R C Care Rosehill Ltd

R C Care Rosehill Limited (Rosehill) is a residential care home and is registered to provide personal care to up to 17 people, including those living with dementia. At the time of inspection there were 13 people living at the service.

Rosehill is an adapted detached house on the outskirts of Bideford. It has bedrooms on three floors with a stair lift to access those on the first and second floor. There are communal areas on the ground floor including a lounge and dining area. There is a secure courtyard for people to enjoy some outside space safely.

People’s experience of using this service and what we found

Most people said they were happy with the care and support provided by staff at Rosehill. Not everyone could give an informed view, but our observations showed people looked relaxed and at ease with the staff team and their surroundings.

Since the last inspection in September 2020 the service had employed a new manager who had worked with the registered provider and staff team to make some significant improvements to the way the home was being run, how care was being recorded and to the general environment. This has impacted positively towards people having a better experience of life with the service.

The service had a new electronic care plan recording system. This had enabled the manager to fully update people’s care plans in a systematic way and ensure all relevant details were included. This in turn had helped ensure staff understood people’s individual needs and how best to care for them. Monitoring of these plans and daily records had helped to improve the accurateness and timeliness of changing plans as people’s needs changed.

Staff recruitment was robust, and staff had the right training and support to do their job effectively. Improvements had been made to the number and skills of staff available on each shift. This had impacted positively for outcomes for people. One staff member said, “We are able to spend more quality time with people.”

Care and support was being delivered in a person-centred way. People’s choices and rights were fully considered. People said they felt happy and safe living at Rosehill. One person commented “This has been my home for a long time, and I am very settled and happy here.”

The manager had worked with the local authority quality assurance team to develop and embed systems for quality audits checks and reviews. This covered all aspects of care delivery, records and the environment and equipment. People, families and staff were being consulted about the running of the service. Staff morale was good, and staff felt valued and listened to.

Medicines were being safely managed and people received their medicines in a timely way.

Infection control processes had improved since the last inspection and we were assured that people, staff and visitors were protected because the registered manager and provider were up to date with all the latest guidance.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (Published 30 November 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. They have also been sending us monthly reports on their quality assurance systems.

This service has been in Special Measures since November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, protecting people from abuse, safe recruitment, staffing, making notifications and good governance.

In addition, we imposed a condition on the provider’s registration as they had failed to comply with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014) -Good governance. This meant the service were required to provide monthly reports to show their progress on meeting these requirements. We also issued a warning notice in respect of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014)- Safe care and treatment

We undertook this focused inspection to check they 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 of Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for R C Care Rosehill Ltd 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

R C Care Rosehill Limited is a residential care home and is registered to provide personal care to up to 17 people, including those living with dementia. At the time of inspection there were 16 people living at the service.

People’s experience of using this service and what we found

People were at risk of avoidable harm and unsafe care.

Risks to people’s health, safety and welfare had not always been identified, assessed or managed. Where risks had been identified, they were not regularly reviewed, and appropriate action was not always taken to address them, including a delay in seeking medical advice.

Peoples care records did not contain enough information to enable staff to support them effectively. Staff did not have training in how to use equipment safely, or how to manage individual’s health conditions.

Staff were not always recruited safely and had been allowed to work at the service without the required pre-employment checks. There had been a significant staff turnover, and new staff were inexperienced and had yet to receive appropriate training. There were occasions where there were not enough staff to meet people’s needs, and the home did not consider peoples individual needs when deciding staffing levels.

People told us they felt safe living at the home, however safeguarding incidents were not always referred to the local authority or the Care Quality Commission. Staff told us they knew how to recognise signs of abuse but had not had safeguarding training. This put people at risk of abuse and neglect.

People did not always receive their medicines safely. Systems to ensure people received the right dose of medication were not robust and people did not always receive newly prescribed medication in a timely manner. Some improvement to record keeping was needed, for example where people were receiving non-prescribed medications on a regular basis.

The premises did not always keep people safe. One person regularly left the building when unsafe to do, which put them at risk of harm. A safeguarding concern had been raised previously, however the action taken as a result of that concern was not effective in preventing the person continuing to leave the building.

A lack of analysis of safety and safeguarding incidents meant lessons were not learnt when things went wrong. Following this inspection, we raised two individual safeguarding concerns.

We have signposted the provider to resources to help develop their approach to preventing and controlling infection.

The registered manager had made some positive changes to the service, and people told us they were happy, however, there were significant shortfalls in service leadership. Quality assurance reports and action plans provided to the Care Quality Commission following the previous inspection failed to identify or address the concerns we found at this inspection.

