Church Rose 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.

Church Rose accommodates 48 people in one adapted building. Church Rose accommodates 48 people across two floors.

There was a registered manager at the home who had joined the home shortly after the last inspection. 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 registered manager had been at the home for a short period of time but had worked with staff to change practices within the home and promote a more team based way of working.

People at the home liked and felt safe around staff they knew. Staff understood how to keep people safe and how to report any concerns they had. Staff also understood the health needs people lived with and how people required support. Staffing at the home was stable and the provider had reduced their reliance on agency staff so that people had more consistent care. Recruitment process included reviewing a staff member’s background to ensure they were suitable to work at the home. People received support with their medicines. Regular checks were made to ensure medicines were given and stored correctly.

People were supported by staff that had been supported with training and supervision. Both nursing and staff explained they were encouraged to keep their knowledge up to date. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered a variety of choices in their food and drink and where necessary were offered support. Staff worked with a number of healthcare professionals to support people and ensure they received the right care which was based on best practice.

People liked and valued the staff supporting them. People found staff understood their care and cultural needs and responded in a way in which they wanted. People were treated with dignity and respect.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their families were involved in discussions about their care which was updated in response to people’s changing needs. People were supported to have interests and were encouraged to participate in both communal and individual interests. People had not raised any complaints but we saw there was a process in place for investigating and responding to complaints should they arise.

The registered manager had acted upon improvements identified in previous inspections and had worked with staff to share learning. The registered manager undertook regular checks of the quality of care being offered and worked with stakeholders to improve learning about best practice in caring and supporting people. The registered provider explained how they had improved reporting and quality assurance processes within the home so that they had a better understanding of the care being delivered.

People did not always feel they received safe care in this service and were not always confident in reporting their concerns when they felt unsafe. Whilst the provider had procedures in place to keep people safe and staff had received training and were aware of the procedures some people felt they were not treated well and were concerned about staff’s practice that did not support them in a safe way.

There were systems in place to ensure people received their medicines safely, most people received the support they needed with their medicines. However, some people had concerns about the way their medicines were handled. People’s concerns indicated that staff practice did not always ensure people received their medicines as prescribed.

People did not always feel their needs were met in a consistent way. The provider had clear systems in place for handling complaints. However, people were not confident that their concerns were listened to and addressed.

People’s rights were not fully protected. This was because staff were lacking in knowledge about how to ensure people’s rights were consistently protected in regards to certain aspect of their care.

Whilst there were procedures in place to monitor the quality of the service, some people did not experience a quality service. There had been several changes of registered managers since we last inspected the service; this had led to some instability within the service. This had impacted on the provider’s ability to secure and sustain the necessary improvements to the quality of care people received.

Risks to people’s care was not always updated where people’s needs had changed. People did not always feel there were sufficient staff to meet their needs. However, the provider had recognised this and had recently increased the staffing numbers and had plans in place to ensure this did not happen again.

Where incidents relating to people’s care had happened the provider investigated and analysed the incidents and took action to reduce the risks of them happening again.

Staff were safely recruited to work with people and received training to do their job. The provider had recognised that the training provided was not always reflected in staff’s practice and plans were in place to supplement the training. Staff were currently not consistently supervised and supported to undertake their role.

People had a choice of food and drink and were supported to maintain a healthy diet. People had access to health care professionals to ensure their health care needs were met.

Most people felt staff were caring towards them and respected their privacy and dignity. There were some people who felt they were not showed care and compassion by some staff and that their dignity was not consistently maintained.

People were encouraged and supported to be as independent as possible. A range of activities were available for people to participate in if they wished and visitors were welcomed at the service. This enabled people to maintain contact with relatives and friends.

This inspection took place on 9 December 2015 and was unannounced.

Church Rose is a privately owned care home situated in a residential area of Birmingham. Nursing care is provided for up to 48 older people who live at the home. The home is a two storey building, with suitable access for people with restricted mobility. There were 47 people living in the home at the time of our visit.

There were two registered managers 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 and associated Regulations about how the service is run.

We last inspected the home in December 2014. After that inspection we asked the provider to take action to make improvements to ensure people’s needs were met by sufficient numbers of appropriately skilled staff and medicines were managed safely. At this inspection we found improvements had been made, but further improvements were still required.

Most people were happy with the staff, but told us that staff were busy and they sometimes had to wait for assistance with personal care. Staff we spoke with said there were enough staff to support people safely and ensure they received the care they needed. Further improvements were needed in the allocation of staff to ensure there was oversight of communal areas at critical times.

People told us staff were respectful and kind towards them. Staff protected people’s privacy and dignity when they provided care and asked people for their consent before care was given. There was a programme of activities and entertainment to support people’s social needs. Friends and family were welcomed into the home.

Assessments had been completed to determine people’s capacity to make certain decisions. The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS).

People received care from staff who had the skills and experience to meet their needs effectively. People were referred to other healthcare professionals and received their medicines as prescribed.

Staff understood their responsibilities around keeping people safe. There were systems and processes in place to protect people from the risk of harm. These included a procedure to manage identified risks to people’s care

Care plans contained information for staff to help them provide the individual care and treatment people required, however staff were not always able to respond to people’s needs at a time people preferred.

