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Inspection carried out on 15 September 2017

During a routine inspection

Rose Court is a residential care home for 48 people with dementia and physical difficulties. The service is located over four floors and people with the most complex needs live on the second and third floors of the home.

At the last inspection on the 2 June 2015 the service was rated Good.

This inspection took place on 15 and 28 September 2017. At this inspection we found the service remained Good and the registered provider continued to meet all of the fundamental standards.

There was not a registered manager in post. Since the last inspection, the registered manager of the service had left the service. The Care Quality Commission was informed of this change. The registered provider has identified a new home manager, who will transfer from one of the registered provider’s other locations and register with CQC. 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.

Staff understood how to protect people from harm and abuse. The registered provider had an embedded safeguarding process in place that supported actions staff took to protect people at risk.

Risks to people’s health and wellbeing were identified. A plan of action was developed, implemented and followed by staff to reduce risks occurring and to keep people safe.

The management of medicines for people continued to be safe. Staff administered medicines to people as prescribed. People’s medicines were ordered, stored, administered and disposed of in a safe way.

There continued to be enough safely recruited staff employed. Staff rotas showed enough staff were deployed during the day and night to meet people’s needs.

Staff continued to receive regular training, supervision, and appraisals. This provided staff with opportunities to become familiar with expectations of working at the service and with people, and to identify and improve their skills and knowledge in their roles.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff supported people in line with the Mental Capacity Act 2005, and carried out mental capacity assessments and applied for Deprivation of Liberty Safeguards authorisations as appropriate.

Staff continued to meet people’s nutritional needs because they provided enough food and drink for them. People on specialist diets were supported with these as required.

Staff continued to provide support to people in a caring and compassionate way. Staff respected people in a way that protected their privacy and dignity.

People were supported by heath care professionals when required. When people’s healthcare needs changed staff sought support and advice from health care professionals to ensure they continued to meet people’s needs.

People’s needs were assessed to ensure these could be met at the service. Care and support was appropriately planned for people. People had a care plan in place that provided staff with guidance to help them meet people’s needs.

People and their relatives continued to be encouraged to make a complaint about the service where they were dissatisfied. The registered provider had a complaint process that people understood. People and their relatives were supported to make comments about the quality of care received.

The registered provider had an effective system in place to monitor, review and improve the service.

Inspection carried out on 2 June 2015

During a routine inspection

Rose Court provides personal care and accommodation for up to 64 older people, some of whom are living with dementia. When we visited there were 54 people living at the home.

The home was last inspected on 29, 31 July and 9 August 2014 and at that inspection we found there were two breaches of regulation and improvements were required. This included having enough staff at all times to meet people’s needs and giving people’s medicines at the time they required them. People’s need for assistance was not always responded to in a timely manner. There was a system to look at accidents and incidents, but records of how to prevent them happening again were incomplete. We asked for improvements to be made to address these issues.

This inspection took place on 2nd June 2015 and was unannounced. We found improvements had been made to address the breaches of regulations. Improvements made the home safe and caring and the arrangements for the leadership of the home had improved.

The home had a registered manager. 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.

There were enough well trained and supported staff to keep people safe. People were given their medicines when they needed them. Staff were knowledgeable about how to recognise abuse and how to report any concerns they had.

People received the care they required to meet their specialist needs. Staff worked in partnership with health professionals. Staff were aware of when people needed to visit specialist health professionals and who to contact to ensure people got the support they required. People enjoyed the meals and they were designed to meet their individual needs and preferences.

People were treated with respect and warmth and their dignity was maintained. Individual needs were considered and met. People were encouraged to do as much as possible for themselves to maintain their independence.

People knew how to complain and felt confident to do so when necessary. Complaints were investigated and letters of apology sent to complainants. Changes were made in response to complaints to prevent recurrence.

A range of activities was available which people told us they enjoyed. The activities included monthly cocktail parties, musical sessions and dancing. Some people joined in household tasks such as laying the table for meals; this helped them to feel part of the daily life of the home.

The quality of the service was assessed by the registered manager and the provider so they could identify any improvements that were necessary. The improvements were made by the registered manager.

Inspection carried out on 29, 31 July and 9 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service.

Our inspection visits were unannounced. When we last inspected the service on 12 September 2013 the regulations we inspected were being met.

Rose Court provides personal care and accommodation for up to 64 older people, some of whom have dementia. At the time of our inspection there were 59 people living at the service. The accommodation was split into four units. The building was accessible throughout to people with restricted mobility and a car park was available.

There was a registered manager at the service. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Improvements were needed to make the home safe. This included having enough staff at all times to meet people’s needs and giving people’s medicines at the time they required them. People’s need for assistance was not always responded to in a timely manner. There was a system to look at accidents and incidents, but records of how to prevent them happening again were incomplete. There were other arrangements to monitor the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.

There were safe arrangements for recruiting staff and they received good support and training. People enjoyed the meals and they had enough to eat and drink. If people needed a special diet to meet their health or cultural needs this was provided. People’s healthcare needs were attended to, and they were supported to see healthcare professionals when they needed to. There was a wide range of activities offered which people enjoyed, such as knitting, evening parties, music and singing.

Inspection carried out on 12 September 2013

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

We carried out our inspection on 12 September 2013 to follow up non-compliance we had identified for three regulations at our previous inspection on 11 June 2013. At the previous inspection the provider was not meeting the standards for care and welfare of people using the services; management of medicines; and supporting workers. The provider already had an action plan in place in response to concerns identified in these three areas at inspections we carried out on 22 November 2012 and 29 January 2013. However, at our June 2013 inspection this action was incomplete. Despite some improvement, we found continuing non-compliance for all three regulations and we issued a warning notice to the provider for each regulation.

