Rosebery House is registered with CQC to provide residential care for up to 30 older people. At the time of the inspection there were 27 people living at the home.

Rosebery House specialises in providing care for people with dementia and memory loss.

This was an unannounced inspection which took place on 28 July and 1 August 2016.

At the last inspection undertaken on the 1 and 2 June 2015 we asked the provider to make improvements in relation to the safe storage and administration of medicines, safe staffing levels in relation to evacuation procedures and peoples preferences and needs not being met. The provider sent us an action plan stating they would have addressed all of these concerns by August 2015. At this inspection we found the provider was meeting these regulations.

Rosebery House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

The manager was in day to day charge of the home, supported by a deputy manager. People spoke highly of the home and the way it was run. And staff told us that they felt supported.

Staff felt that training provided was effective and ensured they were able to provide the best care for people. Staff were encouraged to attend further training, with a number having achieved National Vocational Qualifications (NVQ) or similar. New staff received an induction and staff received regular supervision annual appraisals and had regular staff meetings. This meant that staff were supported to develop skills, knowledge and training.

Staff demonstrated an understanding around safeguarding and were able to tell us how they would report any suspected abuse. People were involved in day-to-day choices. All staff and management had a good knowledge and understanding of Mental Capacity Assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). This meant that any decisions made had followed this process to ensure they were made in peoples best interest and supported by health professionals and Next of Kin (NoK).

Staff recruitment systems were in place and staffing levels were reviewed to ensure people’s needs could be met. A training programme was on going to ensure staff were appropriately trained to support people’s needs.

The home had a designated maintenance employee who was available at the home. Systems were in place to ensure emergency procedures were in place. And equipment and services were well maintained and checked regularly. There were systems in place to assess and monitor the service. This included auditing and feedback from people. All findings were analysed and used to make improvements to the day to day running of the home.

Staff provided care and support for people with kindness and patience. People’s dignity and privacy were respected and people were involved in decisions about how they received care and spent their time throughout the day.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure good standards were maintained.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and the registered manager was developing photographs of meals to enable people to have a better understanding around meal choices available.

Referrals were made appropriately to outside agencies when required. For example GP visits, community mental health teams and community nurses. Notifications had been completed to inform CQC and other outside organisations when events occurred.

We used a number of different methods to help us understand the experiences of people using the service. Not all of the people who lived at Rosebery House were able to communicate with us. We used Short Observational Framework for Inspection (SOFI). SOFI is a tool used when reviewing services for people who have conditions that mean they are not able to tell us about their experiences of living in the home. Those who could talk with us told us they were happy living at the home.

During our inspection we found that consent was sought before care was given. People were involved in choices and decisions throughout the day.

Care plans were personalised and documented the needs of people.

The home appeared clean and tidy. Appropriate infection control measures were in place.

A complaints policy was displayed in the reception area. Evidence was seen that comments and complaints were listened to and resolved in a timely and appropriate manner.

Due to people’s complex needs, many people were not able to tell us about their experiences. We used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people using the service.

People we were able to speak with who lived in the home told us they liked living at Rosebery House.

People we spoke with who lived in the home told us they were happy living at Rosebery House. Relatives told us “staff are quite caring, they are a good team” and “staff seem very nice, they are always busy”. One visitor told us “everything is labelled and yet items of clothing sometimes disappear, they return again a few days later, but you do wonder where they go”.

People we spoke to using the service made no specific comments about the care and services provided.

One resident who was asked if she could do what she wanted to do when she wanted to,

replied that she could.

When asked about the care in the home one resident said ''I have no reason to complain.''

Feedback from residents who were asked about the food indicated a satisfaction with the

food provided.

One resident who was asked if she could do what she wanted to do when she wanted to,

replied that she could.

When asked about the care in the home one resident said ''I have no reason to complain.''

Feedback from residents who were asked about the food indicated a satisfaction with the

food provided.

ue to the nature of dementia it was difficult to ascertain the views of all the residents. We were able to talk to two people and they stated that they were happy with the care received at the home.

Specific comments included – “The staff are wonderful.” “We have no concerns.” “It is lovely here.”

