About the service:

• Rosemanor Hopton is a care home for people experiencing mental health issues. At the time of our inspection 13 people were living at the home.

People’s experience of using this service:

• The quality of care had improved in some areas since the last inspection.

• At our last inspection we rated the home ‘Inadequate’, at this inspection it had improved to ‘Requires Improvement’. However the home was still ‘Inadequate’ in well-led; and continued progress was needed to ensure that improvements made thus far were sustained.

• The home was still not as well-led as it could be. Management arrangements required more time to successfully embed into the service.

• The provider needed to ensure that quality assurance systems were robust, and important notifications were not always submitted to the Care Quality Commission (CQC) in a timely manner.

• Efforts were needed to ensure that the premises were well maintained and suitable for the needs of the people that lived there. Shower and bathrooms were not well maintained and the premises were not of a satisfactory level of cleanliness

• Fire safety across the home required improvements. The provider had complied with the action plan following a recent London Fire Brigade inspection and took prompt action to make improvements following their inspection findings.

• Staff training was still not up to date, and staff were not always fully trained in all areas to meet the needs of people living at the home. There were people at the home that had experienced issues with substance misuse, and staff were not trained to support people in this area.

• The proprietor had not ensured that duty of candour was duly upheld in responding to concerns raised by people and their relatives. Whilst complaints records had improved one complaint had not been responded to in line with the provider’s policy.

• Improvements were still needed to ensure that people were suitably stimulated and supported to engage in a range of activities. We have made a recommendation in relation to this.

• Medicines were now well managed and people received their medicines safely.

• Any applications to deprive people of their liberty were suitably applied for and records were well kept.

• People appeared settled at the home and felt staff were kind and caring towards them.

Rating at last inspection:

• At our last inspection the home was rated ‘Inadequate’. (Report published 01 February 2019)

Why we inspected:

• All services rated "Inadequate" are re-inspected within six months of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received, and check whether they had complied with their improvement plan following the findings at our last inspection.

Enforcement:

• The service continued to meet the characteristics of Inadequate in the key question of well-led. It met the characteristics of Requires Improvement in safe, effective and Good in caring. We are taking enforcement action and will report on this when it is completed.

Follow up:

• Following the inspection, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety

of the service improves.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

For more details, please see the full re

The last inspection took place on 28 July 2017 and was unannounced. This inspection took place on 11 September 2018 and was unannounced.

Rosemanor Hopton 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.

Rosemanor Hopton accommodates up to 17 people in one adapted building. At the time of our inspection 13 people were residing at the home. People primarily presented with mental health issues, and each person had their own room.

When we completed our previous inspection on 28 July 2017 we found concerns relating to people’s involvement in decisions about their care. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Responsive. Therefore, for this inspection, we have inspected this key question and also the previous key question to make sure all areas are inspected to validate the ratings.

At the last inspection we found breaches of the regulations in relation to safe care and treatment, person-centred care, staffing, premises and equipment and good governance. 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 safe, effective, caring, responsive and well-led to at least good.

At the last inspection on 27 July 2017, we asked the provider to take action to make improvements to the premises, and this action has been completed.

At this inspection of 11 September 2018 we found the service continued to be in breach of the regulations in relation to safe care and treatment, person-centred care, staffing and good governance. In addition, we also found a breach of the regulations in relation to complaints. The provider had not taken appropriate action to improve the quality of the service, and continued to be in breach of the regulations.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager 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.

The registered manager did not have day to day oversight of how the home was run, as well as finding multiple breaches of the regulations at this inspection. Compliance audits were not effective in driving improvements across the service.

Staffing levels were not appropriate to meet the full needs of people living at the home. Appropriate records were not kept of incidents and accidents, and the full investigations into them. People’s risk assessments were not clear in defining appropriate action to be taken to help mitigate any potential risks. The administration of medicines was not safe, nor were medicines always securely stored.

Applications to the Deprivation of Liberty Safeguards (DoLS) were not made in a timely manner. People did not always receive person centred care that reflected their preferences. There was not always sufficient information to guide staff to support people effectively. The provider was unable to provide full records of complaints received and appropriate action was not always taken to remedy issues raised.

Staff did know the steps to take to safeguard people from abuse, and improvements had been made t

We carried out an unannounced inspection of Rosemanor-Hopton on 28 July 2017. This was the first inspection of the service since it was transferred to a new provider in March 2016.

Rosemanor-Hopton is registered to provide accommodation for a maximum of 17 adults who require nursing or personal care. At the time of our inspection, Rosemanor-Hopton was home to 16 male adults with mental health difficulties.

There was 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. The service was being managed day-to day by a manager who had been appointed three weeks before our inspection.

The home is situated in a residential road close to Streatham High Road with access to good transport links and a variety of shops. The home was of a suitable layout for the people living there but needed to be refurbished.

People were not adequately protected against the risk and spread of infection because the provider did not have effective systems in place to ensure that an appropriate standard of hygiene and cleanliness was maintained. The communal areas of the home were visibly unclean.

People felt safe living in the home and staff knew how to report any concerns. However, people were not always protected as they could be against the risk of avoidable harm because the provider did not have appropriate arrangements in place to ensure that risks to people were adequately assessed and managed. Furthermore, staff were not always aware of the content of people's risk management plans.

People received their medicines as prescribed and there were appropriate arrangements in place for ordering, storing, recording and disposing of people's medicines.

People were satisfied with the quality of their meals and told us they had a sufficient amount to eat and drink. Staff worked with external healthcare professionals to support people to maintain good health.

The provider used effective and safe staff recruitment procedures which were consistently applied. The provider did not offer newly appointed staff an appropriate induction and this affected their ability to provide effective care.

There was a sufficient number of staff to meet people's needs. People were complimentary about the staff. Staff respected people’s privacy and interacted with people in a caring and respectful manner. However, people were not as involved in their care planning as could be and the care people received was not personalised.

Improvements were required to ensure the service was well-led. The registered manager and provider did not have effective quality assurance systems in place to assess and monitor the quality of care people received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to people being at risk of avoidable harm; people not being protected from the risk and spread of infection; staff not receiving an appropriate induction; the lack of person-centred care and the lack of effective systems to assess and monitor the quality of care people received.

You can see what action we asked the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.