Audit and monitoring systems were inadequate. Information was not analysed, and the provider did not undertake any quality control audits or checks. Many people had been admitted to the service during a period where the registered manager was new to post, there was a high staff turnover and the home faced the challenges of the early stages of the Covid-19 pandemic.

The lack of quality assurance systems and analysis of current performance meant the service was not continuously learning or driving improvement. Current best practice and information was not being used to improve quality.

There was limited partnership working with other agencies, and records did not demonstrate an open sharing of accurate information or a good understanding of where partnership working might be beneficial to people.

People and their families told us the registered manager was caring and improvements had been made to the atmosphere, culture and approach of the home. However, there were still indications of people fitting into routines to suit the staff, and times where staffing levels did not enable people to receive care at the times that suited them.

People and the public were not consulted or engaged in how the home was run.

Following the inspection, we held a feedback meeting with the provider and the registered manager to discuss our concerns. The following day we were informed the registered manager had handed in their notice and would be leaving the home imminently. The provider has informed us of interim management arrangements until a new manager is in post.

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

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement (published 28 August 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve systems in place to monitor, audit and improve the service. At this inspection, not enough improvement had been made and the provider was still in breach of this and five further regulations.

Why we inspected

We undertook this focused inspection to check the service had completed their action plan from the last inspection and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for R C Care Rosehill Ltd on our website at www.cqc.org.uk.

Enforcement

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, recruitment, fit and proper persons employed, staffing, safeguarding, good governance and statutory notifications.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor the service through ongoing monitoring, seeking an action plan, special measures and working with partner agencies. We may inspect sooner if required.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rosehill Rest Home is a residential care home providing accommodation and personal care. The care home can support up to 17 people in one adapted building. At the time of inspection five privately funded people aged 65 and over were living there. Devon County Council no longer commissions services at Rosehill.

People’s experience of using this service and what we found

There were five people living at Rosehill at the time of inspection. These people had low care and support needs and required minimum help to support them in their daily lives. These five people had lived at Rosehill for the last two inspections.

Whilst improvement continues at Rosehill, we are concerned these improvements are not sustainable or sufficiently embedded enough to support people who may live at Rosehill with higher care needs. The people who previously had higher needs no longer live at Rosehill.

The systems relating to the governance and oversight of the service were not always used effectively to monitor and improve the service. There continued to be deficits in records relating to the running of the service.

People had been assessed of any risks to them and support to mitigate the risks recorded. Each person had a care plan. These had been developed since the last inspection but continue to require improvement to include all the information required. Some of the required information was missing or inconsistent.

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. However, further work is needed to ensure best interest decisions are made appropriately and recorded.

There was a manager in place who had applied to be registered with the Care Quality Commission. They were supported by the nominated individual and deputy manager. The management team were committed and motivated in their roles and reassured us of their plans to improve. They were aware further requirements were still required.

People were happy and relaxed living at Rosehill. They were well looked after and cared for. People described staff as kind and caring. Positive interactions had been developed between people and staff which was shown in the calm and relaxed atmosphere at the service. Due to the low numbers of people, staff knew them very well.

There were enough staff on duty to meet people’s needs. Staff were recruited safely, trained and received supervision in their roles. They were a motivated staff team who knew people very well.

People were kept safe by staff who had received training in safeguarding and knew what to look for and what to do.

People received their medicines safely and received nutritious meals.

Complaints were managed following the processes in place.

People experienced activities and events at Rosehill. These were being further developed to introduce new activities and make them more individual and centred around people’s individual hobbies, skills and interests.

The service was very clean, smelt fresh and was appealing to people to live in. It was very homely and friendly. There were adaptions in place to support people’s needs.

Rating at last inspection and update

The last rating for this service was inadequate (published 7 June 2019) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made to no longer be in breach of three regulations. However, the provider was still in breach of one regulation. This was in relation to record keeping and quality assurance systems.

This service has been in Special Measures since November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to the records and lack of audit and quality monitoring of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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.

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

Rosehill Rest Home is a residential home registered with the Care Quality Commission (CQC) to provide personal care for up to 17 older people.

At the time of the inspection, there were four privately funded people living at the service. A fifth person was in hospital.

People’s experience of using this service:

Systems and processes to monitor the service were not effective and did not identify areas for improvement, together with poor oversight of the service. There was a management team who did not have clear lines of responsibility or a shared vision of how to improve the service. The statement of purpose, along with the vision and values of the care to be delivered, was not clear within the management team.

Although staff were aware of some risks, other risks were not monitored, recorded or managed effectively. This put people at continued risk of avoidable harm. Accidents and falls were not monitored to identify any trends or patterns.

