Rosalyn House provides accommodation and nursing care for up to 46 people with a wide range of care needs. At the time of our inspection there were 29 people living at the service, many of whom were living with dementia and other conditions.

Following our previous comprehensive inspection in November 2016, we gave this location an overall rating of ‘Inadequate’ and was therefore placed into ‘special measures’.

At that inspection we found that people’s risk assessments and management plans were in place for each person, however they were ineffective. We found assessments had not always been updated or reviewed and lacked information to guide staff in reducing levels of risks to people. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that medicines were not managed safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were ineffective systems in place to protect people from harm. Potential safeguarding incidents had not been reported to the local authority or the Care Quality Commission (CQC). This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not involved in decision making in relation to their care and support. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care plans did not accurately reflect people’s current needs and lacked personalisation. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff did not receive frequent supervision and no appraisals had been conducted in 2016. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Systems and processes for governance and quality assurance were ineffective and failed to assess, monitor and improve the quality of care being provided or mitigate the risk of harm to people living at the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read the report from this comprehensive inspection by selecting the 'all reports' link for Rosalyn House on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have them met by. We carried out this unannounced comprehensive inspection on 27 September 2017, to see if the provider had made the necessary improvements to meet these breaches of regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a registered manager in post.

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

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support pe

Rosalyn House provides accommodation and nursing care for up to 46 people with a wide range of care needs. At the time of our inspection there were 44 people living at the service, many of whom were living with dementia and other associated conditions.

This inspection took place on 8 and 9 November 2016, and was unannounced. At the last inspection in November 2015, we asked the provider to take action to make improvements to the management of medicines and the assessment of risks for people living in the service. We received a provider action plan which stated the service would meet the regulations by 30 September 2016. This action had not been fully completed.

The service has a registered manager. However the registered manager had taken the post of the deputy manager and was no longer responsible for the day to day management of the service. A new manager had been appointed in April 2016. 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.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to any 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 question 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. 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.

Potential safeguarding incidents had not been recognised and referrals to the local authority safeguarding team had not been made appropriately. Action was not taken to ensure that people were protected from the risks of abuse and harm. Staff understood their responsibilities with regards to safeguarding people and they had received training.

People were exposed to unnecessary risks. Risks assessments in place were ineffective, had not been reviewed and did not offer robust guidance to staff on how individual risks to people could be minimised.

Incidents and accidents which occurred in the service were not consistently reviewed by management to identify patterns and trends or to ensure action to prevent reoccurrence was identified. Lessons were not learnt from incidents which increased the risk t

This inspection took place on 17 November 2015 and it was unannounced. When we inspected the service in November 2014, we found that the provider was meeting all their legal requirements in the areas that we looked at.

Rosalyn House provides accommodation and nursing care for up to 46 people with a wide range of care needs. At the time of our inspection there were 44 people living at the service, many of whom were living with dementia and other associated conditions.

The service has 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.

It was not clear whether people had been involved in the planning or the reviews of their care. Each person had a care plan which reflected their preferences and included personalised risk assessments however; there were inconsistencies within these records. Assessments of people’s capacity to make decisions was lacking and records of any decisions that had been made in their best interests were not consistently completed.

Sufficient supplies of medicines had not been maintained and there were gaps in the medicine administration records.

People felt safe living in the service and staff had good understanding of safeguarding procedures.

There were sufficient members of staff on duty and a visible staff presence in all areas of the service during our inspection. Staff were competent in their roles, had completed training and felt supported with regular supervisions. Robust recruitment procedures were in place.

People's health care needs were being met and they were assisted to receive support from healthcare professionals when required. People were happy with the food provided at the service and their nutritional needs were being met.

Positive relationships had been formed between people and members of staff. Staff were kind and caring and provided care in a respectful manner maintaining people’s dignity. Staff knew people’s needs and preferences and provided encouragement when supporting them. There were a range of activities available and people received relevant information.

There was a registered manager in post and people, relatives and staff were aware of their presence. Quality assurance processes were in place. Formal complaints that had been received in the service had been recorded and managed appropriately however, there was a lack of awareness amongst people and their relatives of the complaints procedure.

There was an open culture within the staff team and members were aware of their roles and responsibilities however, they were not aware of the vision and values of the service or how they could be involved in the development of the service.