There were systems in place to assess and monitor the quality of the service. This was through feedback from people who used the service, their relatives, staff meetings and a programme of checks and audits.

There was a lack of clarity around the roles and responsibilities of the management team. Changes in managers meant there was uncertainty about the future leadership of the home.

We undertook this inspection to check on actions that we had asked the provider to take following our last inspection. During the inspection we walked around the home and observed the general appearance of people living in the home. We spoke with four people, the manager and two members of staff.

We found that the provider had made improvements to ensure that appropriate processes were in place to ensure that people living at the home were able to give informed consent to their care and treatment. Where people lacked capacity systems had been put in place to ensure that their rights were protected.

We found that staff training had improved and the provider had put systems in place to demonstrate that new staff employed received a basic induction into their role.

The people that we spoke with had no complaints and felt that they were being looked after. One person told us, “I am being looked after.” Another person said, “Oh yes, they are looking after me well, so I have no complaints.” We found that the provider had improved the systems to ensure that people’s views and experiences would influence improvements in the home.

During the inspection we spoke with 13 people that lived at the home, the manager a care coordinator and three other members of staff.

We saw that people gave their consent to care and treatment and people told us that staff talked to them about their care. We found that where people did not have the capacity to consent, the provider was not acting fully in accordance with legal requirements.

The overwhelming majority of people that we spoke with told us that their needs were being met. One person told us, “No problems, they are looking after me." We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

All the people that we spoke with told us that they were treated well by the staff. We found that people were cared for, by staff that were suitable recruited.

Everyone that we spoke with said they thought there was enough staff to care for them. We found that there were enough staff to meet people's needs, but all staff employed may not be sufficiently skilled and experienced.

Majority of the people that we spoke with had no concerns about the quality of care that they received. One person told us, “It’s not a bad home, in my opinion it’s one of the better places.” We found that the provider had a system to regularly assess and monitor the quality of service that people receive but it was not being maintained to ensure it was fully effective at all times.

At our inspection on 14 August 2012 people told us that they felt safe living at the home. However, we found that staff that worked at the home were not clear about the procedures for safeguarding people from abuse. We undertook this inspection to check that the provider had improved the system for ensure that people that lived at the home were safeguarded from abuse. We found that the systems had improved and staff were now clear about what action to take should they suspect someone living at the home was being abused.

There were 37 people living at the home at the time of our inspection and this included one person who was in hospital. We spoke with five people who lived at the home and three visitors. We spoke with the manager and three staff. We walked around the home and observed how people were being cared for.

People told us that staff respected their privacy and dignity and that were given choices about their care. We saw mostly good interactions between staff and people that lived at the home.

People and their visitors told us that they were happy with the care they received. One person told us, “I am very satisfied with the home and the quality of care delivered to my brother.” We saw that people’s needs were assessed and delivered in accordance with their care plan.

People said they felt safe living at the home. One person said, “I feel quite safe living here.” We found that staff were not clear about the correct action to take should they become aware of an allegation of abuse in the home.

People told us they were treated well by the staff. We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People we spoke with said they were happy living at the home. We saw that people were cared for and people and their relatives told us they knew how to raise concerns if they were not happy. We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

This was an unannounced inspection, which took place 1 and 2 December 2014. We last inspected this service on 3 March 2014 there were no breaches of legal requirements at that inspection.

Church Rose is a privately owned care home situated in a residential area of Birmingham. Nursing care is provided for up to 42 older people who live at the home. The home is a two storey building, with suitable access for people with restricted mobility.

There was a registered manager in post at the time of our inspection. 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 we spoke with had no concerns about their medication. However, we found that medication was not always managed in a safe way. We saw that people had received medication that was no longer prescribed to them. This was a breach of the requirements of the law.

A number of people told us that there were not enough staff to meet their needs and this had resulted in people’s dignity being compromised. This was a breach of the requirements of the law.

You can see what action we told the provider to take to comply with the law at the back of the full version of the report.

People and relatives spoken with were happy with the food and felt they had a choice in what they ate and drank. We saw that drinks were not always within easy reach of people cared for in bed, so people potentially may not have access to sufficient fluids throughout the day. We saw some instances where people’s religious and cultural dietary needs were not respected and maintained, in line with their wishes.

People and their relatives had no concerns about safety. There were procedures in place to keep people safe from abuse and staff spoken with knew how to reduce the risk of abuse and harm occurring. We saw that where incidents relating to people’s safety had occurred, they had been managed well.

All the people and relatives we spoke with said they thought the staff group were trained and knowledgeable about people’s needs. With the exception of one member of staff, all other staff spoken with had received the training and support needed to do their job and were suitably recruited into their role.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. CQC is required by law to monitor the operation on the DoLS and to report on what we find. We found that people’s rights were protected in line with the legislation.

People told us and we saw that people’s health needs were being met and that a range of different social activities, which were designed to reflect the cultural, religious and age appropriate needs of people that lived at the home were available.

People said they felt that the staff were caring. However, we saw that staff did not interact with people and we saw instances where people were not respected in the way they should be.

People that had raised concerns told us they had been addressed, and we saw that there was an effective process in place to listen to and respond to complaints. This showed that people should be confident their concerns would be listened to and acted upon.

People said they were happy with the service they received. The management of the service was stable. However, monitoring processes were not sufficiently effective to ensure a quality service.