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Inspection carried out on 28 December 2016

During a routine inspection

This inspection took place on 28 December 2016 and was unannounced. At our last inspection on 15 and 17 September 2015 we found that the provider ‘required improvement’ in all five questions, namely safe, effective, caring, responsive and well-led and was found to be in breach of regulation 17 of the Health and Social Care Act 2014.

Rosemary Retirement Home provides accommodation and personal care for up to 23 older people. At the time of the inspection there were 23 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 15 and 17 September 2015 we asked the provider to take action to make improvements (regarding the audits in place to assess, monitor and drive improvement in quality and safety of the services provided and to seek and act on feedback from people using the service). We saw that these actions had been completed.

People’s dignity was not always respected when receiving care and support. People described staff as kind and caring and supported them to make their own decisions on the support they received. People were supported to retain their independence, where possible.

People were supported by staff who had received training in how to recognise signs of abuse and what actions to take should they suspect someone was at risk of harm. Staff were aware of the risks to people on a daily basis and how to manage those risks.

Staffing levels were based on people’s dependency levels and were reviewed on a regular basis. People were supported by staff who had been safely recruited. There were systems in place to ensure people received their medicines safely.

People were supported by staff who received an induction that prepared them for their role and were provided with the training they needed to meet people’s needs.

Staff understood the importance of obtaining people’s consent prior to supporting them and ensured they offered people choices throughout the day in line with their personal preferences.

People were supported to have sufficient amounts to eat and drink and their dietary needs were adhered to.

People’s healthcare needs were met and they were supported to access a variety of healthcare professionals to ensure their health and wellbeing.

Efforts were made to obtain more information about people’s interests in order to introduce activities that were of interest to them. People had requested for more activities and plans were in place to extend the number and variety of activities on offer. People were involved in the planning of their care and were regularly asked for feedback on the service.

People were aware of how to make complaints and were confident that if they did raise a concern it would be dealt with to their satisfaction

The registered manager had a number of quality audits in place to identify any areas of improvement that were required within the service. Where areas where identified, action plans were put in place to address any issues.

Inspection carried out on 15 and 17 September 2015

During a routine inspection

The inspection took place on the 15 and 17 September 2015 and was unannounced. At our last inspection on the 4 June 2014 the provider was not fully compliant with the regulations inspected.

We found concerns in June 2014 with how the provider managed and administered people’s medicines and the standard of their records. We asked the provider to send us an action plan outlining how they would make improvements and we considered this when carrying out this inspection.

Rosemary Retirement Home is registered to provide accommodation and support for 23 older adults with dementia. On the day of our inspection there were 23 people living at the home and there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act (2008) and associated Regulations about how the service is run.

We saw that the provider had not taken sufficient action to ensure staff had the appropriate guidance to administer ‘as required’ medicines. However by the second day of our inspection this had been rectified to meet our requirements. We found that since our last inspection an audit of medicines had taken place but we found it was not effective as we found gaps on the medicines administration record chart making it difficult to identify whether or not people had been given their medicines. After the last inspection the registered manager and provider told us they would also ensure staff had access to regular staff meetings as part of giving them support. We found this was also not happening and there had only been one staff meeting since our last inspection. We found that improvements to how records were being kept had been made. This meant the provider had not completely met our requirements.

People and relatives told us they felt safe.

The provider did not have a staff dependency tool in place. This tool would ensure they had the right level of staff on duty to ensure people received the support they needed to maintain their safety.

People were able to receive their medicines as required.

People’s consent was sought before any care and supported was given.

We found that the provider was meeting the requirements of the Mental Capacity Act 2005, and where people were at risk of their human rights being restricted the appropriate advice or approval was being sought from the supervisory body. Staff had limited knowledge and understanding about the MCA and DoLS.

Staff were able to access training and support when needed to ensure people were supported appropriately.

People’s health care needs were being met and we saw that a record of visits made by their doctor, optician and other health professionals were kept to show when people received a check-up or when they were not well.

