This inspection took place on 12 February 2018 and was unannounced. At the last inspection in January 2017, the provider was in breach of three regulations of the Health and Social Care Act 2014. These related to risk management in safe, consent in effective, and governance in well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions of safe, effective and well-led to at least good. We checked to see that the action plan had been completed and found improvements had been made in all three areas. The provider was now compliant with the three breaches of regulations.

Rose Villa is registered to provide care for 36 people who need nursing care and who may be living with dementia. Fifteen of the 36 placements are allocated as an interim care service for those people who may need support to prevent hospital admission or rehabilitation following discharge from hospital. The building is two large Victorian houses and has three floors serviced by a passenger lift. There are bedrooms for single and shared occupancy on each floor, and a large communal space divided into two lounges and a dining space on the ground floor.

Rose Villa 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.

The service had 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.

Governance of the service had improved. The quality assurance system consisted of audits, checks, observation of staff practice, meetings and surveys. The audits were completed on a range of topics and shortfalls identified from them and from the meetings and surveys were addressed in action plans. The provider’s representative completed visits and spot checks of the service; they spoke to people and completed a check of the environment. This helped to ensure the provider had oversight of the service.

We saw risk management had improved. A range of risk assessments were completed and these were checked more frequently and kept up to date. A new heating system had been installed which had removed the risk of cold bedrooms and the need for electric heaters.

We found the registered manager and staff had a much improved understanding of mental capacity legislation and the need for consent. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had improved. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision.

At the last inspection, we made a recommendation about ensuring care plans were more person-centred and monitoring charts were accurate. Whilst this had improved in several of the care plans we assessed, there remained some shortfalls and we have made a recommendation that these improvements continue.

Staff knew how to safeguard people from the risk of abuse and harm. They had completed safeguarding training and had policies and procedures to guide them. They were clear about the alerting procedures to the local safeguarding team.

Staff were recruited safely and in sufficient numbers to meet people’s needs. A health professional told us some people had mentioned they had various waiting times when they used the call bell. This was discussed with the registered manager to address.

People told us staff were kind and caring and respected their privacy and dignity. People could

Rose Villa is located on one of the main roads leading into the city of Hull. There is good access to public transport plus local facilities and amenities. The service is registered to provide care for up to 36 people who need nursing care and some of whom may be living with dementia. It also provides an intermediate care service to help prevent hospital admissions and to facilitate early discharge from hospital. A team of therapists, nurses and a hospital consultant provide on-going support to people admitted to the intermediate care service.

Rose Villa has a mixture of shared bedrooms and those for single occupancy; there is a passenger lift to the three floors. There is a large sitting room divided into separate areas to facilitate seated areas, a small dining area and a quieter space in the conservatory at one end. The service has a range of bathrooms, showers and toilets on each floor. At the time of the inspection, there were 13 people living in Rose Villa and 19 people receiving an intermediate care service.

The service had 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.

The last full comprehensive inspection was completed in March 2015 and the service was rated as ‘Good’. We carried out a focussed inspection in July 2016, as there had been some concerns raised with us. We found concerns with cleanliness in parts of the service, management of infection prevention and control and the management of medicines. We found the quality monitoring systems had not picked up these issues. We didn’t change the overall rating of the service as we did not complete a full comprehensive inspection, but we did rate the service as ‘Requires Improvement’ in the three areas we looked at which were Safe, Responsive and Well-led and we planned to re-inspect in six months.

At this full comprehensive inspection, we found improvements had been made regarding cleanliness, infection prevention and control, the management of medicines and aspects of the monitoring system that oversaw these areas. However, when we looked at the full quality monitoring system we found some areas had not been wholly effective in highlighting areas for improvement and there lacked action planning to address issues that had been identified.

We found there was a lack of understanding about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and how these can impact on staff practices in relation to obtaining consent and making decisions in people’s best interest. There was one person whose liberty was deprived but this had not been recognised and actioned appropriately. This meant the registered provider was not acting within the law.

