We undertook a focused inspection at Rosamar on 2 October 2018. The inspection was announced, which meant that the provider knew we would be visiting. This was so people living at the service could be supported by staff prior to our inspection.

This inspection was undertaken due to concerns we had received around people’s finances and safeguarding incidents, which required further investigation. The team inspected the service against two of the five questions we ask about services: is the service safe and well led. This is because the information we received related to these two key areas.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last comprehensive inspection of the sevrice in January 2018, the service was rated Good. At this inspection we found the service remained Good.

Rosamar is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rosamar supports up to 10 people with a learning disability, who may also have additional complex needs. At the time of the inspection there were nine people living at the service. The service has two lounges, a dining area, kitchen, two laundry rooms, office and bedrooms. There is a driveway and back garden, which people could use.

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.

Staffing levels met people’s needs. Staff were consistent, experienced and knew people well.

People’s finances were managed safely. Regular audits and checked were conducted.

Safeguarding concerns were reported in line with the provider’s policy.

Further information is in the detailed findings below.

This inspection was unannounced and took place on 30 January 2018. This was a comprehensive inspection. The previous comprehensive inspection of the home was carried out in April 2016 and the home was rated as requires improvement. Two breaches of regulations 12 and 17 of the Health and Social Care Act 2008 were identified. These were because people were at risk of cross infection because correct procedures for washing laundry had not been followed, some areas of the home required maintenance, an upstairs window did not have a window restrictor and audits had not identified records were not accurate and up to date. We served a requirement notice for the breach of regulation 12, and a warning notice for the breach of regulation 17. We completed a focussed inspection in October 2016, to follow up the breach of regulation 17 detailed in the warning notice and found the required improvements had been made.

Rosamar is a care home which provides accommodation and personal care for up to 10 people with a learning disability, who may also have additional complex needs. At the time of the inspection there were nine people living in the home. It has two lounges, a dining area, kitchen, two laundry rooms, office and bedrooms. There is a driveway and back garden.

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.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

Staff received regular training in topics the provider considered mandatory and were knowledgeable about their roles and responsibilities. Staff had guidance for people’s complex health needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

People received their medicines safely. The manager completed regular checks to ensure medicines were safe. People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Relatives and staff told us the registered manager was accessible and approachable. Everyone felt able to speak with them and provided feedback on the service. Staff told us they felt supported and listened to.

The registered manager employed a consultant who undertook regular audits and spot checks to review the quality of the service provided. Any improvements identified were made.

This inspection was unannounced and took place on 11 October 2016.

Rosamar is a care home which provides accommodation and personal care for up to 10 people with a learning disability who may also have additional complex needs. At the time of the inspection there were nine people living at the home. The home is a terraced house situated in a residential area of the town. It has two lounges, a dining area, kitchen, two laundry rooms, office, and bedrooms. There is a drive way and back garden.

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.

We carried out an unannounced comprehensive inspection of this service on 27 and 29 April 2016. A breach of legal requirements was found as the provider was not always taking action after their audits identified areas for improvement. ¿Where actions had happened these were not always fully documented. Records were not always accurate or up to date and some risk assessments had not been reviewed and updated. We also found where complaints had been raised there was no record of outcomes taken and no system in place to identify trends.

After the comprehensive inspection, we used our enforcement powers and served a Warning ¿Notice on the provider on 21 June 2016. This was a formal notice which confirmed the provider ¿had to meet one legal requirement by 21 September 2016.¿

We undertook this focused inspection to check they now met this legal requirement. This report ¿only covers our findings in relation to this requirement. You can read the report from our last ¿comprehensive inspection, by selecting the 'all reports' link for Rosamar on our website ¿at www.cqc.org.uk

We found action had been taken to improve the governance of the service. ¿

A new system for auditing the service, which identifies risks and concerns, had been set up. The new system was proactive in spotting risks and concerns early so action could be taken to prevent incidents from occurring.

Environmental risk assessments had been reviewed and had been either updated or action had been taken to remove the risk from the home completely. People’s individual risk assessments had been updated to reflect changes in their needs.

Mental capacity assessments had been reviewed and updated where needed. The way of recording complaints had been reviewed and improved.

We inspected this service on the 27 and 29 April 2016. This was an unannounced inspection. At our last inspection in January 2015 we identified concerns relating to people who use services were not protected from the risk of infection because appropriate guidance had not been followed. There were no processes in place to support people to make best interest decisions in accordance with the Mental Capacity Act 2005. There were no effective systems in place to assess and monitor the quality of the service. During this inspection we found some improvements had been made although areas within the building required work and the correct procedure for laundering of soiled and contaminated clothes was not being followed.

Rosamar is a care home which provides accommodation and personal care for up to ten people with a learning disability who may also have additional complex needs. At the time of the inspection there were nine people living at the home. The home is a terraced house situated in a residential area of the town. It has two lounges, a dining area, kitchen, two laundry rooms, office, and bedrooms. There is a drive way and back garden. 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. The registered manager was present during the inspection.