During this inspection we found the service to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

We spoke with two people and the relatives of three people who lived at the home. People told us that they were happy with the care that they or their relative received. One person told us, "They do their best. I might be a bit miserable sometimes and they give me a little 'gee up' to be a bit happier. I have to keep drinking and they keep reminding me. They give me a glass and tell me when they will be back to make sure that I have drunk it."

The individual care plans we looked at were supported by detailed assessments that identified possible risks to people, such as their vulnerability to developing pressure sores, falls, nutrition, challenging behaviour and moving and handling.

The manager told us that they had formal authorisation for deprivation of liberty in respect of one person who had absconded from the home and had suffered a minor injury. However, they were aware that, following a recent court judgement, they needed to obtain this for all the people who lived in the home. This was because people could not freely move around the home, leave it or access the garden area without being accompanied by a member of staff for their own safety. The manager had arrangements in place to formally apply for official authorisation of this from the local authority for every person who lived in the home.

If medicines are stored at inappropriate temperatures they may lose their effectiveness. The temperatures of the room and refrigerator in which some medicines were store on the ground floor had not been checked on a number of occasions in the two months prior to our inspection. The temperatures for the room on the second floor had not been recorded for a period of three days and on five other occasions within the two month period. The provider could not be sure, therefore, that people's medicines had been stored appropriately and had retained their effectiveness for people.

We noted that in some bedrooms there were metal guards to the corners of walls to prevent them from being damaged. In some rooms these metal guards had smooth rounded edges but in other rooms the guards had a sharp edge. There was a risk of harm if a person fell onto one of the sharp edges. In one room we noted that the guard was missing and the decor was damaged. A flexible metal sheet was clearly visible and this presented a risk of injury should a person fall against it. The missing guard was replaced during the course of our inspection.

We looked at the records of the fire alarms tests which were due to be done by the maintenance staff member on a weekly basis. However, there were no records of tests completed for the period from 14 February 2014 to 14 March 2014. People may have been at risk if a fire had occurred during this period and the alarms had failed.

We saw that a review of the risks of Legionella had been completed by an external contractor on 29 March 2013. We noted that there had been three remedial actions requiring attention within three months of the date of the review. We also noted that these actions, as well as some requiring attention within a longer time span, had also been identified at the review undertaken by the external contractor in 2012. This indicated that the remedial actions had not been carried out following identification of the issues in 2012. There was also no indication that the remedial actions had been completed following the review of September 2013.

People’s personal records including medical records were not always accurate and fit for purpose. We noted that, in one care record we looked at, information regarding a person's medication had been recorded in the communication record within the file. We also noted that, although the person's weight had increased and the settings for their pressure relieving mattress had been adjusted to reflect this, the care plan had not been updated to include the required settings. There was a risk, therefore, that a care worker could use the incorrect settings for the mattress. We also noted that their motivation had been assessed as poor but the care plan had been annotated that their motivation appeared to be good.

Other records relevant to the management of the services were not always accurate and fit for purpose. We noted that the maintenance staff member had recorded incorrect dates for when checks of the emergency lighting system had been carried out.

Is the service effective?

One person told us, "There are plenty of staff to help us. If I ask someone to help me there is always someone to do so." They went on to describe the care workers as, "...co-operative, hardworking...with a lot of common sense." One relative told us, "The carer's do a fantastic job." Another relative said, "The home is brilliant. The care staff are fantastic. [Relative] is happy here and can get out, which makes a difference." One relative told us, "On the whole the care is very good. I know [relative] is being looked after." Another relative said, "I have no problems. I know [relative] is being looked after."

Is the service caring?

We observed care workers as they interacted with people and assisted them to eat. The interactions were caring and respectful. People were gently assisted in their activities and encouraged to eat their meals. We saw that the care workers talked to people as they interacted with them. People appeared to be happy and we saw people laughing and joking with the care workers.

Is the service responsive?

One relative told us, "We have a relative's meeting every three months. We can voice what we need to. When we've said about things we notice changes and think 'oh yes they've taken that on board.' Last year people planted daffodils and tulips in the garden. We told the manager that they could not see them because of the bushes in the garden. These were removed so people could see [the flowers]."

