn towels and face cloths continued to be used.” from the report
No registered manager
needs fixingThere was no registered manager in post when inspectors visited. The nominated individual was applying for the registered manager role and planned to find a new nominated individual.
“At the time of our inspection there was not a registered manager in post.” from the report
- 01Has the call bell system now been updated, and how do you check that staff can hear and respond to calls promptly?
- 02What is the current plan for registering a manager, and who is responsible for the home while that process continues?
- 03Have all former residents' belongings and information been removed from vacant rooms?
- 04Have the privacy concerns with window coverings been fully resolved?
- 05How do you check that the new quality monitoring systems are working consistently over time?
This was a follow-up inspection after the previous Inadequate rating; inspectors rated all five key questions and also checked infection prevention and control under Safe. This explanation was written from the published report of 7 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2022
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, staffing, care planning, dignity and management.
This was a planned follow-up inspection after the previous rating of Requires Improvement. Inspectors visited on four dates in November and December 2021, spoke with people, relatives and staff, observed care, and checked care records, medicines, recruitment files and management records.
All five areas were rated Inadequate: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that risks were not properly assessed, there were not enough suitably skilled staff, medicines were not managed safely, and infection control was inconsistent.
People were often not involved in decisions about their care. Care plans were missing or out of date. Inspectors also found waits for help with toilets, poor privacy, limited personalised activities, weak complaint handling and an environment that was not always safe or well maintained.
The provider took some urgent action during the inspection. A new manager and nominated individual were appointed, and external support was brought in. However, inspectors said significant work was still needed. The home was placed in special measures, meaning CQC will keep it under review and normally reinspect within six months.
Kind staff
People said staff treated them kindly and worked hard to support them, although staffing levels meant this was not always enough to protect dignity.
“People told us staff treated them with kindness and staff worked hard to support them.” from the report
Meals and choices
Most people enjoyed the meals. Some people were offered alternatives when they did not want the meal provided.
“Most people told us they enjoyed the meals offered and we saw some people were offered alternative choices if they did not want what was on offer.” from the report
Visits
The home facilitated visits for people living there, in line with the guidance inspectors considered.
“We were assured the provider was facilitating visits for people living in the home in accordance with the current guidance.” from the report
New leadership action
During the inspection, a new manager and nominated individual were put in place. External support was brought in to help with care planning, the building and staff support.
“The new manager had a good understanding of their safeguarding responsibilities.” from the report
Care risks were not controlled
seriousCare needs and risks were often not assessed, monitored or clearly recorded. This meant staff did not always know how to support people safely.
“People were placed at potential risk of unsafe care as their care needs and associated risks had not been routinely assessed, monitored and mitigated.” from the report
Medicines were not managed safely
seriousMedicines were not always given as prescribed. Records did not show accurate stock running totals, and staff with identified competency gaps continued to administer medicines.
“This meant people were continuing to be exposed to potential harm.” from the report
Too few staff
seriousThere were not enough staff with the right skills. People waited for help with personal care and toilets, and some people did not always have a call bell within reach.
“People told us they had to wait for staff to support them, which compromised their safety and dignity.” from the report
Dignity and privacy
seriousPeople reported waiting for help with the toilet and not receiving their preferred baths or showers. Some windows did not have adequate coverings, and personal belongings were left in vacant rooms.
“The provider failed to ensure people were treated with dignity and respect.” from the report
Unsafe and poorly maintained areas
seriousInspectors found concerns including broken and stained furniture, an unsafe bathroom and laundry room, loose paving, and a roof that had not been repaired.
“The environment of the home continued to place people at potential risk of harm, from concerns with the prevention of fire, to environmental areas such as continued trip hazards from loose patio paving slabs, to flat roofs that had not been mended.” from the report
Weak management checks
seriousThe provider's audits had not identified or acted on serious concerns. Leadership had also lacked continuity, with six managers since February 2020.
“This is the third consecutive inspection where the effectiveness of the provider's systems to monitor the quality of service had failed to identify concerns.” from the report
- 01What has been done to make sure every person's care plan and risk assessment is complete, current and shared with staff?
- 02How many care staff are now on each shift, and how do you make sure people do not wait for help with the toilet or personal care?
- 03What checks now show that medicines are counted, stored, recorded and given exactly as prescribed?
- 04Which building, fire safety, bathroom, laundry room and infection control problems identified in the report have been fully fixed?
- 05How are people and relatives now involved in care decisions, complaints, activities and end of life planning?
This was a planned follow-up inspection prompted by the previous rating and concerns about care; inspectors assessed all five key questions and also checked infection prevention and control. This explanation was written from the published report of 11 March 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Rosedale Retirement Home
7 rated inspections over 6 years: the service has held its Good rating throughout.
- October 2022Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2022Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- September 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- July 2020Requires improvementstayed Requires improvementSafe: Inspected but not ratedWell-led: Inspected but not rated
- May 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- January 2019Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- April 2012
Registered with the Care Quality Commission on 4 April 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
11 live-in carers within about an hour of Herefordshire, County of
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £960 to £1,410 a week. 10 can care for a couple. 8 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.