People could be at risk due to staff not following correct procedures for washing soiled and contaminated laundry. Some areas of the home required improvement where one bathroom had water damage and a bedroom where there wall was damp from the guttering outside. People felt safe in the home and incidents and accidents were recorded with actions taken although actions were not always recorded. People received their medicines safely and when required by staff who had received training. Most people had detailed risk assessments and guidelines in place for staff to follow although one person’s risk assessment had not been updated following some falls.

People were supported by staff who had appropriate checks in place prior to commencing their employment. People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff demonstrated they knew people well and felt supported and were able to raise any concerns with the registered manager. People undertook activities that were important to them and had opportunities to voice what days trips they wanted. People had choice about when they ate and choose their menus weekly although people only had a choice of one type of biscuit and this was placed directly onto the table.

People were involved in their care planning along with professionals who were identifying outcomes for people’s future. Changes to people’s needs were identified with referrals to the appropriate health professionals when required. Where people were unable to consent to care and treatment records were not always accurate and best interest decisions paperwork did not always record the involvement of professionals and significant others. People’s care plans were not always written in an enabling, person centred way and some environmental risk assessments were old and required reviewing.

People were able to receive visitors whenever they wished and relatives were able to visit as often as they liked. People were supported by staff who received regular supervision and training to ensure they were competent and skilled to meet their individual care needs.

People, relatives, staff and external stakeholder’s views were sought so that improvements could be identified although there was not always a clear action plan confirming actions taken. People felt happy to raise a complaint with the registered manager and

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, relatives, staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider knew people well as some people had lived at the home for a long period of time. One person had lived at the home for 30 years. The service aimed to provide an environment to people, which was similar to that of a family. This ethos had been effectively transferred to the staff team and was established practice. However, familiarity of people’s needs meant that some processes such risk assessments were relaxed at being changed.

We saw the home sought assistance from relevant external professionals when needed to ensure people’s safety. For example one person’s records showed their Physiotherapist had recently been contacted due to a change in their mobility.

There was safeguarding adults training available and in place for most staff. This ensured staff knew how to identify abuse and what they should do if they suspected abuse. Staff had a good understanding of keeping people safe and the procedure they should follow for visitors to the building.

There were clear behaviour plans identifying risks and any triggers which could affect behaviours. Staff were knowledgeable of these triggers and made visitors aware.

Incidents were recorded and filed and there was clear evidence when action had been taken. However some accidents haven’t been reported to CQC, we have asked for these to be sent to us.

Staff all received initial Criminal Records Bureau (CRB) or Disclosure and Baring service (DBS) checks, however there was no system in place to check risks which arose after these initial checks were done.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place. 90% of staff had been trained to understand when an application should be made, and how one should be submitted.

Is the service effective?

Relatives we spoke with all said they were happy with the care and they felt their family members needs had been met. It was clear from our observations and from speaking with staff they had a good understanding of people’s care and support needs and that they knew them well. One person told us “I am happy here”.

Most staff were trained with more identified training being booked over the next few months.

There were risk assessments and behaviour assessments in place which identified areas which could trigger changes to behaviour. Staff knew these triggers well and informed visitors of them when entering the home.

Care plans had clear likes and dislikes in them and activities which people enjoyed doing. This ensured people were effectively supported.

Is the service caring?

We saw staff were polite and respectful to people. We observed staff took their time with people and give them reassurance when required. All staff we spoke with told us this was people’s home and they made sure people had choice. We saw staff visually show people options so that they could make an informed choice.

Is the service responsive?

Relatives told us that staff responded to people’s needs well and they felt confident they were being cared for appropriately. One person told us “I have good contact with the manager of the home and staff are pleasant and easy to talk to”.

We saw one person had been referred to a Health and Social Care professional. We saw that after this assessment there was a change to their physiotherapy programme and mobility around the home. We saw that appropriate paperwork was completed to make sure that the individual had the capacity to make this decision.

Is the service well led?

The home had a registered manager in place. Relatives and staff all felt confident they could discuss any concerns or problems with the manager.

There were some quality audits in place for medication and room’s. However the building was in a poor state of repair in some areas. We raised these points with the manager and they said there were plans to undertake the work to the front of the property.

Everyone we spoke with was happy with the home and the care provided. There were questionnaires in place for people and relatives to give their views about the service but these had not been filled in and returned.

There was regular supervision in place for new staff however those who had worked at the home for a number of years received less formal supervision. This was not documented and in their files.

This inspection was undertaken in response to information we had received in relation to infection control, staff training and the premises. We did not look in depth at these areas but focused on the areas associated with the information we had received.

We had received information of concern about the laundry arrangements in the home and overall cleanliness. We found there were appropriate and safe arrangements for the management of laundry particularly where there were potential risks of cross infection. The standard of cleanliness was good in all parts of the home with robust arrangements for the regular cleaning of all the facilities and areas of the home. However we noted a lot of dog faeces in the garden.

