Rosemount Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service was now rated inadequate. We found a breach in relation to governance. The provider had continued to fail to implement effective governance and accountability processes. Quality assurance measures were not robust and had not been effective in identifying concerns and prompting action to improve the service. There was limited evidence of learning when things went wrong, and a limited understanding of how to make and sustain required improvements. Leaders acknowledged inconsistencies in home management meant oversight had not been robust and quality assurance systems had not been implemented fully.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some staff told us that they observed a lack of effort from some of the staff working in the home and that they could often appear disinterested. However, the new manager and staff shared vision, strategy and culture of putting people first

The policies and procedures the provider had put in place were based on providing transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and local communities. However, instability with the management had affected the home’s ability to adhere to these. There was some improvement under the new manager.

Staff told us they had not felt supported however, felt things were improving since the appointment of the new manager. One staff member told us they always felt supported by senior staff in the course of their work. The leadership team acknowledged the lack of support historically and oversight and were committed to improving this. Leaders had a good understanding of the issues at the service and told us they were committed to driving improvements but this was still a work in progress.

The organisation’s senior leadership team were a consistent team of staff but there had been some changes in the manger recently. The lack of sufficient oversight and governance meant we could not be assured that the home provided consistent care, treatment and support was consistent. There was a lack of documentation to evidence how staff, people, and relatives were being supported through managerial changes, how they were involved in identifying areas for improvement and development. Inconsistencies in home management meant the oversight of the home had not been robust, quality assurance mechanisms were not utilised to full effect. Staff support and wellbeing had not been consistently supported and the provider had failed to ensure oversight through supervisions and appraisals. Senior leaders told us that, since the appointment of a new manager, they were observing staff being more open and feeling more supported.

Some staff said they felt listened to by the current management team. One person told us, “I am highly confident about using the whistle blower policy and this can be as simply putting a written note under the manager’s door anonymously. Another told us, “We always report anything to the CHAP (Care Home Assistant Practitioner) or manager, we always report anything.” However, leaders acknowledged that staff had not always raised concerns to management about poor practice and safeguarding.

A whistleblowing policy was in place. The management explained that there was a whistleblowing helpline in place and a new company/system in place now. Leaders explained that there were ‘HR surgeries’ in the home where staff can discuss any issues. There was also a policy of the week. We reviewed minutes from staff meetings however, whistleblowing was not included in the discussion. The new manager told us that that whistleblowing would be put on as an agenda in staff meetings in future.

The provider discussed how they valued diversity in the workforce. They offered an inclusive and fair culture through improving equality and equity for people who worked for them. Staff confirmed they had a working environment which encouraged effective teamwork.

The provider had an Equality & Diversity policy which aimed to foster a positive culture where people felt they could speak up and that their voice would be heard. However, this was last reviewed in 07/12/2021 and was due to be reviewed again 07/12/2023. This meant the policy had not been reviewed to ensure the information was still relevant.

The new manager demonstrated a good understanding of the CQC assessment process and the new quality statements. There was some feedback from a person that there was a lack of direction from nursing staff on days but it was better on nights.

We discussed with the provider visits and how certain areas weren’t completed on the audit proforma conducted by the regional manager. They explained that the audits are led by any issues or concerns or specific themes, that not every section needed to be completed, unless it was a home in breach however, this contradicted the wording on the document. Whilst medicines audits were taking place, they had not identified all of the issues we found as part of our assessment. The statement of purpose did not include the correct information for the provider.

Whilst the provider was engaged with partnership working the service was not working seamlessly for people to learn and collaborate for improvement.

The new manager had also undertaken work to improve the home’s relationship with the GP to promote effective communication and efficient working.

Partners told us there had been an improvement in engagement since the new manager had been appointed. However, they report there was still a reluctance from the nursing team to meet with professionals such as the frailty nurse. The new manager had agreed to support with engagement in this. There was also some work ongoing to improve ward round procedures which included the frailty nurse. Partners acknowledge this was positive but agreed they needed to see continued and sustained improvements in order to feel assured.

The provider was engaged with Organisational Safeguarding processes with the local authority safeguarding and commissioning teams to work through an identified action plan to support improvement. The provider had been able to evidence some improvements since the new manager had been appointed. However, it was acknowledged that improvements would need to be ongoing and sustained in order to evidence robust systems had been implemented.

Leaders acknowledged that management of staff had not always been in line with expectations. Quality audits had been but they had not been applied consistently and accurately enough to identify areas for learning, or appropriately measure outcomes and impact. Staff told us that under the new manager they felt they could contribute to the development of the home. One person told us, “I am able to raise issues or suggestions both in person or anonymously.”

Audits had not been effectively implemented to make improvement and ensure continuous learning took place. The audits we reviewed had either not highlighted the shortfalls CQC had identified during the assessment, or ensured timely action was taken, in relation to medicines management, infection control, recruitment processes, staff training and support, care planning and the assessment of risk, equipment, mental capacity and consent and seeking and acting upon feedback. A review of records during the assessment demonstrated the provider did not have an effective system in place to ensure standards relating to seeking and acting on feedback never fell below the requirements of the regulations.