CQC report explained · a nursing home
What the CQC found at Rosewood House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People received medicines at the correct time, but medicines records and checks were not reliable. Inspectors found out-of-date medicines, medicines that were not correctly recorded and missing refrigerator temperature records.
- Effective?
- Requires improvement
- People did not always receive support that promoted meaningful activities, independence, future goals or regular community access. The home did provide nutritious food, communication support and access to health professionals.
- Caring?
- Good
- This question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management was visible and relatives and staff said communication was good. However, governance checks had not identified important problems with medicines, people's goals, daily activities and person-centred support.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found unsafe medicines systems and limited support for people's independence and community life.
This was an unannounced focused inspection on 18 July 2023. Inspectors observed people, spoke with people, relatives, staff and professionals, and checked care records, medicines records, audits and meeting notes.
The home was not always safe. People received their medicines at the right time, but records, stock checks, expiry checks and fridge temperature checks were not reliable. Some medicines were out of date, and one had still been used before the inspection.
Inspectors found that people did not consistently have varied, meaningful activities, regular access to the local community or support to build independence. The home had improved its kitchen and its duty of candour process, but its checks had not found all the problems. The overall rating remains Requires Improvement, as do Safe, Effective and Well-led.
Familiar staff
The staff team was stable, so people were supported by staff who knew them well. Recruitment checks were completed before new staff started.
“There was a stable staff team in place. Some staff had worked at the service for several years.” from the report
People felt safe
Relatives and staff said people were safe in the home. Staff had safeguarding training and knew how to report concerns.
“People were protected from the risk of abuse as staff knew and understood their responsibilities to keep people safe and protect them from harm.” from the report
Improved kitchen
A larger kitchen had been installed. This gave people more opportunity to help prepare food and drinks, with some adaptations for wheelchair users.
“A new, larger kitchen had been fitted. Staff told us at times people took part in preparing food and drinks.” from the report
Health support
Staff knew people's health needs and worked with healthcare professionals. Relatives were told about changes in people's health or medicines.
“A healthcare professional told us staff followed advice and guidance and ensured it was communicated clearly to other staff members.” from the report
Open communication
Relatives and staff said managers listened and that concerns and ideas could be raised. The duty of candour process had also improved.
“Relatives and external professionals told us communication was good and that they felt part of the team looking after their family member.” from the report
Medicines records and storage
seriousThe home did not have reliable systems for recording medicines, checking stock, checking expiry dates or recording fridge temperatures. Inspectors found out-of-date medicines and other medicines that were not correctly managed.
“Some medicines found in the service were out of date. Prior to the inspection, 1 of these had still been in use.” from the report
Limited activities and community access
needs fixingPeople often spent their time doing the same things and did not go out often. Records did not show enough about people's aspirations, choices or alternatives when they declined an outing.
“Records of how people spent their time showed people did not go out often.” from the report
Weak oversight
seriousThe home's audits and checks did not identify all the problems found by inspectors. This included concerns about medicines and whether people were receiving person-centred support.
“Checks of the service had not identified that some people had not been consulted on their goals or aspirations for the present and future.” from the report
Emergency information
minorAn emergency evacuation file still included information about someone who no longer lived at the home. Inspectors recommended regular reviews of this information.
“However, a file to be used in the event of an emergency evacuation or fire contained details of 1 person who no longer lived at the service.” from the report
- 01What has been changed to make sure every medicine is recorded, in date, correctly stored and checked?
- 02How are refrigerator temperatures now recorded every day, and who checks the records?
- 03What weekly activities and community visits would be planned around my relative's interests and goals?
- 04How will my relative be supported to build independence, including choosing, buying and preparing food?
- 05How will managers check that care plans include each person's present and future goals and that staff follow them?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and the overall rating used the previous ratings for those questions. This explanation was written from the published report of 13 September 2023 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, August 2022
Rosewood House is rated Requires Improvement; inspectors found safe, kind care, but limited activities, choice and community access, with weaknesses in management.
This was an unannounced, focused inspection on 4 July 2022. Inspectors reviewed Safe, Effective and Well-led. They spoke with people living there, relatives, staff and professionals, and checked care, medicine and management records.
The home was rated Good for Safe. Inspectors found enough staff, suitable training, safeguarding knowledge and clear guidance for complex health needs. Infection control arrangements were also judged satisfactory.
Effective and Well-led were rated Requires Improvement. Inspectors found limited meaningful activities, community opportunities and support to develop independence. The building did not meet all sensory and accessibility needs, and management systems had not driven the improvements needed.
The overall rating changed from Good at the previous inspection, published in November 2018, to Requires Improvement. The report says the provider had to send an action plan and that progress would be monitored.
Safe care
Staff knew people well and understood how to protect them from abuse and avoidable harm.
“People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse.” from the report
Kind and knowledgeable staff
People received compassionate care. Staff understood individual needs, including complex health needs, and received relevant training.
“People received kind and compassionate care. Staff understood and responded to their individual care needs.” from the report
Staffing and training
There were enough staff to meet people's commissioned hours and support their safety. Recruitment checks, induction and competency checks were in place.
“There were plenty of staff available to support people according to their needs.” from the report
Health and eating support
Care plans gave staff clear guidance about health needs, choking risks and food preparation. Inspectors saw people being supported in line with that guidance.
“People were protected from the risk of choking. Care plans contained clear guidance on how people's food should be prepared and the assistance they would need during mealtimes.” from the report
Limited choice and activities
seriousMany people did not have meaningful, person-centred activities or enough opportunities to pursue interests, develop goals and use the local community. This was linked to a breach of Regulation 10.
“People were not supported to pursue their interests or identify meaningful goals. There were limited opportunities to try new activities.” from the report
Environment did not meet all needs
seriousThe premises had not been assessed fully for sensory needs. There was no quieter communal area, and the kitchen was not designed for people using wheelchairs to take part. This was linked to a breach of Regulation 17.
“There were no alternative quieter areas people could choose to spend time in if they wanted a more relaxed atmosphere.” from the report
Weak management oversight
seriousAudits had not considered the latest guidance, and promised changes to meal arrangements had not been made since the previous inspection. This was linked to a breach of Regulation 17.
“The provider had not assessed and monitored the service in order to improve the quality of the service provided in line with the most up to date guidance and regulations.” from the report
Medicine records
needs fixingStaff did not always sign medicine administration records after giving medicines. Inspectors recommended following national guidance, and a new electronic recording system was due to be introduced.
“Staff did not always sign Medicine Administration Records (MAR) after administering medicines to evidence people had received their medicine as prescribed.” from the report
Recording openness after incidents
needs fixingThe manager had apologised to a family after a notifiable safety incident, but there was no written record of that contact. Inspectors made a recommendation about the duty of candour.
“No written record of the contact had been kept. This was contrary to the regulations.” from the report
- 01What individual goals and meaningful activities will be recorded for my relative, and how will progress be reviewed?
- 02How will people be supported to use the local community and pursue interests outside the home?
- 03What changes have been made to provide quieter areas and better sensory support?
- 04How can residents be involved in menu planning, food shopping or meal preparation where appropriate?
- 05Has the new medicine recording system been introduced, and how are you checking that every dose is recorded correctly?
This was a focused inspection of Safe, Effective and Well-led; the other key questions were not inspected and the overall rating used the previous inspection ratings for those areas. This explanation was written from the published report of 10 August 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 Rosewood House
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- September 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2022Requires improvementdown from GoodSafe: GoodEffective: Requires improvementWell-led: Requires improvement
- November 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
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.
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