About the service:

Rosenmanor 1 is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate and provide support for up to eight people in one adapted building. At the time of our inspection seven women with mental health care needs were using the service.

People’s experience of using this service:

People’s experiences of using this service has deteriorated since their last CQC inspection. The overall rating for this service has therefore changed from ‘Good’ to ‘Requires improvement’.

This was because we found the provider had failed to ensure: medicines records were always appropriately maintained; records were always accessible to people authorised to see them; all the issues we found during our inspection had been picked up; staff had received basic life support training; and, the kitchen had been kept in a good state of repair and the garden clear of rubbish.

The negative points described above notwithstanding people using the service, their relatives and professional representatives told us they were satisfied with the standard of care and support provided by Rosenmanor 1.

The service had safeguarding procedures in place and staff had a clear understanding of these procedures. Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met. Appropriate staff recruitment checks took place before new staff started working for the service. There were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of the spread of infection.

Staff had the right mix of knowledge, skills and experience required to meet people’s needs. Staff routinely sought the consent of the people they supported ensuring they had maximum choice and control of over their lives. People were supported to maintain a nutritionally well-balanced diet. People received the support they needed to stay healthy and to access physical and mental health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff met people’s spiritual and cultural needs and wishes. People were encouraged and supported to develop their independent living skills. Assessments of people’s support needs were carried out before they started using the service.

People’s care plans developed from these assessments were personalised and routinely reviewed to ensure they remained up to date. People had been consulted about their support needs and involved in helping staff develop their care plan. People were supported to participate in meaningful activities at home and in the wider community that reflected their social needs and interests. People were supported to maintain relationships with their relatives and other people that mattered to them. People's concerns and complaints were dealt with by the provider in an appropriate and timely way. People’s end of life care wishes were recorded in their care plan.

Management support was available for staff when they needed it. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives, professional representatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

Rating at the last inspection:

At the last inspection the service was rated ‘Good’ overall (Report was published on 27 November 2018).

Why we inspected:

This inspection was brought forward by 24 months due to information of concern we received from an anonymous source concerned about the health, safety and welfare of people using the service. The

This was an unannounced comprehensive inspection which took place on 5 November 2018.

People living at Rosenmanor 1 received personal care and support as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rosenmanor 1 is a rehabilitation service that provides accommodation and rehabilitation support for eight women with mental health care needs. The service specialises in helping these women develop the necessary skills to move onto more independent living. There were eight, mainly younger women living at the home at the time of this inspection.

The service continues to have the same registered manager who is also the owner of Rosenmanor Limited and the registered manager for all four of this provider’s mental health care services in South London. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. Rosenmanor 1 also continues to have a service manager who is based at the where they permanently work.

At our last inspection of the service in October 2017, we rated them ‘Requires improvement’ overall and for the two key questions ‘Is the service effective’ and ‘well-led’. This was because the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the CQC without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service. In addition, although most people felt Rosenmanor 1 was a comfortable place to live much of the home’s physical environment, furniture, soft furnishings, interior décor and surrounding grounds were not particularly well-maintained. We discussed these environmental issues with the registered manager who agreed the premises at that time were in urgent need of some refurbishment.

At this comprehensive inspection we found the provider had taken appropriate action to address all the issues we identified at their last inspection and improve the premises and their arrangements for notifying the CQC about significant incidents involving the people living at the home. Consequently, we have improved their overall rating from ‘Requires Improvement’ to ‘Good’ and for the key questions, ‘Is the service effective?’ and ‘Is the service well-led?’. The ratings for the other three key questions, ‘Is the service safe, caring and responsive?’ remains ‘Good’.

People told us they continued to be happy with the care and support they received at the service. We saw staff continued to look after people in a kind and respectful way. Staff had clearly built up a good rapport and working relationships with the people they supported. Our discussions with people living in the home and their professional representatives supported this.

There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people's safety in a way that considered their individual needs and wishes. Recruitment procedures were designed to prevent people from being cared for by unsuitable staff. There were enough staff to keep people safe. The environment was kept hygienically clean and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene. Managers and staff routinely carried out health and safety checks on the premises. Medicines were managed safely and people received them as prescribed.

People said Rosenmanor 1 was now a more comfortable place to live. People were

Rosenmanor 1 is a rehabilitation service that provides accommodation and support for eight people with mental health needs. The service specialises in helping mainly younger women with mental health needs develop the necessary skills to move onto more independent living. There were eight women living at the home at the time of this inspection.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was also responsible for managing the providers three other mental health services also located in South London.

