This inspection took place on 01 and 02 May 2018 and was unannounced on the first day. We told the provider when we would come back for the second day of inspection.

At our last inspection on 20 and 22 February 2017 we found the provider had made some improvements to the service following the completion of an action plan. At this inspection we found that further improvements had been made to develop the service, and we were able to assess the effectiveness of these as the improvements had been in place over a sustained period of time.

Rosedene Nursing Home 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.

Rosedene Nursing Home accommodates up to 67 people in one adapted building. At the time of our inspection 43 people were living at the home. The home was split into three floors with a mix of people with varying needs on each floor.

A registered manager was in place at the time of our inspection. 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.

Improvements were needed to ensure medicines were handled as safely as they could be. We have made a recommendation about the management of medicines. Guidance was not always sought from the pharmacist in the administration of covert medicines and appropriate records were not always used to ensure that medicines were accurately recorded. Following the inspection the provider contacted the pharmacist and implemented the appropriate records. We will check on their progress with this at the next inspection.

People told us they felt safe living at the home and staff were aware of how to report and manage any safeguarding concerns. Infection control procedures were in place to maintain hygiene across the home.

Risks to people were assessed to ensure that appropriate action was taken to mitigate risks and keep people as safe as possible. We found that there were appropriate staffing levels to meet people’s needs and keep them safe.

Accidents and incidents were investigated when they occurred and improvements made to prevent future events. People were protected through safe recruitment processes.

Staff received appropriate training, supervision and appraisal to support them in delivering their duties. Effective handovers took place to ensure continuity of care when there were changes in shifts.

People were supported to maintain a balanced diet and received enough to eat and drink. Where required people were supported to access a range of healthcare professionals to meet their needs.

People’s consent was sought in line with the Mental Capacity Act 2005 (MCA), including best interests decisions and applications were made to the local authority where people were deprived of their liberty.

People felt cared for by staff at the home, and staff we spoke with knew the needs of individuals well. People were treated with kindness and compassion and were supported to express their views.

A complaints policy was in place that was accessible to people, and they knew how to raise any concerns. People received stimulation through a range of activities on offer and were supported to access local events of their choosing. Where necessary people’s records evidenced their preferences in relation to end of life care.

People, their relatives and staff spoke positively about the management of the home. Efforts were made to improve engagement with community agencies to ensure people were engaged and involved. Regular quality checks were carried out to drive improvement across the service.

We conducted a comprehensive inspection of Rosedene Nursing Home on 20 and 22 February 2017. The first day of the inspection was unannounced. We told the provider we would be returning for the second day.

At our last comprehensive inspection on 14, 16 and 20 June 2016 we found breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance, staffing and submitting notifications to the CQC. We issued warning notices in respect of the breaches relating to person centred care and dignity and respect. Following receipt of an action plan from the provider we returned to complete a focused inspection on 19 September 2016 to check that the provider had met the requirements in relation to person centred care and dignity and respect. We found that some improvements had been made but these improvements were ongoing and had not been fully implemented at the time of the inspection. During this inspection we checked that the provider had fully implemented their action plan to make the required improvements to the service.

Rosedene Nursing Home provides care and support for up to 67 people who require nursing and personal care. There were 42 people using the service when we visited. There are three floors within the building and people of different genders, mobility and mental health diagnosis were placed on each floor.

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

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or sooner if the person’s care needs had changed.

Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty authorisations to ensure this was lawful.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision, however, not all staff who had been working at the service for over a year had received an annual appraisal of their performance. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice from the dietitian was followed by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with thei

We conducted an inspection of Rosedene Nursing Home on 14, 16 and 20 June 2016. At this inspection a breach of regulations was found in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance, staffing and submitting notifications to the CQC. We issued warning notices in respect of the breaches relating to person centred care and dignity and respect. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these areas. We undertook this focused inspection to check that they had followed their plan in relation to the warning notices and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosedene Nursing Home on our website at www.cqc.org.uk.

Rosedene Nursing Home is a nursing home that provides care for up to 67 people with a broad range of health needs, with the majority having a diagnosis of a mental health condition. There are three floors to the building and people of different genders, mobility and mental health diagnosis were placed on each floor. At the time of our inspection there were 43 people using the service.

There was no registered manager at the service although the manager was in the process of registering with the CQC. 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.

At our previous inspection we found that care records did not contain consistently up to date information about people’s current healthcare needs. At this inspection we found that whilst some improvements had been made, these improvements were ongoing and there were still some gaps in care records.

At our previous inspection we found that whilst people were encouraged to eat a healthy and balanced diet care records contained incomplete information for care workers about how to meet people’s nutritional needs. At this inspection we whilst found some improvements had been made in this area, these were not consistent and care plans still contained some gaps.

At our previous inspection we found that people’s dignity was not respected. Some areas of improvement were noted during this inspection and we saw positive interactions between staff and people using the service. It was noted that people’s personal preferences were not always considered in relation to the drinkware that was used.

At our previous inspection we did not see evidence of activities being conducted to aid people in their recovery or rehabilitation and there people’s involvement with activities was not consistently recorded. At this inspection we found people provided good feedback on the activities on offer. However, there was still little evidence of appropriate activities that provided therapeutic benefit to people and there were still issues with regard to the consistent recording of activities.

We conducted an inspection of Rosedene Nursing Home on 14, 16 and 20 June 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second and third days. At our previous inspection on 7 August 2014 the service was meeting all regulations inspected.

Rosedene Nursing Home is a nursing home that provides care to up to 67 people with a broad range of health needs, with the majority having a diagnosis of a mental health condition. There are three floors to the building and people of different genders, mobility and mental health diagnosis were placed on each floor. At the time of our inspection there were 46 people using the service.