We looked at the maintenance of the building because this had been raised as part of the information of concern we had received. We found there were parts of the home internally and externally which were not of the appropriate standard. This included areas of the kitchen and a communal toilet. Some ceilings had been subject to flood damage and an insurance claim had been made to repair and restore these areas. The condition of the front and entrance of the home was not satisfactory with flaking paintwork and damaged plasterwork.

People's rooms and communal lounges were personalised and in good decorative order. They provided a homely and welcoming environment.

We found staff had received some essential training however this had not included moving and handling.

When we visited the home we found eight people were using the service. People living the home had complex needs, which limited the conversations with us. We were warmly welcomed by a person, accompanied by a member of staff and taken to the manager.

The staff interacted well with the people, showing good knowledge and understanding of their needs. They showed they were quick to respond to any changes in the health and wellbeing of the people in their care.

We observed that all people were able to move around the house as they wished to, having both quiet places and communal areas available at all times. People were asked if they wanted to go out and their decisions respected. We saw how one person wanted to go out alone and how this was enabled, we saw another person who desired to stay in their own room rather than join the other people in the minibus outing.

Staff told us "We are here to support our people"

We saw evidence of training in relevant aspects of the Mental Capacity Act [MCA], and Deprivation of Liberties Safeguards [DOLS], which staff showed a good understanding of. We saw evidence of consultation with all parties concerned in a recent DOLS issue, where decisions had been taken in the person's best interest and was well documented. A relative told us that they were happy "The right thing would always be done for their relative"

The atmosphere was very relaxed, very much the people's own home.

When we visited eight people were using the service. The people who lived at the home had complex needs and were only able to engage in very limited conversations with us.

Staff had a good working knowledge of people and were quickly able to recognise changes when people became unwell or were unhappy with their care. We saw that people responded positively to staff interactions.

People were able to move freely around the home and were protected from unexpected callers. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Records showed that decisions had been made in people's best interests and that the appropriate parties had been consulted.

Staff were able to meet people's individual needs and when a person changed their mind at the last minute about going on an outing, they said "This is never a problem as we have our own mini bus and we arrange the trips around the person when ever we can".

We saw examples of where people's mental and physical abilities had improved since they had been admitted to the home. One family member said "They were now able to have a open conversation on the telephone with their relative which had never happened before".

The atmosphere in the home was relaxed and inclusive.

The inspection took place on 28 January 2015 with one inspector and was unannounced. We returned on 30 January 2015 to complete the inspection. Rosamar is a care home which provides accommodation and personal care for up to ten people with a learning disability who may also have additional complex needs. There were eight people living at the home at the time of our inspection. The home is a terraced house situated in a residential area of the town.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

We inspected Rosamar in January 2014. At that inspection we found the provider to be in breach of Regulation 15 Safety and suitability of premises. The provider wrote to us with an action plan of improvements that would be made to the premises. During this inspection we saw improvements identified had been made, there were however areas of the premises still requiring improvement.

People who use the service appeared calm and relaxed during our visit. Staff knew the people they were supporting well. We saw staff encouraging people to engage in activities within the home. Relatives told us staff treated their family member well and their approach to supporting people was caring.

People were protected from risks associated with their care because staff followed the appropriate guidance and procedures. People’s medicines were administered safely. The service had appropriate systems in place to ensure medicines were stored correctly and securely.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are an amendment to the Mental Capacity Act 2005 which allow the use of restraint or restrictions but only if they are in the person’s best interest. We observed where restrictions were placed on people the principles of the Mental Capacity Act were not always followed. There were no Deprivation of Liberty Safeguards (DoLS) applications made for people living at the home where they were subject to continuous supervision and lacked the option to leave the home without staff supervision. The manager told us they were in the process of seeking advice on making DoLS applications to the local authority.

The service was responsive to people’s needs. We saw that people’s needs were set out in clear, individual plans. These were developed with input from the person and people who knew them well. Relatives were confident that they could raise concerns or complaints and they would be listened to.

Staff received appropriate training to understand their role. Staff had completed training to ensure the care and support provided to people was safe. New staff members received an induction. We found there were some staff who had not received up to date training, the registered manager did not have a plan in place to address the gaps at the time of our inspection.

Staff did not always receive regular one to one supervision with their manager. We found where concerns about staff performance had been identified there was no evidence of this being addressed by the registered manager. Staff did not always feel confident concerns they raised with the registered manager would be appropriately addressed.

The registered manager did not have effective systems in place to monitor the quality of the service. The Department of Health’s Code of Practice on the prevention and control of infections and related guidance was not being followed at the time of our inspection.

Records we reviewed showed staff reported incidents to the manager, we found that we were not notified of these. Services are required as part of their registration to tell us about important events relating to the care they provide using a notification. This meant the appropriate authorities were not always notified of significant events and we could not check the appropriate action had been taken.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.