We saw that the manager had invited people who lived at the home and their representatives to complete a questionnaire about the service in February 2014. This covered aspects of service such as the first impressions of it, the staff, communication, food service, the activities programme, the grounds and the standard of people's rooms. The majority of the responses were very positive. However 43% of people were less than satisfied with the grounds of the home. The manager told us that plans had been developed to change the gardens and we saw that these were displayed for the residents and their relatives to comment on.

Is the service well-led?

We saw that there were a number of quality audits undertaken by the manager and the quality manager. These included weekly audits of people's dependency and any pressure ulcer wounds as well as regular audits of individual care plans. We saw the record of the monthly environmental walk round completed by the quality manager in April 2014, although the action plan from this had not been completed at the time of our inspection. We saw that an action plan had been completed following the walk round in March 2014 and actions from this were ongoing.

When we visited Rosalyn House on 5 June 2013 we spoke with six people who used the service and three relatives. We also spoke to eight staff members, including the registered manager. We found that people were satisfied with the care and support they received.

We saw that people were provided with sufficient food and drink to meet their needs. A person who used the service said, “The food is very good and there’s plenty of it”. Another person said, “The food here is tasty”.

We found the home had an effective system in place to reduce the risk and spread of infection. We noted that personal files were well organised and contained documentation which provided a clear audit trail. This demonstrated that appropriate checks had been undertaken before staff commenced employment.

We found that complaints were fully investigated and resolved where possible to the person’s satisfaction.

On our visit on 13 December 2012 we spent time talking to staff, a relative and one of the people living at the home. The relative said "The staff are amazing. I visit most days and see what happens. You never see staff just standing chatting they are always focused on the residents'." The relative also said "They look after me as well as I have down days. I can't fault them." A resident told us that they had wanted "...to have a 'MacDonald's burger" and the staff went and got one for them. They said they hadn't had one for ages and "... really enjoyed it."

We found that staff had been provided with training and opportunities to observe practices in the home to help them understand the impact of some practices on the people living at the service. Staff told us that they had found this very useful and they had experienced some of the care tasks for themselves. They felt that this had increased their understanding of the experiences of people who had dementia and how they might feel so they were now more considerate of this when supporting and assisting people.

During our visit to Rosalyn House on 9 August 2012, we spoke with several people out of the 42 living at the home, and also seven members of staff. The people living there had complex needs and communication difficulties and as such were not able to tell us about their experiences.

Staff said they enjoyed working at the home and felt supported by colleagues and management.

During our visit on 15 November 2011, we found that many of the people were unable to communicate verbally. We spent some time talking with some people, observing, and listening to the care people received. People told us they were involved in the way that there care is provided and that they are encouraged to maintain there independence where possible.

People told us that the care staff are “wonderful“and “kind“. One person told us, “They can’t do enough for us“. People were complimentary about the food and told us they are offered choices and would be offered an alternative if they did not like the choices on offer. One person told that they did not eat a lot and staff respected this by only putting small portions on their plate.

They also told us that the manager is always coming to check that they are all right.

We carried out this inspection on 5 and 6 November 2014, and it was unannounced.

Rosalyn House provides accommodation, care and treatment for up to 46 older people. The home is spread over three floors and there is a lift available to enable people to access all areas of the home. Some of the people supported by the service were living with dementia, mental health issues and physical disabilities. At the time of the inspection there were 41 people living at the home.

At the last inspection on 29 April 2014, we had told the provider to make improvements to ensure that medicines were managed safely, the premises were safe, and the records were accurate, up to date and stored appropriately. They sent us an action plan telling us that they would meet the requirements by 30 September 2014. We found that all the improvements had been made during this inspection.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection, there was a manager in post and they had commenced the process to register with the Care Quality Commission.

The provider had effective recruitment processes in place, and there were sufficient staff employed. However staff were not deployed effectively on the day of our inspection.

People’s needs had been assessed, and care plans took account of people’s individual care and treatment needs, preferences, and choices. However, some of the people did not always receive the care they needed.

There were risk assessments in place that gave guidance to the staff on how risks could be minimised. There were systems in place to safeguard people from the risk of abuse and medicines were managed safely.

The staff had appropriate training, supervision and support, and they also understood their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have sufficient food and drinks in a caring and respectful manner.

People were supported to access other health and social care professionals when required. They were also enabled to maintain close relationships with their family members and friends.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to improve the quality of the service.

The new manager had made significant improvements so that people received safe, effective and compassionate care. However, these had not yet been fully embedded, understood and implemented by all the staff.