The inspection visit at Rossendale took place on 23 May 2018 and was unannounced.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 25 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

Rossendale is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which we looked at during this inspection.

A registered manager was in place. 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.

At our last comprehensive inspection of Rossendale on 18 and 19 January 2017, we rated the service as Requires Improvement. This was because the home was in the process of making ongoing improvements, which required time to embed, in service management, responsiveness, effective care delivery and people’s safety. We additionally found a breach in legal requirements because the provider had failed to manage people's medicines with a consistently safe approach. The review, storage and auditing of medication was poor. We undertook a focused inspection on 13 September 2017 to follow-up on our findings and observed the registered manager had improved processes and procedures in relation to medication administration. They demonstrated they were meeting the requirements of the regulations.

During this inspection, we found the premises and environment were not always suitable for people who lived with dementia to best optimise their wellbeing. For example, there were no table items to promote a positive meal experience and environmental distraction and sensory equipment was limited. The management team assured us they were purchasing and replacing equipment to improve people’s lives. We will review ongoing developments at our next inspection.

We have made a recommendation the provider seeks guidance about the provision of a dementia-friendly environment.

People we spoke with told us they received their medicines on time and as required. Care files we reviewed contained a medication care plan and risk assessment to guide staff about the individualised and safe approach to each person’s administration.

We observed call bells were responded to in a timely way and people did not have to wait long for assistance. Those who lived at the home told us staffing levels had improved to better meet their requirements. The previous management team had not always confirmed staff were suitable and safe in their former employment. However, we noted the new registered manager was introducing a system to prevent this from happening again.

The local authority’s safeguarding policy and procedures were on display in the lobby of Rossendale. This gave people who lived at the home, visitors and staff information about who to report concerns to.

The registered manager completed risk assessments to guide staff about the mitigation of risk to people who lived at Rossendale. We saw completed accident forms with clear documentation about any injuries and measures introduced to reduce their reoccurrence.

To enhance evidence-based practice, the management team provided staff with a training programme they were required to complete. One staff member commented, “Staff training and all policies are always available.”

People were supported to have maximum choice and control of their lives an

We carried out an unannounced comprehensive inspection of Rossendale on 18 and 19 January 2017. At which a breach of legal requirements was found. This was because the provider had failed to manage people's medicines with a consistently safe approach. The review and check of the health and medication of people diagnosed with medical conditions was poor. We saw controlled drugs were not stored as defined in the Misuse of Drugs Act 1971 (Regulations 2001). At our previous inspection on 15 June 2016, we made a recommendation about the safe storage of creams and ointments. We found this had not been addressed at the inspection on 18 and 19 January 2017. Prescribed fluid thickening powder was left unattended.

After the comprehensive inspection in January 2017, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 13 September 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Rossendale Nursing Home’ on our website at www.cqc.org.uk.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 19 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

During this inspection, we found the registered manager was improving processes and procedures in relation to medication administration. This included the implementation of an entirely new system of storage, documentation and oversight. We saw medicines, including controlled drugs, food thickening products and creams, were consistently stored securely.

Staff who administered medicines received medication training. The management team set up two files with information, guidance and policies to underpin staff skills and understanding. We observed the nurse administered medication carefully and followed each person’s associated care plan. New forms and documents had been introduced, such as monitoring charts and risk assessment, which we found staff had fully completed.

The management team undertook regular audits of all medicines and related general procedures. We saw evidence to show action was taken where issues were identified, such as missing signatures on associated records. The registered manager told us, “Where a staff member is omitting signatures on charts, we will discuss this with them as part of their supervision.” The management team worked with the local authority to improve medicines procedures. This showed the registered manager had good oversight systems and worked with other organisations in the improvement and safe administration of people’s medicines.

The inspection visit at Rossendale Nursing Home was undertaken on 18 and 19 January 2017 and was unannounced.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 19 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

A registered manager was in place. 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.

At the last inspection on 15 June 2016, we rated the service as Inadequate and placed it in Special Measures. This was because breaches of legal requirements were found. The provider failed to ensure the environment was safe. They had not always assessed risks to people's health and safety. The provider had not done everything reasonable to mitigate risks, such as maintaining good infection control practices. They had not safeguarded them from abuse and improper treatment. People who lived at the home did not always have comfortable, well-maintained accommodation. Care plans had not been designed to reflect individual needs and people were not always treated with dignity and respect. Signed consent to care was not consistently obtained. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed. The registered person had not implemented effective systems to assess, monitor and improve the quality and safety of the service provided. They did not have thorough recruitment processes to safeguard those who lived at the home from the employment of unsuitable staff.

We additionally made recommendations for the provider to further improve people’s safety and welfare. These concerned tools to enhance safe medication recordkeeping, providing more personalised activities and the management of complaints.

During this inspection, we found the provider had made a number of improvements following our last inspection. They worked transparently and collaboratively with local authorities, staff, people who lived at the home and relatives as part of their improvement requirements. The management team enabled everyone at Rossendale to feel a part of the improvement drive. One staff member said, “It was a good home and I want to help it get back to what it was.”

When we discussed safeguarding principles with staff, they demonstrated a good understanding of related principles. Training records we looked at confirmed they had completed relevant training. The provider was implementing new risk assessments and related procedures to protect people from an unsafe environment and inappropriate care. This included fire safety procedures and up-to-date evacuation plans for those who lived at Rossendale in the event of a fire. The home was clean and tidy. The provider had introduced a number of systems to maintain good infection control standards.

