This inspection took place on 15 and 22 November 2017. The first day of the inspection was unannounced. This meant that the staff and provider did not know we were coming. The second day of inspection was announced so the provider knew we would be returning.

Our previous inspection of the service took place on 9 and 11 May and 18 July 2016 and at that time we found breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were related to failure to obtain consent, lack of robust risk assessments, poor record keeping and ineffective quality assurance systems.

We took action by asking the provider to send us an action plan stating how they would achieve compliance with the regulations. During this inspection we found there had been improvements made in line with this action plan and the service was no longer in breach of the regulations detailed above.

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

Rosedale Centre accommodates up to 44 people across four separate units, each of which have separate adapted facilities. Two of the units, Willows and Poplars, are assessment units where people’s ongoing care needs are established. The other two units, Oaks and Laurels provide tailored rehabilitation support to people in order to prepare them for a return to their own home. People do not generally stay at Rosedale for more than six weeks although there are, on occasion, exceptions to this. People are admitted following discharge from hospital or from the community in an attempt to prevent hospital admission.

The service had a registered manager in place. 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 and their relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, whistleblowing and infection control. Staff had received safeguarding training although some refresher training was overdue. Staff we spoke with could describe the types of abuse and how to spot them. They told us they would report any concerns to management and were confident they would be investigated.

Bed sensors were now checked daily to ensure they were in good working condition. People had individual personal emergency evacuation plans in place that reflected their individual support needs. Fire equipment was tested regularly and drills were correctly recorded including information on evacuation times and names of staff involved. People’s weights were monitored on scales that were calibrated regularly. Care records contained detailed risk assessments which addressed each person’s identified areas of risk.

People’s medicines were safely stored, correctly recorded and administered as prescribed by trained staff.

Accident, incident and safeguarding concerns were recorded and investigated to look for trends and prevent any reoccurrence. Regular maintenance checks and repairs were carried out. A business contingency plan was in place that clearly explained the action to take in the event of an emergency. Infection control procedures were followed. The building was clean and free from odour and staff had access to personal protective equipment such as gloves and aprons.

Safe recruitment procedures and pre-employment checks continued to be undertaken and there were sufficient staff members on duty to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way p

This inspection took place on 9 May 2016, 11 May 2016 and 18 July 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 11 May 2016. We made a further unannounced visit to the service on 18 July after information was received from the local coroner regarding the death of a person who had previously used the service.

We last inspected the service on 12 June 2013 and found there to be no breach of regulations at that time.

Rosedale Centre provides accommodation and support for up to 44 people to receive short-term intermediate care of up to six weeks. It is a multi-disciplinary integrated re-enablement and assessment service providing both assessment and rehabilitation for adults over the age of 18 including older people. People are referred from local hospitals and from the community via GPs, social workers and therapy staff. The service is situated in a residential area close to local amenities and public transport.

The service was divided into four units. Willows (12 beds) and Poplars (10 beds) were assessment units. Oaks (12 beds) and Laurels (10 beds) were rehabilitation units.

The home had a registered manager in place. 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 and their relatives told us they felt that care was delivered safely.

We saw that people had some individual risk assessments within their care files that covered areas specific to the individual’s needs however some identified risks had no corresponding risk assessment in place.

Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing [telling someone] procedures and said they felt confident to report any concerns without fear of recrimination.

At the time of our visit individual personal emergency evacuation plans (PEEPs) were not in place for each person. We have been told by the registered manager that these have been put in place since our visit.

The service had policies and procedures in place to ensure that medicines were ordered, stored and administered safely. People received their medicines as prescribed but one of the records we checked had not been correctly completed.

Accidents and incidents were recorded but there was no procedure in place to analyse this information for trends and patterns.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff received support via one to one supervision and annual appraisal. Staff had not received supervision as often over the past year due to a review of the service being undertaken.

Staff rotas indicated that the service was correctly staffed according to the required levels identified by the registered provider. Some people who used the service felt there were enough staff on duty, others told us they felt staff were over worked and they sometimes had to wait for assistance. Our observations during the inspection indicated there were sufficient staff available to meet people’s needs.

Training was up to date and staff had the required skills and knowledge to provide support to the people they cared for. New staff underwent a structured induction process.

DoLS authorisations were being correctly applied for but not always recorded on support files. Staff had a limited understanding around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care staff had not received training in MCA and we did not see evidence of consent with

Rosedale Centre is a rehabilitation and assessment centre for up to 44 adults. The service is a purpose built, single storey short term centre made up of four units; Oaks and Laurels providing rehabilitation and Willows and Poplars providing assessment.

The service offered people up to six weeks of rehabilitation free of charge and there were 34 people resident on the day we visited with three people discharged during the day.

The ethos of the service was about working together to enable people. This was the general impression we were left with following the inspection.

There was a registered manager working at this service who had worked at this service for over 30 years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The manager showed good leadership and worked hard to make continuous improvements using the knowledge they had gained through working alongside other professional groups. The registered manager and the management team were good role models who had sustained a positive and supportive culture over time.

People told us that, “They encourage my independence, but will always help me if I need it” and “I can’t fault anything here. My mother is looked after so well”.

People worked with care staff, physiotherapists and occupational therapists to decide on the level of support they needed. The therapists worked on site for periods of up to a year but were employed by the NHS although the senior therapist was permanently employed to provide continuity.

Communication was effective and people who used the service were relaxed with staff. We observed many positive interactions between staff and people who used the service. For instance we observed a staff member kneel beside a person to talk to them at eye level. We also saw staff at lunchtime chatting and joking with people which created a happy atmosphere.

There were no planned social activities but people were sat in small groups chatting throughout the day. They also had occupational and physiotherapy up to four times a day if necessary. People told us they were happy with this.

We found that staffing levels were safe and that people had support over the weekends. There was a positive culture in the service and staff understood their roles and responsibilities.

We observed that the dining room provided a homely environment with small dining tables for up to four people which encouraged communication.

We found the service to be meeting the requirements of the Deprivation of Liberty safeguards. People’s human rights were therefore properly recognised, respected and promoted.

During this inspection we spent time in communal areas within the service, as well as walking around each of the four units. This was so we could observe the interaction between people who used the service and the staff. We saw throughout the inspection that people were treated with dignity and respect. People spoken with told us, “The attitude and manner of the staff has been excellent, they have been very accommodating.”

We found that people had been fully involved in their care and therapy and saw that they were well documented. People said, “It has been planned in stages, with monitoring and assessment.” “I have been fully aware of my therapy plan and the changes to equipment were discussed along the way.”

We found that the support and treatment plans provided staff with the information they needed to meet people’s needs.

We found that a range of health and care professionals were involved in meeting people's needs.

Staff had received appropriate training and support in respect of their job roles.

People were confident about the care, support and therapy provided within the service and had no concerns, but would raise them if they needed to.

We spoke directly with three people who were receiving care and support at the Rosedale Centre. We chatted with other people and observed interactions between people staying at Rosedale and staff.

One person was receiving respite care, another had very recently been admitted and the third person had been receiving care and therapy for a few weeks in one of the rehabilitation units.

The person receiving respite care said, "They ask me about my care needs every time I come in, they talk to me abut any changes that have occurred" and "They show you the care documentation."

All the people told us they had received very good care, treatment and support. One person said, “The standard of care if very good, I have come on a ton.”