CQC report explained · a nursing home
What the CQC found at Rothsay Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2022
Rothsay Grange is rated Good overall, but inspectors found that personalised care records and end-of-life planning needed improvement.
Inspectors visited on 4 and 5 October 2022 without giving notice. They reviewed records, including 55 medicines records and four care plans, and spoke with people, relatives, staff and managers. The inspection was partly prompted by concerns about dementia care, staffing, behaviour that could put people at risk and infection control.
The home was rated Good for Safe, Effective, Caring and Well-led. Inspectors found improvements in staffing, medicines management and quality checks. People generally felt safe and well cared for. The premises were clean, staff were trained and people could access healthcare, activities and visitors.
Responsive was rated Requires Improvement. Some clinical care plans did not contain enough information about stoma care or oxygen use. Inspectors also found that some ReSPECT and advance care plans lacked detail about treatment choices and end-of-life wishes. The overall rating improved from Requires Improvement at the previous inspection, and the provider was no longer in breach of regulations.
Safety and safeguarding
Staff were trained to recognise abuse and knew how to report concerns. People said they felt safe.
“People were safeguarded from abuse by staff trained to protect them.” from the report
Clean and well-maintained
Inspectors found the premises clean and in good condition. Equipment and building safety checks were carried out regularly.
“Regular servicing and checks of equipment and aspects of the premises ensured risks were minimised.” from the report
Kind, person-centred care
Staff treated people as individuals and supported their choices, dignity and independence.
“People were treated as individuals and care was person-centred and tailored to specific needs and wishes.” from the report
Activities and relationships
People could take part in group and individual activities, including gardening, outings, games and exercises.
“There was an activities programme including group sessions and entertainers and individual sessions for those who preferred them.” from the report
Improved management checks
The home had extensive audits and acted on concerns identified through them. This was an improvement since the previous inspection.
“Audits were thorough and should they identify a concern, clear plans had been added and completed to rectify that concern.” from the report
Clinical care records
needs fixingSome plans did not explain enough about stoma care, oxygen equipment, mouthcare or epilepsy. This could make it harder for staff to provide the right support if a person became unable to manage their own care.
“We found some details were lacking in clinical care plans.” from the report
End-of-life planning
needs fixingSome ReSPECT forms did not clearly record choices about antibiotics, hospital admission or other treatment. Advance care plans also lacked important personal wishes.
“Forms focussed on cardiopulmonary resuscitation (CPR) which is just one aspect of possible resuscitation meaning there was no clarity about interventions up to that point.” from the report
Busy staffing periods
needs fixingInspectors were concerned that only two care staff were deployed on the nursing floor between 3pm and 5pm. People and relatives also described delays at busy times and concerns about agency staff changes.
“We were concerned that between 3pm and 5pm on the nursing care floor there were just 2 care staff deployed.” from the report
Some medicines arrangements
needs fixingInspectors found missing capacity and best-interest records for one person's covert medicines. They also found a PEG medicine that should not be crushed and antibiotics that were not given at eight-hour intervals.
“One person who needed to have covert medicines did not have a capacity assessment and best interest decision in place to support this method of administration.” from the report
- 01What has been added to the care plans for people who use stomas or oxygen, and what would staff do if the person could no longer manage this care?
- 02How will you make sure ReSPECT and advance care plans clearly record treatment choices, hospital admission decisions and end-of-life wishes?
- 03How many staff are normally on each floor between 3pm and 5pm, in the mornings and at weekends?
- 04How do you check that covert and PEG medicines are safe to give, correctly documented and administered at the right times?
- 05What steps have been taken to reduce the effect of agency staff changes and previous changes in registered manager?
This was an unannounced inspection covering all five key questions, with particular attention to concerns about dementia care, staffing, behaviours that could put people at risk and infection control. This explanation was written from the published report of 6 December 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, May 2021
Inspected but not rated; inspectors found infection controls in place but gaps in mouthcare records and staff understanding.
This was an unannounced, targeted inspection on 26 March 2021. Inspectors looked specifically at mouthcare after a concern about the care of a person's dentures during a respite stay. They also checked infection prevention and control.
Inspectors found no specific mouthcare plans and said records did not show consistently whether mouthcare had been provided or refused. Staff had limited understanding of the more serious risks of poor mouthcare. The provider was asked to review mouthcare, introduce its planned policy and training, and make care records clearer.
The home had appropriate protective equipment and clear visitor procedures. Inspectors were assured that it was following current infection control guidance. This inspection did not give new ratings. The overall rating remained Requires Improvement from the previous inspection.
Infection control
Inspectors were assured that the home was following current infection control guidance and had measures to help prevent and manage outbreaks.
“We were assured that the service was working within current infection control guidance.” from the report
Visitor safety
The home had clear instructions for visitors before they entered and staff were using appropriate protective equipment.
“There were clear processes in place for visitors to the service to follow before entering the premises.” from the report
Missing mouthcare plans and records
needs fixingThe home did not have specific mouthcare plans. Records did not consistently show whether mouthcare had been provided or refused.
“There were no specific care plans for mouthcare and records of mouthcare were not maintained.” from the report
Staff knowledge and escalation
needs fixingStaff did not show enough understanding of the possible harms caused by poor mouthcare. Inspectors were also not assured that repeated refusal of mouthcare would be reported to the nurse in charge.
“All staff knew that poor mouthcare could lead to cavities, however none considered the possibility of infections, abscesses, pain or more serious conditions” from the report
- 01How are each person's mouthcare needs assessed and recorded now?
- 02How do staff record mouthcare that has been provided or refused?
- 03What happens if someone refuses mouthcare for several days, and who is told?
- 04Has the new mouthcare policy been introduced, and have all relevant staff completed the planned training?
- 05How can staff identify and respond to signs of pain, infection or other problems linked to poor mouthcare?
This was a targeted inspection of a specific mouthcare concern and infection prevention and control; it did not assess the full key questions, so the previous ratings remained in place. This explanation was written from the published report of 11 May 2021 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 Rothsay Grange
6 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- December 2022Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- May 2021Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not rated
- October 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2017Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2016Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: InadequateWell-led: Requires improvement
- May 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- March 2014Inspected but not rated
- January 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- May 2011
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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