We completed this comprehensive inspection on 31 October and 1 November 2018. The inspection was unannounced on the first day. The service was rated Requires Improvement at the last inspection on 10 October 2017, which was an improvement from the inadequate rating of March 2017. At this current inspection, we wanted to see that improvements had been sustained. Whilst we saw that improvements had been made and sustained in most areas, there remained concerns in Effective and Well-led domains in relation to the stroke service provided to people. The service has been rated overall as Requires Improvement. This is the second consecutive time a Requires Improvement rating has been given and we will meet with the provider to discuss how improvements can be made.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Rossmore 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.

Rossmore is situated in a residential area and is several town houses linked to make one building. The service is registered to provide residential care for up to 56 people, although due to refurbishment, the number of beds had been reduced to 50. There are designated beds for stroke rehabilitation, enablement following a period of ill health or hospital admission and for permanent residency. There are bedrooms and communal space on the ground floor and further bedrooms on the upper floors. The service also has a separate building used for therapy support for people recovering from a stroke. At the time of the inspection, there were 17 people using the stroke service, 15 people admitted for support with their enablement and 11 people who lived at the service.

Whilst there were no concerns raised with care and treatment in the enablement service and the main part of the home, there were issues raised by health and social care professionals with management oversight of the stroke service. We found there was an approach to care and treatment in the stroke service that was not as effective as it could be. Staff morale was described as low and there was a lack of teamwork between care staff who worked in Rossmore and external staff who delivered therapy. There were also issues with the consistency of records and some elements of quality monitoring required improvement. Senior management were aware of the concerns and were taking steps to address them. There had been occasions when delays in preparing for weekly multi-disciplinary meetings had impacted on treatment decisions and discharge planning. We found a pressure relieving mattress was not set at the correct level and two other mattresses were displaying a fault. The issues with mattresses had not been identified by staff. Those mattresses registering a fault were addressed straight away by the deputy manager.

We found a breach in regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report. We have also issued a recommendation in Effective for the provider and registered manager to follow through with plans to improve monitoring and preparation for multi-disciplinary meetings.

Staff had completed safeguarding training and knew how to safeguard people from the risk of abuse. They knew the different types of abuse, how to recognise potential signs and symptoms and what to do if they had concerns.

People had assessments completed to identify any

This inspection took place on 10 and 11 October 2017 and was unannounced. At the last inspection in March 2017, we had concerns in multiple areas. The service was rated inadequate and placed in special measures. The provider sent us an action plan and weekly updates so we could monitor progress. At this inspection, we found improvements had been made and the service is no longer in special measures. However, we are unable to rate the service higher than ‘Requires Improvement’ overall as to do so needs evidence that improvements continue and are sustained; we will continue to monitor the service and will check out improvements at the next full comprehensive inspection.

Rossmore Nursing Home provides personal and nursing care for up to 56 people. The service is accommodated in a series of converted, large, terraced houses in a residential area of Hull, close to amenities and public transport; there is on-street parking available. The service has 17 placements for people who have had a stroke and who require therapy input to assist their rehabilitation. There is a separate building in the grounds of Rossmore Nursing Home specifically for stroke rehabilitation and an adjoining house to this has been purchased to extend the area. There are eight step-down placements for people who require an interim service following discharge from hospital until a package of care can be arranged for them in the community. The remaining 31 placements are for people who require on-going residential or nursing care. There is a large sitting room, a small seated area and a dining room on the ground floor. There is a mixture of single and shared occupancy bedrooms on the ground and first floors; the upper floors are accessed by a passenger lift, a stair lift and stairs. There are bathroom and shower facilities on both floors.

At the time of the inspection, there were 12 people using the stroke rehabilitation service, 15 people admitted for residential care and four people requiring nursing care. The hospital step-down beds had been closed to admissions since the last inspection.

The service is required to have 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. A new manager had been in post for the last few months and was undergoing registration with the Care Quality Commission; their interview was due to take place on the day of the inspection. We liaised with our registration team to rearrange the interview until a later date to ensure the manager could focus on the inspection. As the registration process has not been completed yet, the manager will be referred to throughout the report as ‘the manager’.

We found there had been improvements with the overall management of the service and also regarding governance from directors. We saw documentation which highlighted the directors had made visits to the service, spoke with staff and people who lived there, looked at records and checked on the progress of action plans. Staff confirmed management had improved and said they could raise concerns with directors if required. We found people had been informed of the changes underway and those planned for the future.

There had been a change in the structure of the therapy service, which at the last inspection was provided by staff from a local hospital trust. However, the therapy staff were now part of the provider’s organisation and measures were being put in place to begin team-building, improve communication and address the issues with disjointed working between care/nursing staff and therapy staff, which was found at the last inspection.

The quality assurance and monitoring system had improved. This consisted of audits, checks, meetings and surveys

This inspection was completed on 14 and 15 March 2017 and was unannounced. City Health Care Limited has been the new registered providers of Rossmore Nursing Home since September 2016. This is their first inspection since registration and was brought forward from the planned date due to a notification of an incident that raised concerns.

Rossmore Nursing Home is registered to provide personal and nursing care for up to 56 people. The service is accommodated in a series of converted, large, terraced houses in a residential area of Hull, close to amenities and public transport; there is on street parking available. The service has 17 placements for people who have had a stroke and who require therapy input to assist their rehabilitation; an adjoining house has been purchased next door to extend the stroke unit. The day therapy activity is currently provided by Humber NHS Foundation Trust in a separate building in the grounds of Rossmore Nursing Home. There are also eight step-down placements for people who require an interim service following discharge from hospital until a package of care can be arranged for them in the community. The remaining 31 placements are for people who require on-going residential and nursing care. There is a large sitting room, a small seated area and a dining room on the ground floor. There is a mixture of single and shared occupancy bedrooms on the ground and first floors; the upper floors are accessed by a passenger lift, a stair lift and stairs. There are bathroom and shower facilities on both floors.

The service had a registered manager in post as required by a condition of their registration. 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.

Due to concerns found during the inspection, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection, we met with the registered provider and have received an interim action plan. We also requested and have received weekly updates to assure us actions have been taken to address the concerns. We found multiple concerns and are considering our regulatory response. Full information about