The inspection took place on 27 March and 4 April 2018. The first day of inspection was unannounced and the second day announced. We last inspected the home on 15, 19 and 20 December 2016. We found the provider had breached the regulations relating to safe care and treatment and good governance because the arrangements for managing medicines were not always safe. We rated the home as ‘Requires Improvement’. Following this inspection, to reflect the improvements the provider has made, we have rated the service as Good.

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 is the service safe. We found progress had been made and the provider was now meeting the regulations. In particular, medicines were administered safely and there was a structured approach to quality assurance to check on the effectiveness of medicines management.

Rosemount Care 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. Rosemount Care Home accommodates up to 60 people. At the time of our inspection there were 53 people living at the home, some of whom were living with dementia.

The home had a registered manager. 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, relatives and staff told us the registered manager was supportive and approachable.

People and relatives had positive feedback about the care provided at the home. They told us the care people received was good and staff were kind and considerate. We observed there were positive interactions between people and staff.

People, relatives and staff told us the home was safe.

There were sufficient staff on duty to meet people’s needs. People told us staff responded as quickly as they could to their requests for assistance. We noted staff were visible around the home and available to support people when needed.

Staff had a good understanding of safeguarding procedures and the provider’s whistle blowing policy. They knew how to raise concerns and told us they would not hesitate to do so if they were concerned about people’s safety.

The provider followed the agreed local safeguarding procedures when dealing with safeguarding concerns. Previous concerns had been fully investigated involving advocates when needed.

There were effective recruitment processes to help ensure new staff were recruited safely.

Health and safety checks were completed and risks were assessed to help maintain a safe environment. Personalised evacuation plans were written to help ensure people received the support they needed in an emergency.

Management supported staff well and staff received the training they needed. Records confirmed training, supervisions and appraisals were up to date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people to meet their nutritional and healthcare needs. We saw people received support with eating and drinking in line with their needs. Care records showed people had input from a range of health care professionals.

People’s care plans were accurate and contained personalised information which reflected their particular circumstances.

Previous complaints had been fully investigated and resolved in line with the provider’s complaint procedure.

There were opportunities for people, relatives and staff to provide feedba

Rosemount Care Home is a residential care home based in Whitley Bay, North Tyneside which provides both nursing and personal care for up to 60 older people. People are accommodated over one floor; there is a mixed residential and nursing care unit and in addition, a unit for people living with dementia. There were 53 people in receipt of care from the service at the time of our visit.

At the time of our inspection there was a registered manager in post, who had been in post since September 2016 and registered with the Commission to manage the carrying on of the regulated activities since October 2016. 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.

Our first comprehensive inspection of this service took place in May 2015 where we identified the provider was in breach of multiple regulations of the Health and Social Care Act 2008. The provider achieved compliance with legal requirements following subsequent inspections in December 2015 and April 2016, as they had taken steps to make the necessary improvements.

This inspection took place on the 15, 19 and 20 December 2016 and was unannounced. The inspection team consisted of one inspector. It was carried out in line with re-inspecting timeframes based on the rating allotted to the service following our last inspection.

At this inspection we found improvements to the service overall had been made and there was a positive feeling amongst people, relatives and staff about the home and service delivered. However, we found some shortfalls did exist.

People were complimentary about the service and told us they felt safe living at the home. Their relatives told us they had not seen anything of concern about how people were treated when they visited the service. People were supported appropriately with their mobility and staff adopted safe practices when assisting them. However, we found shortfalls with the management of medicines that put people's health and wellbeing at risk. Stocks of medicines were not well managed and several people did not have their prescribed medicines available to them. Recording around the administration of medicines was also not robust.

Risks that people were exposed to in their daily lives because of their physical and mental health conditions had been assessed and measures were in place to minimise people's exposure to risk. Environmental risks had been appropriately assessed and these were regularly reviewed. Checks on equipment and the premises were carried out regularly. Accidents and incidents were recorded and monitored for any emerging patterns and trends so that preventative measures could be put in place where needed. Emergency planning had also been considered and guidance was in place for staff to follow about how to support people in the event of, for example, a fire or flood.

Safeguarding policies and procedures were in place and records showed that historic safeguarding matters had been referred to the local authority safeguarding teams in line with protocols. Staff were aware of their own personal responsibility to report matters of a safeguarding nature in order to protect vulnerable people from harm or abuse.

Recruitment procedures were robust and staffing levels at the time of our inspection were appropriate to meet people's needs. Staff had been trained in key areas relevant to their roles and also in specific areas related to the needs of the people that they supported. Staff supervisions, appraisals and competency assessments were carried out regularly to ensure that staff remained competent in their roles and that they were fully supported to deliver good standards of care.