On 10 July 2013 the provider submitted an updated action plan in response to the June 2013 inspection and four further updates up to 27 August 2013. During this period the provider continued to provide additional management support to the home in improving service delivery. The provider also informed us that they had been successful in recruiting to the business manager and care manager positions. The local authority commissioners reported to us from their monitoring visits carried out at the service that there had been dramatic improvement in the areas of concern previously identified at the home. On 25 July 2013 they lifted the voluntary embargo on placements to the home that had been in place since May 2013.

At our inspection on 12 September 2013, we found the provider had made significant progress in implementing actions to address the concerns identified at our previous inspections. The planning and delivery of care now took account of people's individual needs and ensured their welfare and safety. There were appropriate arrangements in place to ensure that people were protected against the risks associated with the unsafe management of medicines. Suitable arrangements were now in place to support staff through appropriate training, supervision and appraisal.

The provider had met the requirements of the warning notices we issued after the previous inspection and now complied with the three regulations these related to.

People we spoke with were happy with the care and support they received and felt staff met their needs. One person said, “Staff treat me very well, there is enough to do and we go on trips out. The food is nice and the laundry service is very good.”

Inspection carried out on 11 June 2013

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

We carried out our inspection on 11 June 2013 as part of our planned schedule of inspections but also to follow up non-compliance we had identified for three regulations at our previous inspection on 29 January 2013. At the previous inspection the provider was not meeting three of our regulations for care and welfare of people using the services, medication management, and supporting workers. The provider already had an action plan in place in response to concerns identified in these areas at an inspection we carried out on 22 November 2012. However, there had been insufficient progress in the implementation of this plan. The provider had also put additional management support into the home and had recently appointed a new care manager to lead on implementing service improvements.

In February 2013 the provider submitted an updated action plan in response to the January 2013 inspection and two further updates to the plan in March and May 2013. Since the previous inspection there have been further changes in the management of the home and an interim manager has been appointed pending the recruitment of a permanent appointment. The provider was also continuing to provide additional management support to the home in improving service delivery. In addition the provider had agreed with the local authority commissioners a temporary embargo on new placements at the home to allow time for improvements to be made.

At our inspection on 11 June 2013, we found for all three standards which did not meet our standards previously that action to address the concerns identified was still on-going or incomplete. Despite some improvement seen, we found continuing non-compliance for all three regulations. For two other standards we inspected we found the provider was meeting the standard: the service worked in co-operation with other providers and there were appropriate arrangements in place to protect people from abuse.

The six people we spoke with told us they were satisfied with their care. One person said, “I know they are not family but they treat me alright.” Another said, “When you are ill, they (the staff) try and make you well again.” However, the continuing non-compliance we identified meant that people were not sufficiently protected against the risks of receiving inappropriate or unsafe care and support.

Inspection carried out on 29 January 2013

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

We carried out our inspection on 29 January 2013 to follow up non-compliance we had identified for three regulations at our previous inspection on 22 November 2012. The provider was not meeting the standards for care and welfare of people using the services and supporting workers. In addition, we found people were not always fully protected against the risks that might arise if medicines were not managed appropriately and we issued a warning notice to the provider.

In response to our previous inspection the provider had put in place a comprehensive action plan to address the concerns identified. We found that the provider had made some progress in implementing this action. The provider had also put additional management support into the home and had recently appointed a new care manager to lead on implementing service improvements. However, for all three regulations we inspected, action was ongoing or incomplete and despite some improvement seen, we found continuing non-compliance for all three regulations.

The three people we spoke with told us they were satisfied with their care. One person said, “The staff are nice and all of my needs are being met at the moment.” Another said, “I can’t fault the home and was pleasantly surprised when I came here.” However, the continuing non-compliance we identified meant that people were not sufficiently protected against the risks of receiving inappropriate or unsafe care and support.

Inspection carried out on 22 November 2012

During a routine inspection

We spoke with three people living at the home and two people’s’ relatives, and observed staff giving people care. We found that people received appropriate support from the staff team to meet most of their observed needs.

People we spoke with were mostly content with the care and support they received, although two people were unhappy about some of the activities they took part in. Two visitors said that they were happy with the way the home looked after their relatives. People’s comments included:

“It’s an OK place to live and the staff are helpful.”

“The food is OK and you get a good choice at breakfast. The carers are good”

This was a scheduled inspection but we took the opportunity to check that the provider had made improvements following our last inspection 23 September 2011. We also reviewed some additional standards not covered in our last inspection.

Although people told us they were satisfied with their care, we found other evidence that people were not always protected against the risks of receiving inappropriate or unsafe care and support.

Inspection carried out on 23 September 2011

During a routine inspection

People we spoke to said that the staff respect them and are kind and caring and they feel safe with them. They told us that they are kept well informed about what is happening in the home. They are able to make choices about their care, what they eat and what they do with their time. They have the care and treatment they need.

One person said they “feel very safe at the home”, and if they had any concerns “the manager’s door is always open”. Another told us that the home “is very nice and I am happy here”.

People’s views were supported by much of what we found during our visit. However, there were some areas where we found that improvements were necessary, including the review of care plans; management of medicines; and the training and supervision of staff.