At our last CQC comprehensive inspection of Rosenmanor 1, which we carried out on 26 January 2016, we rated the service ‘Good’ overall and for the five key questions ‘Is the care home safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led’. This was because we found the service was meeting all the regulations and fundamental standards we checked.

At this inspection we found the provider to be in breach of a regulation and some of the fundamental standards. Consequently, we have now rated the service ‘Requires Improvement’ overall and for the two key questions Is the service ‘effective’ and ‘well-led’. This was because the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the CQC without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service. This meant we did not know what action the provider had taken to keep people safe and mitigate the risk of similar incidents reoccurring.

This failure represents a breach of Care Quality Commission (Registration) Regulations 18 (Notifications of other incidents) 2009.

You can see what action we told the provider to take at the back of the full version of the report.

In addition, although most people felt Rosenmanor 1 was a comfortable place to live much of the home’s physical environment, furniture, soft furnishings, interior décor and surrounding grounds were not particularly well-maintained. We discussed these environmental issues with the registered manager who agreed the premises were in need or urgent refurbishment. Progress made by the provider to achieve this stated aim will be assessed at the service’s next inspection.

The issues described above notwithstanding people told us they remained happy with the standard of care and support they received at the home. We saw staff looked after people in a way that was kind and respectful. Our discussions with people living in the home, their relatives and mental health care professionals supported this.

People continued to be safe at the home. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs and food preferences. They also received the support they needed to stay healthy, emotionally and physically, and to access healthcare services.

Staff treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their

This unannounced inspection took place on 26 January 2016. Rosenmanor 1 provides personal care and accommodation for up to eight people with mental health needs. Six people were using the service at the time of the inspection.

The service has 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 previous inspection of the service took place on 6 September 2013. The service met all the regulations we checked at that time.

People told us they were happy at the service. They told us staff knew them well and they were friendly and helpful. Staff upheld people’s rights and dignity and treated them with respect. Staff asked and received people’s consent prior to providing support. People received support to promote their independence.

People were protected from the risk of abuse and neglect. Staff identified risks to people’s health and ensured they followed guidance provided to keep them safe. People had always received their medicines safely as prescribed. There were enough staff to meet people’s needs.

Staff assessed people’s individual needs and supported them as indicated in their care plans. People received support in line with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards. Staff knew people’s interests and preferences and supported them in line with these.

People liked the food provided at the service and the choice offered. People told us they had sufficient food to eat.

People received appropriate support for their health and care needs. The service worked constructively with health professionals to promote people’s mental health and physical well-being. Staff promptly sought guidance from the community mental health team (CMHT) when people’s mental health declined and followed the advice given.

The registered manager checked the quality of the service and made improvements if necessary. Staff received appropriate support and training to carry out their jobs.

The registered manager had investigated and resolved complaints in line with the service’s procedures. People contributed their views about the service and their concerns acted on. People had individual recovery plans which identified what care and support they required from staff and how it should be delivered.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People using the service told us that the service at Rosenmanor 1 had improved because they could use the kitchen, lounge and garden at all times, both day and night and they had been offered a key to the front door.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person using the service told us that they found it useful to talk to the staff and make plans with them.

People were protected from the risks of inadequate nutrition and dehydration and had been involved in planning menus that suited their cultural needs and personal preferences. People using the service told us the food had been either "Good" or "OK".

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People using the service told us that their bedrooms were warmer and they were satisfied with the home environment.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. People told us that staff responded to any concerns they raised.

We found that people's care and support needs were assessed before they moved to Rosemanor 1. This meant that the provider assured that they could meet a person's needs before they moved in. Arrangements for how people were to be cared for had been discussed with the person themselves so that they could contribute their views to their care plans. We found that people were being supported to maintain their physical and mental health.

Mental health professionals involved in the care of some of the people using the service told us that they were satisfied with the support provided to enable people to manage their physical and mental health care needs. However, some of these healthcare professionals had concerns about the way the support was delivered at times. For example, there were concerns that some members of staff were well-meaning but spoke without sufficient diplomacy and tact. There was also a concern that there was insufficient space at the service to support people to meet their visitors in private.

We spoke with five of the people using the service. Their comments to us included:

"I have complained about the heating and hot water but the managers don't listen to me. My room is too cold and my shower doesn't work sometimes." "I like the staff. They are good. If I have any problems I can talk to them." "I want to get up and make a drink at night sometimes but I don’t feel able to."