This comprehensive inspection took place on 23 November 2016 and was unannounced. The service was previously inspected in May 2014 when the service was found compliant with all the standards inspected.

The home provides accommodation and personal care for up to 29 older adults. At the time of inspection there were 28 people living at the home. The service provides care for older people, some of whom are living with dementia or physical frailty.

The home is a large well maintained detached house on the outskirts of Sidmouth. All bedrooms are for single occupancy, although some are large enough to accommodate couples if requested.

The home was well run by a registered manager who was supported by an experienced deputy and other senior staff. 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.

The registered manager and staff were proactive in looking for ways to improve the home and the services provided. They did this in consultation with people living in the home and their families. Minutes of resident meetings showed how they had made suggestions about mealtimes which had led to the time of lunch being altered.

The registered manager described how the emphasis was on all staff taking responsibility for leadership. As part of this, the registered manager and her deputy had introduced a ‘traffic light’ card system to ensure that people’s needs were dealt with in a timely manner by team leaders and care staff. This system was monitored regularly to ensure its effectiveness.

The registered manager took quality assurance very seriously. This involved getting feedback from people, relatives and staff. Staff were encouraged to be involved in quality improvements. Trustees and senior staff from the provider organisation visited the home on a regular basis and also monitored the quality and safety of the home. Regular audits were undertaken to ensure the quality of the home and the care provided was reviewed. Where shortfalls were identified, actions were taken to address the issues.

Meals were served so that people could select from a choice of dishes and accompaniments. People praised the standard of the food and were encouraged to discuss menus and preferences. People were supported to eat and drink in a relaxed and supportive manner by staff who worked to promote a pleasant meal time experience.

The atmosphere of the home was one of constant stimulation whether on a one to one basis or through group activities. People were encouraged to continue their own interests as well as join in a programme of activities which ran throughout the day and evening. These included regular sessions of exercise, discussion groups, singing, musical entertainment and art classes. Additionally there were special events run which included a ‘pub quiz’ and a fashion show which people had taken part in. People were also supported to go out either individually or as a group. Trips had been organised including a visit to a local zoo. People described how much they enjoyed the wide range of activities. Staff were well-organised, working as a team while maintaining a relaxed and unrushed manner.

Visitors to the home, including relatives and health professionals, praised the care of the staff. Everyone we spoke with said the registered manager and her deputy were always available to discuss care and were open to suggestions about how the home could be improved. People felt safe and well cared for. Staff were attentive to people's needs and supported them quickly and effectively. Staff consistently demonstrated affection and warmth in their relationships with people. People commented how staff were “lovely” and “really wonderful.” T

We inspected Rose Lawn to follow up compliance actions made at our last inspection in May 2012. We had received an action plan from the service about how they intended to ensure that they were compliant with the essential standards and regulations. There were 28 people living at the service at the time of the inspection and one vacancy. We spoke with six people living there, the registered manager, Head of Care, four relatives and two care workers. We also toured the home and spent time observing life in the communal areas. We looked at key documents such as staff meeting minutes, care plans and risk assessments.

Care and support was delivered in a kind and respectful way. People told us that they were able to do what they wanted to do. Staff offered drinks to service users and relatives throughout the day were attentive to people’s needs. There had been restructuring of staff roles and documentation which meant that staff had time to assist people in an unhurried way and ensure that they knew how to meet people’s needs. We saw that people were involved in making decisions about their care.

Everyone we spoke with made positive comments about the running of the home and opportunities made available to them. The home regularly monitored the quality of the service. People’s comments included “The staff are so kind and prompt to help; they are always so good and supportive” and from a visitor “I’m so impressed, every time we visit it is so wonderful.”

We visited Rose Lawn on 16 May 2012 from 10-17.00 and briefly on 18 May 2012 to collect further information. On the day of our visit there were 25 people living at the home.

We spent time with seven people who lived at the home and observed care delivery throughout the home and in the communal areas. We spoke to the manager, head of care, administrator, chef and six care staff and looked at records.

Although we saw that staff were caring and had a good rapport with people living at the home we were told that staff were ‘rushed’, ‘we have to wait’ and ‘it’s the system that counts’. Some people were independent and able to come and go as they pleased. They said that they enjoyed living there and regularly went out to town or to the sea front. There was some evidence of topical activities going on such as a VE Day supper, shop with Lily, Friends coffee morning and a springtime song show from an external entertainer but we heard that generally there was not much going on. There was an activities co-ordinator who showed lovely rapport with people and was taking people out on a one to one basis. However, there was no regular system showing how each persons’ leisure and wellbeing needs were being met.

We looked at three care plans in depth. These were not kept up to date, read thoroughly by staff or easy to identify people’s changing needs from. Staff generally felt that they did their best but that they did not have the information consistently to be able to know whether they were meeting people’s needs at all times.

The building had a high standard of décor and was kept clean and well maintained. People living at the home enjoyed visiting the bantham hens, who live outside the front of the home. There was a lovely outdoor patio that looked across the parish church and rugby ground.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

This inspection was undertaken to follow up that required improvements had been made in relation to care and welfare, infection control and medicines management following our previous inspection in October 2013. Following the inspection the provider sent an action plan to us detailing the improvements being made

On the day of our inspection there were 27 people living at Roselawn with one person currently away from the home.

We spoke with nine people using the service, the deputy manager and nine staff supporting them. In addition we spoke to a registered manager from one of the provider’s other homes, the provider’s operations manager and an agency care worker working at the home.

We also spoke to a visitor and three district nurses who visits the home to support people living there.

Is the service safe?

The deputy manager ensured there were staff on duty with the appropriate qualifications, skills and experience required to ensure people’s needs were met.

The deputy manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLs). The deputy manager told us that there had been no reason to restrict or deprive people using the service of their liberty, in line with Deprivation of Liberty Safeguards legislation.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated.

The home was clean and had processes in place to maintain a clean environment. A person living at the home and a visitor told us “they keep it nice and clean here” and “it is lovely here they keep it beautifully clean”.

Is the service effective?

People’s health and care needs were assessed and their care plans and assessments were reviewed monthly. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking to people and staff that they had a good understanding of people’s care and support needs and that they knew them well.

Visiting district nurses told us that they had seen improvements at the home. They told us they were working with the home and felt staff would benefit from additional training in catheter care and tissue viability.

Is the service caring?

People were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave reassurance and encouragement when supporting people.

People at the home told us they were happy at the home. Comments included, “I am very comfortable here” and “We are very well cared for”.

Is the service responsive?

The home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the deputy manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they knew how to make a complaint if they were unhappy. A complaint received since our last inspection had been acted upon promptly and in line with the homes complaints policy and procedure. People can therefore be assured that the home acts upon complaints, they are investigated and action is taken as necessary.

Is the service well-led?

The home do not currently have a registered manager in post. The provider Keychange Charity had put in place support for the homes deputy manager in the absence of a registered manager. The provider’s operation manager and registered manager from one of the provider’s other homes visited a minimum of weekly. This meant that the provider had ensured the home was managed by a person supported by competent managers in the absence of a registered manager at the home.

Staff were confident in the deputy manager, they told us since she had taken charge there was a positive atmosphere amongst the staff. Comments included “X has done really well” and “X has done a great job, we are now working as a team”.

The provider’s representative undertook a monthly compliance visit. This showed that they worked with the deputy manager and the staff to ensure the standards that people expected at the home were maintained.

There had been communication difficulties between the local district nurse team and the home. Systems were being put into place to remedy this to make sure people received their care in a joined up way.