Rosenmanor 1

People’s experience of using this service

People were not suitably protected from harm because the risks they might face were not always properly assessed and managed. This meant staff did not always have access to enough sufficiently detailed guidance to help them keep people they support safe.

The provider had established governance and monitoring systems in place however, these were not always operated effectively. This meant the provider had failed to always identify and take appropriate action to prevent people living in the care home being placed at risk of harm. This included staff working excessively long hours without taking sufficient time off to rest and recuperate, staff not always wearing personal protective equipment (PPE), and not always respecting the privacy of people living in the care home.

In addition, records the provider is meant to keep and make available to the CQC on request were not always made immediately accessible on request.

Furthermore, staff were not always adequately supported and supervised by their line managers. This was because staff did not have sufficient opportunities to routinely reflect on their working practices and professional development.

People were kept safe from abuse. The provider ensured there were always sufficient numbers of suitably trained staff to support people and keep them safe. People received personal care and support from staff whose fitness to work in adult social care had been checked. People received their medicines as they were prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay emotionally and physically healthy and well, and to access relevant community mental health and social care services as and when they needed to.

People were treated equally and had their diversity respected, including their cultural and spiritual needs and wishes. People typically described staff as “kind”. People were encouraged and supported to maintain their independent living skills and to do as much for themselves as they were willing and capable of doing safely.

People's care plans were person-centred, which helped staff provide them with the individualised care and support they needed. Staff ensured they communicated and shared information with people in a way they could easily understand. People were encouraged to make decisions about the care and support they received at the care home and staff respected their informed choices. Where appropriate, people's end of life wishes and contacts were known and recorded for staff to refer to.

The registered manager promoted an open culture which sought the views of people, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people's packages of care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good (published 26 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, building maintenance, food and social activities. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified 3 breaches at this inspection in relation to how the provider assessed and managed risk, operated their oversight and scrutiny systems and ensured records they were expected to keep were always easily accessible, and supported and supervised staff.

We have also made some recommendations in relation to how the provider manages ‘as required’ medicines and arranges meaningful social activities for people to participate in.

In addition, we discussed issues we found in relation to the way the provider managed the premises and dealt with outstanding maintenance issues.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rosenmanor 1 is a residential care home. At the time of our inspection the service was providing accommodation and personal support to eight women with mental health care needs. The service can accommodate up to nine people in an adapted building.

People’s experience of using this service

People told us they were satisfied with the overall quality of the care and support they received at Rosenmanor 1.

At our last inspection the provider had failed to ensure medicines were always managed safely, staff were suitably trained and governance systems were operated effectively. At this inspection we found the provider had improved how medicines were recorded, staff were trained on how their governance systems were operated. This meant the provider was no longer in breach of regulations.

We have made a recommendation about assessing and managing infection risks staff working at the care home might face, especially in relation to those deemed to be in high COVID-19 risk groups. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19.

People continued to be kept safe and protected against the risk of avoidable harm and abuse. People were cared for and supported by staff who knew how to manage risks they might face. The service remained adequately staffed by people whose suitability and fitness to work in an adult social care setting had been properly assessed. Medicines were well-organised and people received their prescribed medicines as and when they should.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People lived in a suitably adapted and adequately decorated and furnished care home. People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and access community health and social care professionals as and when required.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives, community health and social care professionals and staff working there. The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people’s packages of care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was requires improvement (published 11 June 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 and 16 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve how their medicines and governance systems were managed.

We undertook this unannounced focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led where we previously identified issues.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for the key questions Caring and Responsive, which were not looked at on this occasion, were used in calculating the overall rating at this inspection.

Based on the findings of this inspection the overall rating for the service has improved from requires improvement to good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosenmanor 1 on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

Rosenmanor 1 is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate and provide support for up to eight people in one adapted building. At the time of our inspection seven women with mental health care needs were using the service.

People’s experience of using this service:

People’s experiences of using this service has deteriorated since their last CQC inspection. The overall rating for this service has therefore changed from ‘Good’ to ‘Requires improvement’.