There was no registered manager at the service although the manager was in the process of registering with the CQC. 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 completed medicines administration training within the last year and were clear about their responsibilities. However, staff were not recording the site at which they were giving people their injections creating the risk of causing people unnecessary pain by potentially injecting them in the same place and the date of opening on some topical medicines was not marked.

When questioned, staff appeared to be clear about safeguarding procedures and when to report an incident. However, we became aware of two safeguarding incidents which had not been reported or investigated and potential safeguarding concerns were not always addressed.

Staff told us they had received training in what to do in the event of an accident or incident, but most staff told us they had not received training in how to manage instances of violent aggression from people and the training records supported this. We observed one incident where a care worker did not manage a potential incident appropriately.

Information in care records and risk assessments was inconsistent and confusing. We found some examples of known risks not being fully explored through specific risk assessments and care planning as a result. We also found that staff did not always respond to risks appropriately to ensure that people were protected from avoidable harm.

Care staff gave us mixed feedback about whether they felt there were enough of them on duty to do their jobs properly. The manager was unable to provide us with evidence of how they determined safe staffing numbers or ensured that people with the right skills were on duty.

Recruitment records contained the necessary documentation to recruit staff safely.

The service was not compliant with the Mental Capacity Act 2005. We found examples of people being deprived of their liberty without having the necessary authorisations from the local authority.

However, staff told us they had received training in the MCA and were able to demonstrate that they understood the issues surrounding consent.

Care records did not contain consistently up to date information about people’s current healthcare needs.

Care records contained very little detail about people’s life histories and some care staff lacked basic knowledge about the people they were caring for. Some care staff had very limited knowledge about some of the common mental health conditions people had and some staff providing one to one care were unable to explain why the person they were supporting required this level of care from them or what risk they were addressing by doing so.

People were encouraged to eat a healthy and balanced diet. People provided good feedback about the food available and the chefs were clear about what food they were required to prepare to cater for people’s individual health needs.

Staff training records were inc

There were forty two people living at Rosedene Nursing Home at the time of our inspection. On the day that we visited we spoke with four people and six staff including the manager. We looked at six care plans, and other documents such as incident reports, meeting minutes and audits.

A single inspector carried out this inspection. We were supported on this inspection by an expert-by-experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

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

Is the service safe?

The provider had an effective system in place to report and investigate safeguarding concerns.

Is the service effective?

Care plans were current and reflected people's individual needs and choices. Staff had received relevant training to enable them to carry out their role effectively.

Is the service caring?

We observed staff treating people with respect and offering them choices. They engaged with people and were familiar with the needs of people they were caring for.

Is the service responsive?

Some people using the service had their liberty restricted. The provider had followed appropriate guidance and applied for a Deprivation of Liberty Safeguards (DoLS).

Is the service well-led?

The provider had taken steps to enable learning from incidents. Staff told us they felt well supported and that there was an open culture at the home.

We spoke to three members of staff about the steps they would take if they were concerned about the welfare of people using the service. All three staff members had a clear understanding of what steps to take if they had any concerns. One person told us "if I suspect anything then I would speak to my manager". We saw the safeguarding policy which had been reviewed in February 2013. Training records showed that safeguarding training had been booked for October 2013.

We noted that the home was clean and staff were knowledgeable about the requirements for infection control. Staff said they were happy with the current arrangements and equipment for keeping the home clean and controlling infection. All staff carried hand sanitizers with them.

Staff told us that they were “never short of the necessary equipment” in order to carry out their jobs. One cleaner told us that “We are never short of cleaning staff”.

The majority of the people using the service had single rooms. Each room had a lockable safe for people to keep their personal belongings. People using the service were able to personalise their rooms. One person we spoke with said "I like living here".

We looked at ten care plans, these included risk assessments. These were reviewed on a regular basis. We observed lunch time at the home; people using the service made positive comments about the food; one person told us "the food is very tasty and just like home".

We looked at staff rotas and we spoke with the manager about staffing levels at the home. The home employed a range of clinical and non clinical staff, including nurses, healthcare assistants, cleaners, kitchen staff and maintenance contractors.

Monthly residents meetings were held at the home and people using the service were encouraged to attend and have their say. The manager told us they tried to implement changes to the homes based on feedback received from surveys that had been conducted recently.

The people we spoke with and their relatives said that they liked the staff and found them friendly, supportive and responsive. People living in the home, and their relatives, said they felt safe in the home and were able to approach the staff to discuss their needs and concerns.

People that we spoke with were of the opinion that the staff treated them with dignity and respect. They told us ”I am always treated as an individual” and ”I prefer to spend time in my bedroom and staff respect my wishes”. One relative said their family member had been living at Rosedene Nursing Home for ten years and “I am pleased with the way she is treated, never disrespectfully and always kind”.

We looked at a number of care plans. Although they had been reviewed and updated recently, they lacked detail to enable care workers to support people using the service appropriately. We saw that staff did not always read the care plans for people, this meant they were not always aware of the risks to people, what mental health illness they had or how best to support them.

People using the service told us they felt safe in the care of staff in the home. One person said ”I have lived here for five years and have never had to make a complaint”. A relative said ”after visiting my aunt I always feel confident that she will not come to any harm”. The safeguarding and whistleblowing policy contained out of date information.

Although staff attended training, there was a lack of staff supervision at the home. Staff felt they were not fully supported.

Records relating to health and safety around the home were accurate and fit for use. However, other records relating to the care and welfare of people were missing key information.