This inspection took place on 18 October 2017 and was unannounced. A second and third day of inspection took place on 19 and 25 October and these dates were announced.

Rosewood House is a residential home which provides nursing and personal care for up to 78 people. At the time of our inspection there were 74 people living at the home, some of whom were living with dementia.

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 (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 last inspected this service in August 2015 when an overall rating of 'Good' was awarded. At this inspection we found the service remained ‘Good.’

People we spoke with told us they felt safe living at the home. Relatives we spoke with all said they felt their family members were safe. Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

The arrangements for managing people's medicines were safe. Medicines were stored securely and medicine records were up to date with no gaps or inaccuracies.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Although people's needs were met in a timely manner, we have made a recommendation about staffing levels and the deployment of staff. This was because we noted that a high number of people who used the service had complex needs both in relation to dementia and general nursing needs, and some people and staff we spoke with felt more staff would be beneficial.

Risk assessments about people’s individual care needs were in place, for example in relation to falls, pressure damage and nutrition. Control measures to minimise the risks identified were set out in people's care plans for staff to refer to. Each person had a personal emergency evacuation plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

People had 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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

Staff received regular supervisions and appraisals and staff training in a range of key areas was up to date.

Staff spoke with people in a kind, caring and respectful way. People’s individual choices were sought and respected.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members, staff and visiting health and social care professionals

People were given all the information they needed to make an informed decision about their care and were asked to provide their consent to such care. We saw people were cared for effectively and care was planned for the individual.

People were provided with a suitable choice of food and drink.

Staff were supported in their role and were suitably qualified and experienced.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

People who used the service were positive about the care and support provided. Comments included “It is very good here. They look after you very well” and “It’s so good it’s like a hotel”.

We were able to speak with people at each of our visits.

The majority of people who were able to express an opinion told us they were happy and were well cared for.

One person was dissatisfied about the way staff were dealing with his continence needs.

Positive comments included, “I’m happy with everything here”; “It’s a pleasant place to live”; “The staff are kind and always friendly” and, “They are always patient and careful when helping me”.

People using the service and their visitors were complimentary about the care and support they received at the home. They told us, “We are happy with the care here”; “I can’t fault anything, the staff are wonderful”; “The residents with dementia receive good care”; and, “Staff are friendly and kind”.

People using the service gave positive comments about the care provided and said that staff were kind and understood their needs. They also told us that they enjoyed the food.

People using the service told us they were satisfied with their care and support and the accommodation. They said their individual needs were met and gave positive comments about how they were treated by staff and the quality of the service.

This was an unannounced inspection which took place over two days, 21 and 22 April 2015. The last inspection took place on 3 July 2013. At that time, the service was meeting all the regulations inspected.

Rosewood House is a three storey home for up to 78 people in a residential area in Gateshead. The service is primarily for older people, some of whom may have a dementia related condition. It is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury.

Rosewood House has a registered manager who has been in post since 2010. 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 home was warm, clean and had comfortable communal areas. There was some building work going on at the top floor, but this had been managed well to reduce noise, mess or risk to people using the service. There were sufficient staff, with different skills and qualifications on each of the three floors to meet the different needs of the people there.

People told us they felt safe, being cared for by staff who knew them well. Staff told us they knew how to raise concerns and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Rosewood House and the home was welcoming and had a family atmosphere.

We saw that risks to people, such as malnutrition and skin integrity, were risk assessed and care plans were in place to protect people from harm. Where people’s needs changed we saw that referrals were made, with advice from professionals integrated quickly into the care plans.

We saw that nursing and care staff, as well as other staff, were effectively deployed to meet the needs of people. Staff were trained so that they could work flexibly with different people and were deployed so that at peak times there was sufficient staffing. An example being the use of domestic staff to assist at breakfast on the top floor.

We saw that people’s medicines were managed safely; stock control and ordering were managed by trained staff with checks to ensure that the risk of errors were minimised. Audits were carried out regularly to ensure that staff were competent and that any errors would be quickly identified.

We saw that care was effective, that people received care based on best practice and the advice of professionals. Care plans were detailed and personalised. People’s consent was sought, where this was possible. Where people could not consent, their care was delivered in their best interests after consultation with family and professionals. One person told us “The girls look after you as if you were one of their family.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. There were a number of people subject to DoLS and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals of authorisation were requested promptly.

Staff were recruited robustly and trained based on the needs of people using the service. People were involved in the recruitment of new staff to the home. Staff had undergone an induction period and their mandatory training was up to date. We saw that staff were also being trained in ‘Dignity in Care’ and dementia awareness.

People were supported to eat and drink and maintain a balanced diet. We saw staff supporting people with mealtimes in a dignified way, and the service monitored people’s weights and took further action if needed. We spoke with a number of visiting health professionals who told us the care and support offered was effective. We saw evidence in records of health professionals’ advice being sought by staff, and then acted upon.

We saw that care was positive and that there were good relationships between people and staff. All staff we spoke with knew people’s needs well and spoke about them in a positive manner. A relative told us “All the staff know you and always ask how you are”. We saw that people and their families were encouraged to express their views and be actively involved in making decisions about their care and support. We saw evidence of people’s involvement in their admission and review of care, as well as records of house meetings and feedback surveys.

People’s choices and rights were respected, we saw staff knocking on doors before entering, offering people choices and looking at alternatives if they were requested. People were encouraged to be part of their community and continue relationships and activities that were important to them, such as voting in the upcoming general election.

We saw, in records of where people had complained or raised queries about the service, that the registered manager responded positively to these and people were satisfied with the outcomes.

Throughout the visit we saw staff and people responding to each other in a positive way. People were engaged in meaningful activity with staff support, and staff took the time to talk to people as they were carrying out their duties.

The registered manager had taken steps to ensure that the service ran effectively. There was evidence of regular meetings between teams within the home, of sharing information and of responding to need. There was evidence of regular audits and action being taken where incidents occurred or where improvements could be made. Visiting professionals all rated the registered manager highly and felt the staff team reflected their values and ways of working, where the person is at the centre of the care.