The requirements of the Mental Capacity Act 2005 (MCA) were not adhered to and mental capacity assessments and Deprivation of Liberty Safeguards were not always completed as necessary.

The provider had not ensured any prospective staff underwent a robust recruitment process to ensure they were safe to work with vulnerable people.

The provider did not notify the Care Quality Commission (CQC) of all incidents or accidents which affected people.

People had care plans in place. Whilst these contained pertinent information, they did not always reflect people’s current needs, contain the right information and were duplicated in places.

People were cared for in a respectful, kind and caring way. Staff had built up relationships and knew people well. People were relaxed and were comfortable with staff.

People received a varied diet which reflected their choices on the meals served. People had access to snacks and drinks throughout the 24 hours.

People received their medicines safely and on time.

Some activities took place in the home, but these were limited and based in group settings which did not reflect people’s individualised hobbies or interests.

The home was kept clean and was homely and welcoming in appearance.

Rating at last inspection:

At the last inspection in November 2018 the service was rated as inadequate in safe, effective, responsive and well led. It required improvement in caring. The overall rating was inadequate.

Why we inspected:

This comprehensive inspection was scheduled based on the previous rating. We received an action plan following the previous inspection. However, this did not address all the improvements required and timescales for completion.

Enforcement:

At the last inspection in November 2018, six breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 were found.

Following the last comprehensive inspection in November 2018, the service was placed in special measures by the CQC. The purpose of special measures is to:

• Ensure providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

• Provide a clear timeframe within which providers must improve the quality of care they provide, or we will seek to take further action, for example to cancel their registration.

The service was placed in whole service safeguarding by Devon County Council (DCC) on 2 November 2018. As a result of persistent contractual default, DCC also cancelled their commissioning contract with Rosehill Rest Home in January 2019; they no longer place state funded people at this service. The provider placed a voluntary suspension on admitting any further privately funded people to the service. This was still in place at the time of this inspection.

We asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection sufficient improvement had not been made and the provider was still in breach of regulations.

During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009. People were still at risk of harm because the provider’s actions did not sufficiently address the ongoing failings. Our findings do not provide us with confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

The overall rating for this service is 'Inadequate' and the service remains in 'Special Measures' by CQC. This means we will keep the service under review and if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

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

Follow up:

The service is still being followed up by the whole home DCC safeguarding process which includes multidisciplinary safeguarding strategy meetings being regularly held.

CQC will follow up by ongoing monitoring, reviewing the service improvement plan, meeting the provider and working with partner agencies.

Rosehill Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premised and the care provided, and both were looked at during this inspection.

Rosehill Rest Home accommodates up to 17 people in one adapted building over three floors. There is a stairlift giving access to all three floors. There were 13 people living at the service when we carried out the inspection.

The provider was also the registered manager. A registered manager is a person who has registered with the CQC 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 focussed inspection in February 2017, there were two joint registered managers in post. Following that inspection, one of the joint registered managers applied to the CQC to voluntary deregister from this post. The provider remained the one registered manager in post.

At the time of this report, the local authority safeguarding team were continuing to investigate concerns raised. As a result of the concerns, the home was in ‘whole home safeguarding’ and there was a restriction on admissions to the home.

The service was not well led. There was no management structure in place and staff did not have clear lines of responsibility. The provider was being helped to run the service by the senior care worker. However, they did not have the skills or knowledge to undertake this role without further training.

There was a clear lack of governance in place, together with a lack of the necessary record keeping pertaining to the running of the service. There were record deficits in all areas and these records were either unavailable, could not be found or were not in place. The provider was aware of this and knew this was an area for improvement. Some of the records relating to the running of the business had had not been completed ort updated since 2016.

People did not receive individualised care suitable to their individual needs. Some of the care practices at the service were old fashioned and out of date. There was a lack of understanding of person centred care. Three people living at the home had not had a care plan in place since they came to live at the service. Other people did have a care plan but these were incomplete and the information held within them outdated.

Staff did not always treat and speak to people in a way which showed privacy, dignity and respect. Some practices at the service were old fashioned and contained ‘unwritten rules’ which impacted on people’s daily lives and choices.

Risks to people’s health, care and welfare were not identified and systems not put in place to reduce these risks. These included risks to people’s nutrition, skin pressure damage, safe moving and handling, environment and falls.

People were nursed in specialised beds and some people had bed rails in place. This equipment was not regularly monitored and checked to make sure they were at the correct settings for the people’s weights and were in good working order.

People had their weights monitored but these were not reviewed and appropriate referrals made where people had lost weight.