Rosebery House is a residential home in Eastbourne, providing care for people with dementia. Rosebery House provides local authority and privately funded long term care and periods of respite. People’s care needs varied, some had complex dementia care needs that included behaviours that may challenge others. Other people’s needs were less complex and required care and support related to personal and social care needs. Some people were independently mobile and able to walk unaided or with the use of walking frames, whilst others used a wheelchair and were reliant on staff for all their personal care needs. The service is registered to provide care for up to 30 people. At the time of the inspection there were 22 people living at the service.

This was an unannounced inspection which took place on 1 and 2 June 2015.

Rosebery House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

Care plans had been written and reviewed regularly by the manager. These provided clear individualised care guidance for staff. However, daily charts and records had not been written to identify that care had taken place in accordance with people’s care plans.

Activities were provided on a daily basis by care staff, but these were not person specific. Staff told us they had not received any training to provide appropriate activities for people with dementia. Some staff felt uncomfortable being asked to facilitate activities. Others told us they wanted more training to ensure they were doing this well. There was a lack of accessible equipment for people to access throughout the day.

Quality assurance checks were completed regularly by the manager to ensure that the service provided good care and continued to improve. However some areas of auditing including completion of records and activities needed to be improved.

At lunch time one person was taken to the dining room and left sat alone for a long period of time before and after their meal. During the meal this person was assisted by three separate staff, this could be disorientating for a person with dementia and memory loss. People were offered a selection of snacks and drinks throughout the day with staff taking the time to assist people to encourage good nutrition and fluid intake. This was logged onto daily food and fluid charts used to assess people’s nutritional intake and highlight any concerns. Meals provided looked well-presented and appetising with people’s likes and dislikes documented to inform staff.

People’s weights were reviewed every month with referrals made to outside agencies when people had poor nutrition or had lost weight. People who required assistance at meal times had this provided in a dignified interactive way, with conversations taking place between staff and people throughout the meal time.

People living in the service told us they felt safe at Rosebery House and staff felt safe and supported working at the service. The manager was a visual presence at the service on a daily basis and had an ‘open door’ policy for staff, people living in the service and visitors. However we found some elements of medicines storage and administration were not always safe.

Staff had received safeguarding training and were able to demonstrate a good knowledge around recognising and reporting concerns appropriately. Safeguarding policies and procedures were in place and were up to date and appropriate. Safeguarding referrals were made to the local authority when required. The manager was open and transparent about previous safeguarding investigations and it was clear that learning had taken place with changes implemented in the response to investigation findings.

Staff knew people very well and were able to tell us about their individual needs. Environmental and individual risk assessments had been completed. There was an organisational recruitment policy and procedure to follow when recruiting new staff. This included an in house induction for new staff. Staff told us the manager was always around and available if they had any concerns. Staff felt able to speak to the manager and felt that they would be listened to and supported.

Equipment maintenance and servicing had taken place. With environmental and maintenance audits completed to ensure the building and equipment were maintained appropriately. This included contingency plans and procedures for evacuation, although the fire risk assessment was inaccurate and needed to be reviewed and updated.

Staff told us they knew people well and could respond appropriately when people became anxious or upset. When someone new moved into the service they took the time to get to know them and how they liked to be cared for. Information about people’s lives and background had been completed in care files to inform staff of people’s likes, dislikes and preferences.

A training schedule was in place which identified when staff attended training or when training was due. Staff felt supported by the manager and work colleagues .There was a programme for supervision and appraisals to take place, this included further ‘ad hoc’ meetings when required and policies and procedures were in place to support staff.

A number of staff including the manager had attended Deprivation of Liberty Safeguards (DoLS) training. We saw that DoLS applications had taken place when required. Care staff informed us how they gained consent from people, and displayed awareness around mental capacity, choice and restraint. Mental capacity assessments had been completed when appropriate.

People were seen sitting the lounge, dining area and their own rooms. During the inspection we saw many examples of positive communication and interaction between staff and people. Staff took the opportunity to introduce people and this led to a conversation. Staff demonstrated an obvious affection for people, and responded calmly and positively when they sat with people or passed them in the corridor. Staff showed a clear fondness for people and cared about their care and welfare. Responding in a calm manner, and providing support when people became anxious or distressed. People recognised staff and it was apparent in their body language they felt comfortable and trusted staff to look after them.

Staff told us they were part of a team, and felt that they all shared the same values to ensure people received the best care.

There were no current complaints investigations in progress. Past complaints had been dealt with following the organisations complaints procedure.

Staff spoke positively about the manager, the culture within the service and how they all worked together as a team to support each other.

We found a number of breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.