We saw that for a period of time during our inspection that staff were not as vigilant as they could have been to ensure people had access to a snack or drink. However, people told us that they were able to access a drink and snack when needed.

People and relatives told us that staff were ‘Kind’ and ‘Friendly’. They told us they were able to make decision on the support they received.

People’s privacy and dignity was not always respected. We observed on an occasion where someone’s dignity was not respected while they received personal care.

We saw limited activities taking place which were not always linked to people’s preferences. We were told that people had access to activities but we saw no plan in place and we saw people being left for long periods to just sleep in the lounge.

People told us that if they had to complain they would speak with the registered manager.

People were able to complete a quality assurance questionnaire to share their views on the service.

We found that audits being carried out were not consistently effective and failed to identify occasions where medicines administered were not being recorded appropriately and checks on the cleanliness of the environment had not identified that necessary dusting was not being done.

Notifiable events were not being reported to us consistently as required within the law.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 4 June 2014

During a routine inspection

We carried out an inspection on the 7 December 2013 and found that the provider was not meeting the regulations for management of medicines and records. The provider wrote to us and told us what actions they were going to take to improve. During this, our latest inspection, we looked to see what actions had been taken.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. On the day of the inspection there were 23 people living at the home but they were not all able to verbally express their views so we observed how they were supported. We were only able to speak with one person. We also spoke with two members of staff who supported people, two relatives, the manager and the provider who was supporting the inspection process and a district nurse. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. Staff we spoke with were able to explain how these types of events would be managed.

Records showed that there were systems in place to identify potential risks to how people were supported. We found that these risks were being reviewed along with the care and support people were given, there was no evidence that people or their relatives were involved in the process. One person said, "No I have not been part of any reviews". This meant that the review process did not allow for people or their representatives to be involved.

We observed people throughout the inspection being offered drinks by staff on a regular basis. This ensured that people would not be at risk of dehydration. Relatives we spoke with told us they felt people were well looked after and safe.

The concerns identified with the management of medicines previously had not been fully rectified and evidence showed that the provider was not meeting the regulation for this standard. Medicines were not being audited on a regular basis and there was not a protocol in place to consistently advise staff when they were administering 'as required' medicines.

No applications for the Deprivation of Liberty Safeguards had been submitted by the provider. Staff we spoke with knew how to keep people safe from abuse but had limited knowledge of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff told us they had received training in both areas, but records we saw only confirmed that training was available in the MCA. This meant that staff were able to keep safe, but further training was needed in DoLS.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

We found that people were being supported appropriately and the records being used were not always consistent. People's care records were not all in one place so staff could access records easily. Appropriate documentation was being used to support people, but records were not always signed and dated. There were instances of blank paperwork on people's care records. This could lead to staff not having the appropriate information they needed to support people because paperwork had not been completed.

We found that checks were not regularly being carried out to ensure the quality of the service being provided. One person said, "I am happy with the service, staff support me when I need it". This meant without regular audits being done people could not be sure about the quality of the service.

The provider was required to action some concerns found from the previous inspection, however we found that some of this had not been carried out. For example, we found that people's care records all had diabetic forms on even if people were not diabetic.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

Staff we spoke with were able to explain people's needs. Our observations were that staff were very caring and supportive to people. We carried out a Short Observation Framework for Inspections (SOFI) assessment and found that people had little if any interaction on a regular basis. Activities which allow for stimulation were very limited and we saw no plans on display. One person we spoke to told us that they were able to take part in activities some of which they liked. This meant that people were able to get some stimulation but this needed to be more regular.

We saw staff asking people if they were okay and getting their consent before supporting them to mobilise for afternoon tea or for particular personal care tasks. We saw staff reminding people the time of the day or what they had decided to have for tea. This showed that staff had an understanding of how people needed to be supported.

Where people needed their medication before or after a meal, we saw that this was now being carried out appropriately.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found from our previous inspection that the provider had taken some action to improve the service to people. We found that there were still areas to be improved that had not been identified on their action plan or had just not been carried out. The manager and the provider told us that where there were still areas of concern they would be actioned immediately.