People did not receive their medicines in a consistently safe way. This meant we could not be sure people had received their right medicines, at the right dosage and at the right time.

Accidents and incidents were recorded and filed by staff. However, these reports were not analysed to identify any patterns or trends to reduce the risk of them happening again.

There was no activities programme in place and no record of any activities undertaken. There was a lack of meaningful interactions seen between staff and the people who lived at Rosehill, except for those related to daily living tasks.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do no support this practice. People were restricted in their choices due to a lack of appropriate assessment and care planning.

The service did not follow the principles of the Mental Capacity Act 2005 and people had not had a mental capacity assessment carried out. There was confusion as to which people living at the home had an application made to the local Deprivation of Liberty Safeguards team to deprive them of their liberty. None had not been completed in the last two years.

People received simple home cooked meals at set times, sometimes with more choice of food than other times. The lunchtime experience was not pleasurable and enjoyable for everyone. Some people were restricted to their bedrooms to eat their meals.

There was a lack of staffing which led to hurried care and support at times. There was only one waking night staff on duty when two people regularly required the help of two staff to support them. On other occasions, staff were unable to support people and take the time to sit with people, such as at mealtimes.

People were not involved in the running of the service and their views were not regularly sought on how it could be improved. There was a complaints procedure in place but some people did not feel able to voice concerns to the provider.

Staff were generally safely recruited, but they were not up to date in the training they required to do their jobs properly. They did not receive supervision and their hands on practice was not monitored. Staff understood the more obvious signs of abuse, but had not received refresher training to make them fully aware of all the types of abuse.

Following the inspection, the provider contacted CQC on 22 November 2018. They informed us they would be appointing a new manager for the service who was due to start on 3 December 2018. They assured us of their intention to improve the service and practice to provide an improved home for people to live in. They confirmed they would be stepping down as the registered manager and the new manager would be applying to be registered with the CQC as soon as possible. The new manager also contacted CQC to confirm they were taking over as manager on the date given.

The local authority safeguarding team told us the provider was working with them to investigate the concerns made to them. The were in the process of reviewing people living at the service and found the provider and staff welcoming in their approach.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key questions or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months, It the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found seven breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, person centred care, privacy and dignity, safe care and treatment, safeguarding, the need for consent and good governance. We found one breach of the Care Quality Commission (Registration) Regulations 2009 relating to the notification of deaths of people living at the service.

We made one recommendation relating to improving the lunchtime experience for people.

After that inspection we received concerns in relation to poor care practice, people being restricted in the home and poor cleanliness of the home. The concerns were also reported to the local authority safeguarding team by the CQC. CQC undertook a focussed inspection. This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Rosehill Rest Home on our website at www.cqc.org.uk.

We carried out this unannounced focussed inspection on 23 November at 8.10pm and 5 December 2016 at 11am. This was to observe practice at different times of the day.

Rosehill Rest Home is registered to provide accommodation and personal care for up to 17 older people, including those people living with dementia. There were 13 people living at the home at the time of our visits.

The service had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager was also the provider. They planned to retire as registered manager in the near future. An application had been received by CQC from the deputy manager to become the registered manager.

On our first visit, two people were in the lounge watching television and the rest of the people were in their bedrooms. Two care staff were assisting people to go to bed. There was a calm and restful atmosphere at the service. People were reading, watching television or relaxing in their bedrooms. People we spoke with told us they could go to bed when they wanted but liked to retire to their bedrooms at certain times.

We looked at people’s care records so see if the service was acting in accordance with the Mental Capacity Act 2005 (MCA). Some people had bedrails in place to reduce the risk of them falling out of bed. We looked at whether these were being properly used and recorded.

During this inspection we found people were not being restricted, care practice was satisfactory and the home was very clean. On our first visit we found gaps in record keeping in people’s care files. These were in relation to consent, mental capacity assessments and best interests decisions. On our second visit appropriate action had been taken and records updated.

The local authority safeguarding team carried out a full investigation into the concerns raised. No further action was taken.

The provider now met the breach of regulation. However, improvement is still required. The provider had not been proactive in ensuring records were kept up to date until our second visit when they were in place. These records need to be in place consistently in each person’s care file in accordance with the Mental Capacity Act 2005.

Rosehill Rest Home is registered to provide accommodation and personal care for up to 17 older people, including people living with dementia. There were 17 people living there on both our visits.