The provider had commenced an audit form to check recruitment processes were completed. They had carried out mandatory checks of each employee and their practice requirements to recruit suitable staff. We further noted staffing levels and skill mixes were adequate and deployed well.

We found the management team had implemented regular supervision sessions and a wide range of training to improve staff skills. They underpinned this by assigning staff as champions in a variety of specialist areas, such as health and safety, infection control and dignity in care.

However, we found concerns with how people’s medicine

This comprehensive inspection was unannounced, which meant the provider did not know we were going to visit the home. It was conducted on 14 and 15 June 2016.

The Rossendale Nursing Home is registered to provide personal and nursing care for up to 27 adults, including those who are living with dementia. The home is a detached Victorian property situated in a residential area and within easy reach of shops and local amenities. A small number of double rooms are available for those who wish to share facilities. Communal areas consist of three lounges and a separate dining room. Parking spaces are limited, but on road parking is permitted in the surrounding area.

The last comprehensive inspection of this service was conducted on 25 January 2016, when improvements were identified as being required in relation to cleanliness and infection control, safety, the management of medicines and monitoring the quality of service provided. These shortfalls were incorporated in the planning of this inspection.

At this inspection we identified numerous areas where improvements needed to be made, which are detailed within each relevant section of the report.

People who lived at Rossendale Nursing Home were not adequately safeguarded from abuse and therefore their safety was not always protected. The recruitment practices adopted by the home were not sufficiently robust, to ensure all employees were fit to work with this vulnerable client group.

We identified several areas of the home which presented potential risks to those who lived at Rossendale and therefore people were not always protected from harm.

There seemed to be sufficient staff on duty on the day of our inspection and it was observed that staff were always present in the communal areas of the home. However, people told us that there had been shortfalls in the staffing levels, but these had recently been increased. Records showed that there was a high level of agency staff used in order to maintain the current staffing levels.

The staff team had received training in safeguarding adults and whistle-blowing procedures. However, refresher training was overdue for a good number of staff members. Some records we saw, which related to people’s monies were poorly kept and did not sufficiently protect individual’s finances.

The management of medicines was, in general satisfactory. We identified a small number of areas, which could have been better. We made a recommendation that medicines procedures continue to be reviewed and improved in line with the NICE guidance ‘Managing Medicines in Care Homes.’

Some areas of the home could have been cleaner and more hygienic. Infection control practices could have been better. This constituted a continuing breach of regulation.

The risk assessment in relation to fire safety was not always being followed in day to day practice and the Personal Emergency Evacuations Plans (PEEPs) needed to be updated. We have made a recommendation about this.

Care plans did not always reflect people’s assessed needs and some information provided was vague and not specific to the care and treatment of those who lived at the home. This did not give the staff team clear guidance about how individual needs were to be best met.

Some care files reflected people’s preferences and what they liked to do and needs assessments had been conducted before people moved into the home.

Deprivation of Liberty Safeguard (DoLS) applications had been submitted, in line with the requirements of the Mental Capacity Act. Records showed that people’s mental capacity had been considered. However, the Mental Capacity Assessments were not always decision specific. Formal consent had not been obtained from the relevant people before care and support was provided.

The management of meals could have been better organised and people who required assistance could have been better supported.

The majority of staff we spoke with had a good understanding of the support people require

The Rossendale Nursing Home is registered to provide personal and nursing care for up to 27 people. Care is offered to people with physical/medical needs and with needs associated with dementia. The home is a detached Victorian property situated in a residential area and within easy reach of shops and local amenities. Accommodation is provided in nineteen single bedrooms and four shared rooms. Communal areas consist of three lounges and a separate dining room. The service had 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.

People who lived and worked at the home were fully aware of the lines of accountability at the home. Staff spoken with felt well supported by the management team, however, we believe that others who contacted us following our inspection were not. (Following our inspection visit, we were contacted by three people who we classified as whistle-blowers.) The systems operated within the home relating to how information was processed and how systems were audited needed improvement. Having robust systems in place will assist staff to identify areas of service delivery that require improvement and mitigate risks. Engagement with the staff team by the management team, in order to determine how best to resolve the issues linked to staff support, will support the processes linked to the reporting of concerns regarding quality issues.

There were systems in place to ensure people's needs were assessed, and their care planned for. Greater effort was needed to ensure that when charts and recording tools are used to monitor various aspects of people's health, these are completed in a timely manner to ensure that clear health care records are maintained. Activities linked to people's assessed needs, abilities and interests need to be improved. People were able to express their choice in relation to meals and how they spent their time. People knew how to access the complaints process, and knew who to talk to if they wanted to raise a concern.

People were treated in a kind, caring and respectful way. There were systems in place to ensure people were involved in their own care planning and support. The training records showed that staff had received awareness training on the subject of end of life care. If people were found to be in need of end of life care, there were systems in place to support this.

Staff had access to on-going training and supervision to meet the individual needs of the people they supported. However, this needed to be improved to ensure that all staff received the support they needed to ensure they could perform their role effectively. The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and depriving people’s liberty, and these were put into practice. The menu offered people a choice of meals and their nutritional requirements were met. Some areas of the building were in need of repair or renewal, and we recommend that a full review of the building takes place to ensure the environment is safe and fit for purpose.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Employees were asked to undertake checks prior to employment to ensure that they were not a risk to vulnerable people; the records relating to these checks were complete. Risks associated with medicines management, infection control and cleanliness, and environment factors were not robustly assessed. Adequate control measures were not always in place. The registered provider and registered manager needs to ensure that all people associated with the home are g