This was because we found the provider had failed to ensure: medicines records were always appropriately maintained; records were always accessible to people authorised to see them; all the issues we found during our inspection had been picked up; staff had received basic life support training; and, the kitchen had been kept in a good state of repair and the garden clear of rubbish.

The negative points described above notwithstanding people using the service, their relatives and professional representatives told us they were satisfied with the standard of care and support provided by Rosenmanor 1.

The service had safeguarding procedures in place and staff had a clear understanding of these procedures. Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met. Appropriate staff recruitment checks took place before new staff started working for the service. There were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of the spread of infection.

Staff had the right mix of knowledge, skills and experience required to meet people’s needs. Staff routinely sought the consent of the people they supported ensuring they had maximum choice and control of over their lives. People were supported to maintain a nutritionally well-balanced diet. People received the support they needed to stay healthy and to access physical and mental health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff met people’s spiritual and cultural needs and wishes. People were encouraged and supported to develop their independent living skills. Assessments of people’s support needs were carried out before they started using the service.

People’s care plans developed from these assessments were personalised and routinely reviewed to ensure they remained up to date. People had been consulted about their support needs and involved in helping staff develop their care plan. People were supported to participate in meaningful activities at home and in the wider community that reflected their social needs and interests. People were supported to maintain relationships with their relatives and other people that mattered to them. People's concerns and complaints were dealt with by the provider in an appropriate and timely way. People’s end of life care wishes were recorded in their care plan.

Management support was available for staff when they needed it. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives, professional representatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

Rating at the last inspection:

At the last inspection the service was rated ‘Good’ overall (Report was published on 27 November 2018).

Why we inspected:

This inspection was brought forward by 24 months due to information of concern we received from an anonymous source concerned about the health, safety and welfare of people using the service. The information shared with Care Quality Commission (CQC) also indicated potential concerns about the way the service was managed, which we examined as part of our inspection.

Enforcement:

At this inspection we identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 regarding staff record keeping and the accessibility of records to people authorised to see them, and the way governance systems were operated.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in keeping with our inspection methodology.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People living at Rosenmanor 1 received personal care and support as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rosenmanor 1 is a rehabilitation service that provides accommodation and rehabilitation support for eight women with mental health care needs. The service specialises in helping these women develop the necessary skills to move onto more independent living. There were eight, mainly younger women living at the home at the time of this inspection.

The service continues to have the same registered manager who is also the owner of Rosenmanor Limited and the registered manager for all four of this provider’s mental health care services in South London. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. Rosenmanor 1 also continues to have a service manager who is based at the where they permanently work.

At our last inspection of the service in October 2017, we rated them ‘Requires improvement’ overall and for the two key questions ‘Is the service effective’ and ‘well-led’. This was because the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the CQC without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service. In addition, although most people felt Rosenmanor 1 was a comfortable place to live much of the home’s physical environment, furniture, soft furnishings, interior décor and surrounding grounds were not particularly well-maintained. We discussed these environmental issues with the registered manager who agreed the premises at that time were in urgent need of some refurbishment.

At this comprehensive inspection we found the provider had taken appropriate action to address all the issues we identified at their last inspection and improve the premises and their arrangements for notifying the CQC about significant incidents involving the people living at the home. Consequently, we have improved their overall rating from ‘Requires Improvement’ to ‘Good’ and for the key questions, ‘Is the service effective?’ and ‘Is the service well-led?’. The ratings for the other three key questions, ‘Is the service safe, caring and responsive?’ remains ‘Good’.

People told us they continued to be happy with the care and support they received at the service. We saw staff continued to look after people in a kind and respectful way. Staff had clearly built up a good rapport and working relationships with the people they supported. Our discussions with people living in the home and their professional representatives supported this.

There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people's safety in a way that considered their individual needs and wishes. Recruitment procedures were designed to prevent people from being cared for by unsuitable staff. There were enough staff to keep people safe. The environment was kept hygienically clean and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene. Managers and staff routinely carried out health and safety checks on the premises. Medicines were managed safely and people received them as prescribed.