We had some concerns with the management of risk and not all areas of risk had been identified. For example, some people told us their bedrooms were cold; there were portable heaters used and one in the lounge was very hot to touch. The bedroom doors upstairs were wedged open as there were no fire door stops. Some extension leads had multiple plugs in them. Disposable gloves were not always made inaccessible. Some people lacked a current risk assessment with control measures to guide staff in how to minimise risk.

You can see what action we have asked the registered provider to take, regarding the above concerns, at the back of the full version of the report.

We found there were some activities taking place but some people told us they would like to do more. There was no programme of events and we didn’t see any activities during the two days of the inspection. The person designated the role of activity coordinator was new to the role, had limited information and had not completed any training.

Rose Villa Nursing Home is registered to provide accommodation for a maximum of 36 people who need nursing care, some of whom may be living with dementia. It also provides an intermediate care service (ICS) for those people whose admission to hospital may be prevented by receipt of additional care and also to facilitate an early discharge from hospital. The people who used the ICS had access to hospital doctors and consultants, therapists and nurses to provide assessment, treatment and rehabilitation.

Rose Villa is located in a residential area, on a main road that leads into the city centre. There is good access to public transport, local facilities and amenities. The service is located over three floors and has a selection of bedrooms for single and shared occupancy. There is a large communal room on the ground floor which is divided into three distinct areas; two sitting room areas and one for dining in. There is a selection of bathrooms and toilets on each floor.

The service had a manager in post as required by a condition of registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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.

We undertook this unannounced inspection on the 27 July 2016 in response to concerns raised by a member of the local safeguarding adult’s team and we focussed on specific areas. At the last inspection in March 2015, the service was rated as ‘Good’ in all five domains of Safe, Effective, Caring, Responsive and Well-led. As we have not completed a full inspection, we have not changed the overall rating for the service. However, we have changed the ratings in the three domains assessed which were Safe, Responsive and Well-led, from ‘Good’ to ‘Requires Improvement’. We will be monitoring the service and completing a further inspection to check on progress with the areas of concern we found on the day.

At the time of the inspection there were a total of 17 people who lived in Rose Villa and 15 people who used the ICS.

We found people had not always received their medicines as prescribed. There was also an issue with recording of medicines which made it difficult to assess if people had been given them or had them applied such as creams and ointments. There was a lack of guidance for staff when people were prescribed medicines ‘as required’.

We found some areas of the environment such as sluice rooms, linen rooms and store cupboards required cleaning and tidying to ensure good infection prevention and control.

The shortfalls in medicines management and infection prevention and control meant we had concerns in these areas. You can see what action we have asked the registered provider to take at the back of the full version of this report.

The CQC had not received all notifications for incidents which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been a misunderstanding by the registered provider and registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

We found there was a quality assurance system in place which consisted of audits and seeking people’s views. However, the shortfalls in quality monitoring and checking that up to date and accurate records were in place for people who used the service, meant we had concerns in these areas. The registered manager told us they would review some of the audits in place to make sure they were more robust and enabled a thorough check of the environment and records. You can see what action we have asked the registered provider to take at the back of the full version of this report.

People gave us

People’s capacity to make an informed choice or decision was assessed and recorded, if they found this difficult the person who acted on their behalf was identified in their care file. If decisions were made on people’s behalf all those who had an interest was involved including health care professionals, staff at the home and relatives.

People we spoke with told us they were happy with the meals provided. Comments included, “The food is superb you can’t fault it”, “It’s like home cooking” and “It’s always very good and there’s plenty of choice.”

People’s medication was administered, stored and handled safely. Qualified nursing staff administered people’s medication.

There were enough staff on duty to meet people’s needs and they had received the appropriate training. People who used the service told us they were happy with the level of care they received and the competency of the staff. Comments included, “The care staff are brilliant”, “They get me up in the morning and help me throughout the day and they never complain” and “Yes there are always enough staff on duty both day and night.”