The last comprehensive inspection took place on 9 and 15 June 2015. Six breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. This was because: risk assessments were not in place; medicines were not managed safely; people’s rights under the Mental Capacity Act (2005) had not been adhered to; the correct procedures to deprive people of their liberty had not been followed; staff had not received the necessary training; people did not receive planned person centred care, and systems to monitor and improve the service were not in place. You can read the report by selecting the ‘all reports’ link for Rosehill Rest Home on our website at www.cqc.org.uk.

After the last comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation. According to the action plan, all breaches of regulation would be met by 28 August 2015.

We undertook this comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements.

The service had a registered manager who was also the registered provider. 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.

People lived in a family run home where they were relaxed and comfortable. The atmosphere was homely and friendly and people and relatives felt safe. Relatives said, “People are happy … it’s very nice … people are treated with respect … all the people are looked after … it’s very small and it’s like a proper ‘home’, it’s full of knick-knacks and I am very impressed with them” and “(My relative) is content and happy and that is all you can ask for.”

Staff knew people well and cared for them as individuals. Two people said, “Staff are very kind … they are very good” and “I am looked after.” People received care suitable for their needs and with enough staff on duty. Staff were safely recruited, trained and enjoyed their work. Staff said, “I absolutely love my job here … I never want to change … we all pull together to look after residents … they get what they need day or night” and “It’s lovely here because it is family run … I look after people properly just as I would if it were my mum and dad.”

Two people said, “I feel safe here … I am well looked after” and “I’m happy here … it’s very good.”

Staff felt supported by management and felt part of a team. They had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

For those people who lacked capacity and were unable to give consent, the Mental Capacity Act 2005 (MCA) had not been followed. People had not had a mental capacity assessment undertaken and ‘best interest decisions’ had not always been carried out in accordance with the MCA. However, applications had been made appropriately to the local authority Deprivation of Liberty Safeguards team for those people who need to be deprived of their liberty.

Each person had a care plan with suitable risk assessments in place. Care plans included key information and were up to date. Health and social care professionals were involved in people’s care and their advice acted upon. Good working relationships had been developed with the local GP surgery who were very complimentary of the service.

People enjoyed an activities programme which was being developed. However, activities were not always planned around people’s individual interests, hobbies or abilities.

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Staff recognised the importance of family and friends who were welcomed at all times. Relatives said they felt part of their family member’s care and were kept informed of any changes.

People received their medicines in a safe way. People enjoyed the food served but people’s choices and preferences were not always planned and sought.

People lived in a home which was maintained and decorated to a high standard.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints.

There were systems in place to monitor the quality of the service and any issues identified were acted upon and resolved.

We found one continued breach of regulation and made one recommendation. You can see what action we told the provider to take at the back of the full version of the report.

We looked at risk assessments, care plans and care records. We found that people's needs had been assessed individually and staff were well informed so they knew how to support people.

People told us they were able to get staff attention when they needed and that the providers were available if they wished to speak with them. We saw that people were calm and contented in their daily life. We saw staff treating people with dignity and asking them when they wanted to move, for example when it was time to go for lunch.

A professional who had visited the home told us they had observed that staff found out what people liked to do, and arranged for them to be involved in activities that were meaningful for them.

People told us they liked living at Rosehill Rest Home. 'I'm very pleased with what I have here,' one person told us. Another who had not lived at Rosehill Rest Home for very long told us, 'You begin to feel that people like you ' that makes all the difference.'

Staff made time to get to know the people they cared for and were able to provide individual attention.

We found that the registered manager had admitted one person to the home without assessing their needs or whether the home was suitable for meeting their needs. This placed them at potential risk of harm. It also meant that staff had no information about how they preferred their care to be provided.

We found that the house was clean and hygienic throughout and that good systems were in place to protect people from the risk of cross infections.

Measures were taken to ensure that suitable people were employed to work in the home.

The quality of the service provided was monitored and maintained by regular attention from the service providers.

One person told us, 'Overall, the food is good. I am confident that will like what is brought ' I have never sent anything back. It is fresh home cooking.'

They had a call bell attached to their chair so that they could reach it easily through the day. "They come quickly when I ring it,' they told us. Another person who lived at the home said, 'I am well cared for. The staff help me if I need to go to my room' and another told us that staff helped them to wash and dress in the way that they liked.

A health care professional who had visited regularly said that staff at Rosehill Rest Home had called for assistance appropriately on behalf of people living in the home, and followed nurses' guidance. They said it was, 'Always lovely and warm here, and smells nice.'

We found that the staff were competent and caring. We saw staff helping people sensitively at mealtimes, giving time and encouragement to people to eat their food.

We found that some assessments of risk needed to be updated to make sure people would be cared for in a safe way, and some of the arrangements for providing care did not protect people well enough against potential risks of cross infection.