Staff and people enjoyed good relationships. People and their rela

We carried out an unannounced comprehensive inspection of this service on 28 and 29 April 2015 and 2 May 2015, at which five breaches of legal requirements were found. We undertook a further inspection of the home on 9, 10 and 17 December 2015 to check if improvements had been made to the delivery of care. Whilst we found there had been some improvements, we found two continuing breaches of regulations. These related to staffing and good governance. We took enforcement action against the provider and issued warning notices in respect of these two regulations. We carried out an additional unannounced inspection of the home on 27 April 2016 to check that the required improvements had been undertaken.

This report only covers our findings in relation to these regulations and the domain areas in which they are reported. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Rosemount Care Home’ on our website at www.cqc.org.uk’

Rosemount Care Home is registered to provide accommodation for up to 60 people. At the time of our inspection there were 45 people using the service, some of whom were living with dementia.

At the time of our inspection there was no registered manager in place at the home. 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. A manager was overseeing the running of the home and had been in post for approximately four weeks. She had previously been the registered manager of one of the provider’s other homes. She stated that she was in the process of starting a formal application to register with the CQC. We have written to the provider to remind them that a registered manager is required as part of their registration requirements.

People told us that staff were still busy, but that they did not have to wait long for care or support. Staff were more visible around the home and available to check on the safety of people throughout the day. Call bells did not ring for long periods and call bell records did not show significant time elapsing before bells were answered. Additional nursing staff had been recruited and there was reduced use of agency nursing staff. Sufficient care staff were rostered to work, although short term sickness remained an issue. Action was being taken to further address sickness and support staff.

Records had improved. Documents related to the Mental Capacity Act and best interests decision making had been reviewed and updated. Records related to the application of topical medicines were up to date. Daily record completion had improved and showed only minor gaps or omissions.

This meant the provider had met the requirements of the warning notices issued. We have not changed the ratings we gave in these domains following our comprehensive inspection in April/May 2015, as we wish to be assured that the changes instigated to date will be sustained in the long term.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• 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 –

Is the service caring?

We saw people's needs were assessed and care was planned in line with their assessed needs. We found specific care plans were in place in relation to areas such as mobility, nutrition and skin integrity and monthly reviews had been undertaken.

People we spoke with told us that they were happy with the care they received. People’s comments included, “I think everything is alright. I have been here quite a while now and wouldn’t stay if it wasn’t”; “It couldn’t be better”; “I’m quite happy here. The staff are good. I am well looked after.”

Is the service responsive?

We spent time observing care at the home and how staff responded to people’s needs. We saw that staff responded in an appropriate and timely fashion. Staff were supportive, considerate and sympathetic to people’s individual needs. We saw that call buzzers were responded to within an appropriate timescale. Additional advice from other professionals was sought to ensure appropriate care was provided.

One person told us, ““It couldn’t be better. The staff are nice and pleasant. If I press the buzzer they come in a reasonable time.” One staff member told us, “They are all individuals and they all need individual help.”

Is the service safe?

People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were stored and administered safely and medicine administration records were held securely.

Is the service effective?

We observed that staff supported people, where they were unable to eat or drink for themselves. We saw that this support was provided on a one to one basis and that staff engaged with people during the meal time; asking them if they wanted more food, a drink or generally conversing with them.

We saw there was a record of what people had eaten or drunk and a note made of their weight. Where there were concerns that perhaps weight was being lost, then action or advice was taken.

Is the service well led?

In this report the name of a registered manager appears who was not in post at the time of the inspection. Their name appears because they were still the registered manager on our register at the time of the inspection.

The acting manager showed us that a range of checks and audits were now in place to ensure that care was effectively delivered. We saw that care plans and medicines had been audited and changes made where necessary.

There had been one staff meeting and a "residents’/ relatives’" meeting. We saw that suggestions from the meeting had been taken forward and a radio provided for people to listen to.

The acting manager had in place a process to ensure that all staff working at the home had regular supervision sessions and annual appraisals.

We spoke with 14 people and six relatives about their experiences of the care and support they received. We also spoke with the manager and four staff.

People and staff told us that consent was gained before care was delivered and we found that the provider acted in accordance with people's wishes.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people looked clean and well cared for.

There were enough qualified, skilled and experienced staff to meet people's needs. One person said, "I can't complain, the staff are always there to help when I need them."

The provider had effective systems to regularly assess and monitor the quality of service that people received.

During our inspection we looked at the care records for five people. We found care records contained accurate and appropriate information and could be accessed in a timely manner.

At the time of the inspection there was no registered manager but the person in charge was in the process of submitting an application to become registered.

Many people were unable to tell us their experiences owing to the nature of their illness and some others were asleep during our visit. We spoke with three people who lived in the home. They told us they had no complaints regarding their care as the staff were very attentive. They said the home was clean, comfortable and their bedrooms were always clean and tidy. Comments included, "It's a very good home, I like it here" and "My bedroom is kept spotless, the staff work very hard."

