Rose Villa Nursing Home

“The provider had made notable progress since the last assessment. The management team demonstrated a clear commitment to improvement, with quality assurance systems becoming more utilised and embedded. Some concerns remained regarding the consistency and effectiveness of care delivery and governance arrangements.”

“Records were not always accurate or fully completed, with discrepancies identified in accident and incident documentation. Policies and procedures were in place. However, staff did not always follow them consistently in practice.”

“Care records demonstrated that support was not always delivered in line with people's agreed care plans. For example, pressure area care was not always consistently provided in accordance with people’s assessed needs and documented guidance.”

“Audits were being completed regularly. However, actions identified through these processes were not always followed up or completed promptly. The provider’s governance tracker did not always capture actions identified during audits, resulting in insufficient monitoring to ensure that identified issues were addressed and that the necessary improvements were completed in a timely manner.”

“Significant improvements have been made across a range of areas within the service. Improvements to the environment had enhanced the quality and safety of the premises, including refurbishment works, replacement flooring, and the resolution of previous concerns relating to odours in communal areas. Fire safety arrangements had strengthened, with improvements to fire doors and ongoing staff training and fire drills.”

“Care planning and risk management processes had improved, with more detailed care plans and clearer risk assessments to guide staff practice. Governance arrangements were more established, supported by a comprehensive suite of policies, regular auditing processes, and increased provider oversight.”

“The registered manager demonstrated a stronger focus on quality assurance and was responsive to feedback during the assessment and showed a clear commitment to driving further improvements.”

“The provider has strengthened its oversight arrangements and maintained a clear focus on improving the quality and safety of care. These improvements contributed to the service's continued progress and improvement outcomes.”