Systems were in place which enabled people to make complaints or raise concerns. People told us “I would go to the manager he’ll sort it out”, “I would see the manager or the owner they are both very approachable” and “I know I can complain but I don’t have any at the moment.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. People’s comments included “My relatives and I feel it is nice”, “We are all encouraged to move around and be as independent as possible” and “It’s very nice”. People told us that “Meals are good and sufficient in size” although one person did comment they would have liked salad as an alternative meal. Another person commented, “The food is lovely, it is warm and there is plenty of it. I have not had a bad meal.”

People’s dignity was respected by the staff and people were asked their consent with this being recorded. We saw there were menus in the home which offered people choices of meals and people’s preferences were recorded. We saw that support from staff was polite and respectful.

People told us they would raise any concerns with the staff, saying “I would just tell the carer”. Staff were aware of the process to follow should an incident of harm be raised. Staff had received a variety of training and records were in the process of being transferred to electronic versions.

This inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who had personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People’s comments included that they thought the overall care in the home was excellent, they felt that staff were polite and that the food was of a good quality

People we spoke with told us they were able to lead a lifestyle of their own choosing limited only by their dependence on the staff for help. They told us the home was very good. One person said, “I would recommend it to anyone.” People also told us they had attended meetings and had been involved with choosing to stay at the home. One person said, “I asked to come here as it was so good.”

People also told us they found the care staff very helpful and caring. One person told us, “The girls just can’t do enough for you.” Another person said, “The staff are fine, you just can’t fault them.”

People told us they would see the manager if they had any concerns or complaints. They also told us they found the manager and the staff approachable and felt confident any concerns would be dealt with to their satisfaction. One person was unsure about whom they would talk to if they had any concerns but they had no complaints so did not see it as an issue.

This was an unannounced inspection undertaken on the 23 and 24 March 2015.

Rose Villa is located on Beverley Road, Hull; it is close to the city centre. There is good access to public transport plus local facilities and amenities.

The service is registered with the Care Quality Commission (CQC) to provide care and accommodation for 36 people who need nursing care and who may be living with dementia. It also provides an interim care service for people who may need support following discharge from hospital with support from local NHS services.

The service was last inspected September 2013 and found to be compliant with the regulations we looked at.

At the time of the inspection there were 28 people living at the service.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The staff understood they had a responsibility to keep people safe and knew how to identify and report any abuse they may become aware of. The registered manager had audited the environment to ensure it was safe for people to live in. Staff were recruited safely and provided in enough numbers to meet people’s needs.

People were provided with a varied, wholesome and nutritious diet which was of their choosing. Staff monitored people’s wellbeing and made referrals to health care professionals when required. Staff were trained to meet people’s needs and were supported to pursue further qualifications. Newly recruited staff received induction training, however, it was not evident this was based on good practise guidelines; we have made a recommendation about this. Systems were in place to ensure any decisions made on people’s behalf were in their best interest, however, the principles of the Mental Capacity Act 2005 were not full applied; we have made a recommendation about this.

People were cared for by staff who were caring and understood their needs. People who used the service or their representative had been involved with the formulation of care plans and had contributed to this process, this meant people received care which was appropriate to meet their needs and of their choosing.

The care people received was person centred and staff made sure people’s dignity, privacy and independence was promoted. A range of activities were provided for people to participate in and staff understood the importance of engaging those people who may spend a lot of time away for the main lounge in their own rooms. People could choose what they wanted to do and when and were supported by staff to pursue individual hobbies and interests. The registered provider had a complaints procedure in pace which people could access if they felt the need to raise any concerns or complaints. These were investigated and resolved to the complainant’s satisfaction wherever possible.

The registered provider had systems in place which monitored the quality of the service provided; this included a range of audits the registered manager was expected to complete. Surveys were used to gain the views of people who used the service, their relatives and health care professionals who had an interest in the people’s welfare and wellbeing. All accidents and incidents were analysed and any learning was shared with staff and changes made to working practises or procedures if necessary. This meant people could have a say about how the service was run and the service provided was safe and based on learning and good practise.