Relatives we spoke with told us that when they had concerns they would speak to the manager or the provider. One person we spoke with said, "People used to come in my room and I spoke to the manager who arranged for a lock to be put on my door". This meant that the service respond to concerns brought to their attention.

A relative told us that they had completed a questionnaire about the service. Records showed that the provider had a process to gather people's views to help improve the service.

The provider had a complaints process in place so people could share any concerns they had. We found there was not a process in place for logging complaints so they could be monitored.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive.

Is the service well-led?

The service was led by a registered manager, who was closely supported by the provider who were both present at the time of our inspection and assisted us with any information we needed.

We found that care records had not improved sufficiently since our last inspection. Concerns we had about the lack of record being archived when they were no longer relevant had not been actioned appropriately. People's care records were still in a number of different places and were not easily found. This could potentially lead to staff confusion when trying to find people's care notes.

Inspection carried out on 7 December 2013

During a routine inspection

We spoke with four people, four relatives, three staff members, the registered manager and the owners.

We found that people received care and support which met their needs. We observed staff supporting people appropriately. One person said, “This is a lovely place, the staff are so caring.”

Arrangements were not in place to ensure appropriate storage, recording and safe handling of medicines.

Processes were in place to support staff to carry out their role. People and relatives we spoke with were complimentary about staff. One staff member told us, “They support me really well.”

We found that some systems were in place to monitor the quality of the service. One person said, “I have no complaints at all.”

We found that people’s care records were not always accurate and fit for purpose. This could increase the risk of people receiving inconsistent care.

Inspection carried out on 6 March 2013

During a routine inspection

We spoke with four people, two family members, four members of staff, the registered manager and a visiting health professional. People said that staff treated them with respect and maintained their privacy and dignity when providing care.

People were happy with the service they received and how their needs were met. One person said, “The staff are very nice, they do anything I want”. The visiting health professional described the care given by the home as, ”Excellent”.

People’s dietary needs were being met. One person said of the food, "It’s been pretty good but there is not much choice”. Another described the food as being, “Good quality”.

All of the staff had been trained in safeguarding and the policy and procedure were readily accessible. They all knew what they should do in respect of reporting safeguarding matters.

People were being cared for, or supported by, suitably qualified, skilled and experienced staff.

All of the people we spoke with had no complaints about the service but told us they knew how to make a complaint should the need arise. The people we spoke with told us that they felt confident to raise any complaint either directly with their care worker or with the management of the service.

Inspection carried out on 1 March 2012

During an inspection to make sure that the improvements required had been made

We carried out this review to check on the care and welfare of people using this service. We talked with three people who lived at Rosemary Retirement Home, the provider, the registered manager, a relative and two staff about the quality of care. People who lived at the home told us that they liked living there. One person said, “I am happy here, the staff are lovely”.

We found that some people had lived at the home for a long time and knew each other well. We saw that they were happy in each other’s company. We saw that everyone who lived at the home was individually dressed according to their own taste. Staff told us they manicure people’s nails and that a hairdresser comes to the home on Mondays. Some people we talked with told us that that they enjoyed reading the newspaper or books and talking with other people who lived at the home. One person we spoke with said, “We have our lunch at that table and we can sit in here and read or watch the TV”.

At lunch time we saw that people who were not able to sit at the dining room tables were helped to eat by staff. We found that staff were patient and supportive. Some of the people who lived at the home were not able to converse through speech. We saw that people responded positively when staff engaged with them through body language, facial expression and touch. A relative we talked with said, “M is not conversant, but the staff are reliable and know her well”. This meant that people received care that reflected their needs.

One relative we talked with said, "I have no complaints, I wouldn't change a thing". We saw kind and genuinely affectionate interactions between staff and people who live at the home. We saw positive encouragement given by staff to maintain people's sense of self through conversation. This meant that people received care that was centred on them as an individual.

Reports under our old system of regulation (including those from before CQC was created)