We undertook this unannounced inspection on 12 December 2016. Rosewood Residential Care Home is registered to provide accommodation and personal care for a maximum of 43 people, some of whom may have dementia. At this inspection there were 33 people living in the home.

At our last inspection on 12 August 2014 the service met all the regulations we looked at.

The care home 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People using the service and their relatives informed us they were satisfied with the care and services provided. They said they had been treated with respect and felt safe living in the home. This was reiterated by relatives we spoke with. There was a safeguarding adults policy and suitable arrangements for safeguarding people.

The premises were clean and no offensive odours were detected. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and maintenance of fire equipment. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. Window restrictors were in place.

Care workers were responsive and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and recorded. Care workers prepared appropriate care plans which involved people and their relatives. Arrangements were in place to ensure that people's special choices and preferences were noted and responded to. People’s healthcare needs were closely monitored. Care workers worked well with healthcare professionals to ensure that people’s needs were met. This was confirmed by people, relatives and a healthcare professional we spoke with. Monitoring charts were in place to evidence that allocated tasks had been carried out and care workers provided appropriate personal care.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and personal preferences were met. People were satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people who spoke with us confirmed that they had been given their medicines.

Care workers had been carefully recruited and provided with a comprehensive induction and on-going training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from the registered manager. There were enough care workers to meet people's needs. Teamwork and communication within the home were good. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity within a homely environment and providing a high quality of care.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held with people to enable them to discuss their care and the services provided. The minutes of meetings were available for ins

The inspection was conducted by one inspector over the course of seven hours. There was a new manager in place who had started in their position only seven weeks prior to our inspection and whose registration with CQC was in process. We spoke with the new manager, the Head of Care, three care workers, the Head of Housekeeping, a maintenance person, one domestic staff, six people who lived in the service and two of their relatives. We looked at six sets of records for people who used the service, eight sets of staff records files, the service's satisfaction surveys, activities programme and the service's policies and procedures.

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to residential units. We spoke with the manager and they demonstrated their knowledge of the procedures to follow if an application needed to be made to deprive a person of their liberty. We saw evidence that all staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found that risk assessments with clear action plans were in place to ensure people remained safe. Emergencies measures were in place and people who lived in the service had personal evacuation plans.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. A relative of a person who used the service said, "We cannot fault the care that is given, our family member’s needs are fully met". We saw that the delivery of care was in line with people's care plans and assessed needs. Staff‘s mandatory training was up-to-date and they received additional training when requested. Additional training included palliative care, dementia care, diabetes and mental health awareness.

Is the service caring?

We found that the people who stayed in Rosewood Residential Care Home were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. Request for assistance were responded to promptly. We saw that staff showed kindness and patience when they supported people at mealtimes or during activities. A relative of a person who used the service told us, "The staff are really caring". A person who lived in the service said, “They (staff) are like my friends they are so nice to me, they are treasures”. A member of staff said, “We know the residents well and their comfort and happiness is our priority, we are like a family”. Another told us, “I would gladly have a member of my own family staying here”.

Is the service responsive?

People's needs had been assessed before they moved into the service and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included their life history, wishes and preferences and desired outcomes to be achieved. We observed that people’s requests for help and call bells were responded to without delay and acted on. Requests that were made during residents meetings or expressed during satisfaction surveys were followed through and responsive action was taken.

Is the service well-led?

We found that the manager had accomplished a large amount of improvement in a short period of time. A member of staff told us, “We feel totally supported and motivated to do well by the manager”. The manager operated a system of quality assurance and completed audits to identify how to improve the service. Additionally, a Director of Care and a Quality Assurance Assessor carried out unannounced compliance checks and completed additional audits. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives and staff were consulted about how the service was run. Annual survey questionnaires were provided or sent and the results were analysed. A member of staff told us, "There is an open door policy, but as the manager spends as much time as they can on the floor with us and the residents we can discuss anything with them straight away".

We found that people’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

We found people did not experience care, treatment and support that met their needs and protected their rights. We spoke to people who used the service and relatives who told us they were not involved in the care planning process. Comments included “We have never been involved in care plans or reviews”.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the provider did not have effective system to regularly assess and monitor the quality of service that people receive.

We found that the provider had an effective complaints system available. Comments and complaints people made were responded to appropriately.

People we spoke to told us they liked living at the home. Comments included “I like living here” and “I am happy here”.

People we spoke to told us they were looked after at the home. Comments included “The staff are very nice, I like them”.

A relative we spoke to told us ‘I have not come across any problems and do not have any concerns, but know that I could go to the manager at any time’.

This inspection was to follow up on the findings from our previous inspection of 25 May 2012. The purpose of the visit was to assess if action had been taken in regards to concerns, which had been highlighted at the last inspection.

We found that the provider had taken action to address the identified concerns around supporting staff, so that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

This visit was to follow up the findings from our previous visit of 29 February and 1 March 2012. The purpose of the visit was to assess if action had been taken in regards to concerns, which had been highlighted at the last visit.

We spent time talking with people living in the home during this visit, however, their feedback didn’t directly relate to the outcome areas we were assessing. People indicated that they were happy living in the home.

Some of the people in the home had complex needs which meant that they were not able to tell us their views. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. The findings of our observations are included in this report.

We were unable to verbally communicate with all the people who used the service; we therefore used our observations to help inform some of our judgements. We observed positive interactions between people and staff. Observation showed that people using the service were relaxed and enjoyed taking part in activities inside the home.

We did speak briefly to some of the people who used the service and we found that people responded positively about the service and the staff. People commented that staff were “Nice” and “Very helpful”.