This inspection visit took place on 24 and 25 October 2018 and was unannounced.

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

Rose Villa is registered to provide accommodation and personal care for up to 20 people. The service does not provide nursing care. At the time of our inspection 15 people were living at the home. The home provides a service for older people and people living with dementia. Accommodation at the home comprises six double rooms and eight single rooms, provided over two floors, which can be accessed using stairs or passenger lifts.

The service had two registered managers. 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.

Staff had not received appropriate supervision and support to enable them to carry out the duties they are employed to perform.

The provider did not fully understand the legal requirements of the MCA 2005 and its associated Code of Practice and how these should be used to protect and support people who do not have the ability to make decisions for themselves.

The provider did not fully understand their responsibilities in relation to their registration with the Care Quality Commission (CQC) and the reporting to the Commission of accidents and or incidents.

The provider had a robust and effective recruitment procedure that ensured people they employed were of suitable character and background.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment.

Medicines were managed in a safe way.

People, their relatives and staff told us the registered managers were supportive and approachable.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009.

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

The inspection took place on the 18, 19 and 20 October 2016 and was unannounced.

Rose Villa is a privately owned residential care home which provides accommodation for up to 20 people who are elderly and or may be living with dementia. On the day of our inspection 16 people were living at the home.

Accommodation at the home comprises six double rooms and eight single rooms, provided over two floors, which can be accessed using stairs or passenger lifts.

The service had two registered managers. 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 told us they were safe and well cared for at the home. Staff knew how to identify abuse and protect people from it.

There were enough staff deployed to provide the support people needed.

Staff were supported by the provider through regular supervision, appraisals and on-going training.

People received care from staff that they knew and who knew how they wanted to be supported.

People were supported to maintain their independence through positive risk taking.

People were encouraged to maintain relationships that were important to them. Relatives were able to visit the home when they wanted to.

People were encouraged to take part in daily activities that ensured the risk of social isolation was reduced.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

People who required support to eat or drink received this in a patient and kind way.

The registered managers and staff were knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. Staff understood their responsibility to ensure people's rights were protected.

People, relatives, staff and health care professional told us the service was well led by the registered managers

There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted to.

At the time of our inspection 17 people lived at Rose Villa (the home). We spoke with five of them to hear about their experiences of living there. We also spoke with a visiting health care professional and three visiting relatives to obtain their views about the service the home provided.

Due to their physical and/or mental frailty we were unable to speak with some people who lived at the home and consequently we used other methods to help us understand their experiences such as observation of daily life in the home and looking at records and other documents.

We also spoke with four of the five care staff on duty and the home’s managers.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

• 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.

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

Is the service caring?

All the people we spoke with who lived at Rose Villa told us they received all the support and help they wanted. People also described the home’s staff as “accommodating”, “attentive”, “very good”, “top class”, “friendly”, “amazing” and “lovely”.

Is the service responsive?

The assistance and support people needed was set out in care plans and these plans were reviewed regularly or when people’s needs changed. This was to ensure the home could provide people with the help they wanted.

From observations during our inspection we saw staff did not make assumptions about what help people needed but always asked them what support they wanted. The only exceptions to this were if people were very frail mentally and not always able to ask for help they needed. Staff anticipated the needs of these individuals by interpreting their behaviour.

Is the service safe?

All the people we spoke with during our inspection told us they thought there were always enough staff on duty. They told us that when they used the home’s call system the staff responded quickly.

The provider had arrangements in place that ensured equipment installed or provided to help promote people’s independence and safety was regularly checked and serviced and if necessary repaired or replaced.

The home’s managers had recently received information from the local authority about changes to the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. This meant they would be able to take steps to ensure people who lived at the home would be protected from unlawful discrimination and arbitrary decisions to limit their freedom. They would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

Is the service effective?

People were asked for their consent before they received help and support and staff acted in accordance with people’s wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People’s needs were assessed and the support they needed and wanted was planned and delivered in line with their individual care plans.

Is the service well led?

The provider had systems in place to check and monitor the quality of the service people received and to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However arrangements and plans to deal with some foreseeable emergencies were not sufficiently robust. We have asked the provider to tell us what they intend to do about this.

We spoke with three people who all complimented the staff on the service they provided. One person said “I have no complaints, the staff are lovely, nothing is too much trouble”. People we spoke with were happy with the care and support that they received at the home. They were also complimentary about the food provided and said there was “plenty of choice”.