The domestic staff on duty at weekends had been increased from one to two staff. This meant there were enough domestic staff on duty to ensure the home was kept clean and tidy at all times.

We looked around the communal areas in the home and three bedrooms. These were clean and free from preventable malodours.

We looked at the records for five people who lived in the home and found these were up to date and provided staff with up to date information about how individual needs should be met. This meant that people were protected from unsafe and inappropriate care.

Fifty seven people were using this service at the time of our inspection. We spoke with five of them about their experiences of the care and support they received. We also spoke with relatives of another four people, and we spoke with the manager and six staff.

Relationships between staff and people were clearly good. People told us staff treated them with respect and helped them to remain as independent as possible.

People we spoke with were positive about the care and support they received. Comments included, “The care is good; staff look after me properly” and “It’s got everything I need.” Relatives told us, “The care is smashing, first class” and “It’s a care home with a capital C.”

We found there were infection control systems in place and, in most cases, we found these were adhered to.

We found there were suitable numbers of skilled, qualified and experienced care staff on duty but there were not always sufficient domestic staff.

People and relatives told us they felt comfortable approaching the staff, or the manager, if they wanted to discuss any concerns and we found there were systems in place to assess and monitor the quality of the service.

We carried out an unannounced comprehensive inspection of this service in April and May 2015, at which five breaches of legal requirements were found. These related to person centred care, safeguarding, safe care and treatment, good governance and staffing. At the time of the inspection the home was under organisational safeguarding. Organisational safeguarding means that the local authority regularly monitored the practices and delivery of care at the home because of concerns about people’s safety.

After the comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches. We undertook a focused inspection on 9, 10 and 17 December 2015, which was unannounced, to check that they had followed their plan and to confirm that they now met legal requirements.

You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for ‘Rosemount Care Home’ on our website at www.cqc.org.uk’

Rosemount Care Home is registered to provide accommodation for up to 60 people. At the time of our inspection there were 48 people using the service, some of whom were living with dementia.

There was a manager in post who had been at the home since May 2015. However, they had not formally registered with the CQC. 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. We reminded the manager and the provider of the legal requirement for the service to have a registered manager in place as soon as possible.

Staff and people using the service told us they felt more staff were required to meet people’s needs. Visiting professionals told us they often found it difficult to locate staff because they were so busy. Records showed that call bells were sometimes not being answered in a timely manner and occasionally rang for over 10 minutes. People said staff did not always have time to talk with them and they sometimes found it difficult to be supported with baths and showers. Staff said that if two staff were supporting a person, this could leave just one care worker available to support other people in their particular area of the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

The manager had submitted DoLS applications to the local authority for authorisation in line with legal requirements. Records showed that whilst consent was sought from people and documentation was completed to review certain aspects of care, the capacity of people to consent was considered, but not always clearly documented to demonstrate the Mental Capacity Act (2005) (MCA) was applied appropriately.

People and their relatives told us they felt safe at the home. Staff were aware of the need to protect people from abuse. They told us they had received training in relation to safeguarding adults and were able to describe the action they would take if they had any concerns. They told us they would report any concerns to the manager or the nurse in charge. The registered provider monitored and reviewed accident and incidents.

Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home. We found medicines were appropriately managed, recorded and stored safely. Topical cream records were not always completed fully.

Staff said they felt they had the right skills and experience to look after people. They confirmed they had access to a range of training and training was updated where necessary. Staff told us, and records confirmed regular supervision took place and that they received annual appraisals.

People’s comments about the food they were served were variable. Some people indicated the food was good whilst others felt there were areas that could be improved. We observed meal times and saw food was generally of a good standard, looked appetising and was hot. Kitchen staff demonstrated knowledge of people’s individual dietary requirements and current guidance on nutrition. The social aspect of meal times was not always considered as staff did not always converse with, or direct people appropriately.

People and their relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. They were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. We observed staff supported people in a caring and appropriate manner and with dignity and respect.

Care plans reflected people’s individual needs and were reviewed regularly to reflect any changes required. We saw a range of activities were offered, including craft classes and other events, such as a seasonal carol service. Some people said they would like more trips out.

People told us they were aware of the complaints process and could raise issues if they had concerns. Formal complaints had been dealt with effectively and appropriately.

The manager had instigated checks on people’s care and the environment of the home. She confirmed the regional manager also carried out regular audits. Records were not always up to date and accurately kept. We found gaps in records related to topical medicines and the delivery of personal care. Management audits had not identified issues related to the recording of effective best interest assessments and decision making. Information about people’s history and backgrounds was not available in care records for staff to reference.

The majority of staff felt the manager was accessible and supportive. They also felt the deputy manager was helpful and caring. Staff and professionals told us the home was improving although communication systems needed to develop further. There were regular meetings with staff and relatives of people who used the service, to allow them to comment on the operation of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to good governance and staffing.