We carried out an unannounced inspection of The Old Roselyon Manor Nursing Home on 30 May 2018. The Old Roselyon Manor is a ‘care home’ that provides care for a maximum of 30 adults. 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. At the time of the inspection there were 27 people living at the service. The service is on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 10 April 2017. In April 2017 we found the registered manager/provider had not kept up-to-date with changes in legislation in relation to the recruitment of staff and protecting people’s rights. Some audits, carried out by nurses to monitor the nursing care, had fallen behind due to nurse vacancies and sickness. We found there were missing risk assessments, incorrect air mattress settings, lack of analysis of falls and gaps in charts for when people needed to be re-positioned.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection the service’s recruitment systems had been updated to ensure all the relevant recruitment processes, including Disclosure and Barring Service (DBS) checks, had been completed before new staff started to provide care for people. This helped to ensure new staff were suitable and safe to work in a care environment.

People’s legal rights were protected because management understood the legal requirements of the Deprivation of Liberty Safeguards (DoLS). Some people lacked the mental capacity to recognise the decline in their physical capabilities, which potentially put them at risk of harm, such as sustaining injuries from falls. These people were subject to restrictive practices or continuous supervision to protect them from the risk of harm and keep them safe. DoLS applications had been made to the local authority to seek the legally required authorisation to have these restrictions in place.

There were effective quality assurance systems in place and audits were routinely completed. This included the introduction of new audits to check air mattress settings, the dating of creams on opening and the completion of re-positioning charts. A system had also been put in place for the analysing of incidents, such as falls, and where necessary changes were made to learn from events or seek specialist advice from external professionals.

Care records were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. In particular risks in relation people’s skin care and nutrition were being effectively monitored.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make c

The Old Roselyon Manor Nursing Home is a care home that provides nursing care for up to 30 older people. On the day of the inspection there were 27 people using the service. Some people living at the service had a diagnosis of dementia.

We carried out this unannounced inspection of The Old Roselyon Manor Nursing Home on 10 April 2017. At the last inspection, in May 2015, the service was rated Good.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run. Comments included, “This is a very well run establishment” and “They are a competent and caring establishment.” However, the registered manager/provider had not kept up-to-date with changes in legislation in relation to the recruitment of staff and protecting people’s rights. Some audits, carried out by nurses to monitor the nursing care, had fallen behind due to two nurses being on long term sick. We found there were missing risk assessments, incorrect air mattress settings, some recording gaps for medicines, lack of analysis of falls and gaps in charts for when people needed to be re-positioned. We judged that the gaps in records and the lack of some audits had not impacted on the care people received. However, it showed that the management oversight of how the service was performing needed to be improved.

At the last inspection the service had a stable staff team, of care workers and nurses, who had worked in the service for many years. In recent months some care staff had left which resulted in the service needing to recruit new care staff. In discussions with the registered manager and assistant manager it was clear that the interview process was thorough. However, the service had not applied for a new Disclosure and Barring Service (DBS) check and instead had used the applicant’s copy of their DBS check, completed by a previous employer. This meant people sometimes received care and support from staff without the appropriate pre-employment checks in place.

There were two students working part time in the service, carrying out domestic duties, and the service had not applied for a DBS checks for either of them. While these staff did not provide direct care for people, it is still a requirement that any staff member, or volunteer, working in a care setting should have a DBS check.

Management did not have a full understanding about the legal requirements of the Deprivation of Liberty Safeguards (DoLS) and what practices might constitute a person being deprived of their liberty. For some people, who did not have mental capacity, the service had put measures in place to protect them from the risk of harm. However, the provider had not recognised these measures as restrictive practices and therefore had not made DoLS applications to the local authority as is required by law.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005.

People told us they felt safe living at The Old Roselyon Manor and with the staff who supported them. People and their relatives told us, “I am happy here”, “Can’t fault it” and “We are very happy with the service.”

We met with several people living at the service but some were unable to tell us their views about the care and support they received. However, we observed people were relaxed and at ease with staff, and when they neede

We carried out this unannounced inspection of The Old Roselyon Manor Nursing Home on 12 May 2015. The Old Roselyon Manor Nursing Home is a care home that provides nursing care for up to 30 older people. On the day of the inspection there were 28 people using the service. The service was last inspected in October 2013 and was found to be compliant.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

On the day of our inspection there was a calm and relaxed atmosphere and staff interacted with people in a kind and sensitive manner. There was a stable staff team who had a good knowledge of each person’s needs. People and visitors spoke well of staff and said staff had the right knowledge and skills to meet people’s needs. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

People told us they felt safe living at The Old Roselyon Manor Nursing Home and with the staff who supported them. People told us, “I feel safe”, “I am happy and safe here”, “very good I am happy here” and “no problems”. A visitor told us they had “no concerns” about the service.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

All health professionals told us staff had good knowledge of the people they cared for and made appropriate referrals to them when people needed it. People and visitors told us they were confident that a doctor or other health professional would be called if necessary. People were well cared for and were involved in planning and reviewing their care. There were regular reviews of people’s health and staff responded promptly to changes in need. Staff had good knowledge of people including their needs and preferences.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors in one of the lounges, the garden or in their room.

Staff were well trained; there were good opportunities for on-going training and for obtaining additional qualifications. Recruitment processes were robust and appropriate pre-employment checks had been completed to help ensure people’s safety. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. People told us they knew how to complain but said they had never had any reason to complain. They told us the registered manager and staff were so good at asking for their views and listening to what they wanted that any situations that might give cause for concern had not occurred.

There was a management structure in the home which provided clear lines of responsibility and accountability. People told us the registered manager and staff were very approachable and regularly asked them for their views of living at The Old Roselyon Manor Nursing Home.

During our inspection we spoke with the registered manager and registered provider, six members of staff, three people who were living in at Old Roselyon Manor, and one person who was visiting their relative. People told us the staff were “caring and dedicated”.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Each person had a care plan in place which stated their individual needs. People had access to a range of services including hairdresser, chiropodist and GP’S.

People who used the service had their medicines at times they needed them in a safe way.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People told us their rooms were “nice” and “comfortable”.

The staff were supported by the registered manager. Training had been provided for areas such as manual handling, fire safety and infection control.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Some of the people using the service were not able to comment in detail about the service they receive. We did speak to 6 people who lived at Old Roselyon Manor, and a visiting relative. All the comments we received from people who lived at Old Roselyon Manor were positive. Comments from people included “I like it here, they make you so comfortable”, “nothing is too much trouble”, “there's always someone there if you need help”. We saw people’s privacy and dignity being respected and staff being helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.