People were protected from the risks of inadequate nutrition and dehydration. They were cared for in a clean, hygienic environment by staff who had received infection control training.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The purpose of this responsive review was to check for compliance in relation to safeguarding people who use services from abuse. As part of the review we visited the service in the evening. We did not, on this occasion, speak to people about this outcome, so cannot report what the people using the service said. The provider was also not present or available when we visited.

We found two staff working in the evening of our visit. Both were fully aware of how to report any concerns to their immediate line manager. They were aware of their responsibilities under the services whistle blowing policy and told us they would report any concerns to the appropriate authorities if their concerns were not acted on or resolved.

At the time of our inspection the service did not have a registered manager and had been without a manager for more than five months. The provider was taking responsibility for the role as manager at the time of our inspection. We had discussed this with the provider at our inspection in October 2012 and again in December 2012. We were told by the provider that they were in the process of applying for registered manager status. We will monitor the progress of the application.

We did not on this occasion speak to people about this standard, however, we found that the service had put into place a system that ensured staff received the necessary training to care for people and meet their individual needs. People were being cared for by staff that were being formally supervised and would receive an annual appraisal.

People were happy to chat to us. They told us they liked living at Rose Villa. They spoke of being well looked after, where their choices were respected. People told us the staff were kind and looked after them very well.

People were sat together in the lounge and one person showed us their room. People told us they were well looked after and they enjoyed living at Rose Villa. People told us they liked the staff and thought they were kind, patient and caring.

We carried out this unannounced inspection on 26 and 28 May 2015.

Rose Villa is a small family owned care home located in a residential area. The home is arranged over two floors and can accommodate up to 20 people. At the time of our inspection there were 18 people living at the home. The home supports people with a range of needs. A small number of people were quite independent and only needed minimal assistance. Others needed assistance with most daily living requirements including support with managing their personal care, medication and mobility needs. Some of the people being cared in the home were living with dementia and a small number could display behaviour which challenged.

The home had two registered managers who shared the responsibilities of this role. 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. The registered provider lived in the grounds of the care home in their motor home and also took an active role in overseeing aspects of the service.

Some areas required improvement.

The service was not effectively managing risks associated with hot water, legionnaires disease and fire safety. Suitable checks were not taking place to ensure that all aspects of the facilities and amenities within the home were fit for purpose and kept people safe.

The provider had not ensured that there was a fully effective system in place to assess and monitor all aspects of the safety and quality of the service. We identified some concerns in relation to the safety of the service. These had not been identified by the provider before our visit.

The provider was not following relevant guidance when assessing whether people had capacity to consent to key decisions about their care. Where a person lacked capacity to make decisions about their care and support we were not always able to see that appropriate best interests consultations had been undertaken.

Improvements were needed to some aspects of how people’s medicines were managed. Staff were not following best practice guidance which increased the risk of medicines related problems occurring.

Some aspects of the design and decoration of the building could be enhanced to meet the needs of people living with dementia or those with sight loss. Some areas of the home, particularly the corridors on the first floor did not have appropriate light levels. We were concerned that this could increase the risk of falls for people with sight loss.

New staff shadowed experienced staff when they began their employment at the home and had an opportunity to familiarise themselves with people’s care plans and key polices. They did not receive any formal assessed induction in line with recognised standards within the sector. Staff had not been receiving regular supervision and appraisals. A range of essential training was provided for all staff which was mostly up to date. Some staff had undertaken additional training relevant to the needs of people using the service.

People told us they felt safe and staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations had been applied for.

Care plans included a number of risk assessments in relation to people’s individual risks such as falls, moving and handling and skin care. This helped to ensure that people’s care and support was delivered safely.

People told us that the food was tasty and provided in sufficient quantities. People’s care plans included information about their dietary needs and risks in relation to nutrition and hydration and staff were aware of these.

Where necessary a range of healthcare professionals had been involved in planning and monitoring peoples support to ensure this was delivered effectively. A health care professional told us, “The systems work here, they monitor pressure areas well, and are familiar with people, we get called in quickly and appropriately”.

People told us they were happy with the care provided and told us that they were supported by staff that were kind and caring. People’s comments included, “I love the nurses” and “Everybody is so kind and its very free and easy, no-body has ever been horrid”. Staff showed they had a good knowledge and understanding of the people they were supporting and were able to give us examples of their likes and dislikes and daily routines which demonstrated that they knew them well.

People told us they usually received care and support when they needed it. They felt that staff were responsive to their needs and took action to ensure they saw their doctor if they were unwell.

People and their relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

People were positive about the management and leadership of the home. Staff told us they felt fully supported by the registered managers who they said maintained a strong presence within the home. The registered managers promoted an open and supportive culture in the service which helped to ensure that people were supported by a motivated and caring staff team.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of this report.