People said Rosenmanor 1 was now a more comfortable place to live. People were still supported by staff who had the right skills and knowledge to fulfil their roles effectively. People continued to be supported to eat and drink enough to meet their dietary needs and preferences. Managers and staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.

Staff continued to ensure people's privacy was always maintained particularly when they supported people with their personal care needs. Staff consistently demonstrated warmth, respect and empathy in their interactions with people they supported. People had positive relationships with staff, who took time to get to know them. People were supported to maintain relationships with those that mattered to them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People still received person centred care and support that was tailored to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. People were involved in planning the care and support they received, which were kept under constant review and updated accordingly. People had sufficient opportunities to participate in meaningful social activities that reflected their social interests.

The registered manager/owner and service manager of Rosenmanor 1 continued to be well-regarded by people living in the home, external community professionals and staff. The provider operated effective governance systems which ensured all aspects of the home were routinely monitored. Any shortfalls or gaps identified through these checks were addressed promptly. The provider had suitable arrangements in place to appropriately deal with people’s concerns and complaints. The provider also gathered feedback from people living in the home, their relatives, professional representatives and staff.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was also responsible for managing the providers three other mental health services also located in South London.

At our last CQC comprehensive inspection of Rosenmanor 1, which we carried out on 26 January 2016, we rated the service ‘Good’ overall and for the five key questions ‘Is the care home safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led’. This was because we found the service was meeting all the regulations and fundamental standards we checked.

At this inspection we found the provider to be in breach of a regulation and some of the fundamental standards. Consequently, we have now rated the service ‘Requires Improvement’ overall and for the two key questions Is the service ‘effective’ and ‘well-led’. This was because the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the CQC without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service. This meant we did not know what action the provider had taken to keep people safe and mitigate the risk of similar incidents reoccurring.

This failure represents a breach of Care Quality Commission (Registration) Regulations 18 (Notifications of other incidents) 2009.

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

In addition, although most people felt Rosenmanor 1 was a comfortable place to live much of the home’s physical environment, furniture, soft furnishings, interior décor and surrounding grounds were not particularly well-maintained. We discussed these environmental issues with the registered manager who agreed the premises were in need or urgent refurbishment. Progress made by the provider to achieve this stated aim will be assessed at the service’s next inspection.

The issues described above notwithstanding people told us they remained happy with the standard of care and support they received at the home. We saw staff looked after people in a way that was kind and respectful. Our discussions with people living in the home, their relatives and mental health care professionals supported this.

People continued to be safe at the home. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs and food preferences. They also received the support they needed to stay healthy, emotionally and physically, and to access healthcare services.

Staff treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives. People were supported to have maximum choice and staff supported people in the least restrictive way possible.

People continued to receive personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in leisure activities, pursue their social interests and to maintain relationships with people that mattered to them.

The registered manager, along with the service manager who was permanently based at the home, continued to provide good leadership. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person using the service told us that they found it useful to talk to the staff and make plans with them.

People were protected from the risks of inadequate nutrition and dehydration and had been involved in planning menus that suited their cultural needs and personal preferences. People using the service told us the food had been either "Good" or "OK".

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People using the service told us that their bedrooms were warmer and they were satisfied with the home environment.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. People told us that staff responded to any concerns they raised.

Mental health professionals involved in the care of some of the people using the service told us that they were satisfied with the support provided to enable people to manage their physical and mental health care needs. However, some of these healthcare professionals had concerns about the way the support was delivered at times. For example, there were concerns that some members of staff were well-meaning but spoke without sufficient diplomacy and tact. There was also a concern that there was insufficient space at the service to support people to meet their visitors in private.

We spoke with five of the people using the service. Their comments to us included:

"I have complained about the heating and hot water but the managers don't listen to me. My room is too cold and my shower doesn't work sometimes." "I like the staff. They are good. If I have any problems I can talk to them." "I want to get up and make a drink at night sometimes but I don't feel able to."