About the service: Rock Cottage is a 36-bedded residential care home that was providing personal and nursing care to 32 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The service had deteriorated in some areas since our last inspection.

People received their medicines safely. However, we found that protocols and risk assessments for specialist as and when medication was lacking.

Staff were not effectively deployed. People told us that although staff treated them with kindness, there were not able to spend time with them that was not related to a care task. We recommend that the provider source a dependency tool to inform their staffing levels.

People’s support needed were planned and assessed for, however they lacked person centred detail and management of risks to people required strengthening.

Although the service was working within the principles of the Mental Capacity Act (2005), awareness around completing capacity assessments and completing best interest decisions needed strengthening. People had access to healthcare professionals.

Governance systems were not being applied consistently meaning that the services people received were not always effectively monitored.

People were supported by safely recruited staff and protected from potential abuse. Staff knew people well and the registered manager was approachable.

The previous inspection rating was displayed in the service.

Rating at last inspection: Requires improvement (19 January 2017). This service has been rated as requires improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: The next scheduled inspection will be in 12 months. We will continue to monitor information that we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

We completed an unannounced inspection at Rock Cottage Care Services on 19 January 2017. At the last inspection on 14 March and 15 March 2016 we found there were breaches in regulations. We asked the provider to take action to make improvements to the way they managed and monitored the service. At this inspection we found that some improvements had been made, but some further improvements were needed.

Rock Cottage Care Services are registered to provide accommodation with personal care and nursing for up to 36 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 36 people.

There was a registered manager at 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.

The provider had made some improvements to the systems in place to assess, monitor and improve the quality of care. However, further improvements were needed to ensure that all the systems in place were carried out regularly.

Some improvements were needed to ensure that care records contained up to date information.

We found that some improvements were needed to ensure that medicines were managed safely.

People felt safe when they were supported. Staff had a good understanding of people’s risks and we saw that people were supported in a safe way.

People were supported to be involved in meaningful hobbies and interests within the service to promote their emotional wellbeing.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. Where people were at risk of malnutrition care plans were in place to ensure people were eating sufficient amounts to keep them healthy.

People were supported to access other health professionals in a timely manner to maintain their health and wellbeing.

People were supported in a caring and compassionate way by staff who knew people well. People’s privacy and dignity was protected when staff provided support and staff promoted and listened to people’s choices in care.

People were involved in their care. People received care that met their preferences because staff knew people well and knew how they liked their care to be provided.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

Staff felt supported by the registered manager to carry out their role and there were values within the service that staff understood and followed.

There was an open and honest culture within the service and the registered manager was approachable to people, staff and professionals.

The registered manager was aware of their responsibilities and had informed us (CQC) of any notifiable incidents that had occurred at the service.

We completed an unannounced inspection at Rock Cottage Care Services on 14 March 2016 and 15 March 2016. At the last inspection on 19 December 2013 the provider was meeting the required standards.

Rock Cottage Care Services are registered to provide accommodation with personal care and nursing for up to 36 people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 35 people.

There was a registered manager at 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.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was unable to be identified and rectified by the registered manager and provider.

The registered manager was not fully aware of their responsibilities to inform us (CQC) of any notifiable incidents that had occurred at the service.

We found that improvements were needed to ensure that medicines were managed safely.

People felt safe when they were supported and staff had a good understanding of people’s risks, although records we viewed did not always provide details of people’s risks

People were supported to be involved in meaningful hobbies and interests within the service, but improvements were needed to ensure that people had access to hobbies and interests when the dedicated worker was unavailable.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. Where people were at risk of malnutrition there were plans in place but improvements were needed to ensure the records clearly identified the amounts that people had eaten and drank sufficient amount to keep healthy.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported in a caring and compassionate way that protected their privacy and dignity. Choices in care were promoted by staff and people’s choices were listened to and acted on.

People were involved in their care. People’s preferences had been taken into account and staff knew people who used the service well and knew their likes and dislikes.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

Staff felt supported by the registered manager to carry out their role and there were values within the service that staff understood and followed.

During the inspection we spoke with six people who used the service and five staff who provided support to people. We also spoke with a visiting health professional and the provider. The registered manager was unavailable at the time of the inspection.

We found that the provider did not have records in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us they had not received training with regards to the Mental Capacity Act 2005. Staff we spoke with did not fully understand their responsibilities with regards to the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. People we spoke with told us they were happy with the care provided and staff listened to their wishes. One person told us, “The staff are wonderful. I found it difficult to settle in but the staff helped me as they can't do enough for you". Another person told us, “It's great here. I can choose what I want to do and the staff never make me do something I don't want to".

Staff we spoke with understood the various types and signs of abuse. Staff were able to explain the actions they needed to take if they had concerns that a person who used the service was at risk of harm.

The provider had a recruitment system in place. We saw that staff had been checked to ensure that they were suitable to provide support to vulnerable people.

We saw that the provider had an effective complaints system in place. People we spoke with told us that they knew who to complain to if they needed to.

People who used the service were involved with the planning of their care and staff treated people with dignity and respect when providing support.

We spoke with staff who were aware of the individual needs of people and how they preferred the support to be carried out. People we spoke with told us that they were offered choices and staff listened to what they wanted. People told us, "The staff are very good and understand what I need" and "The girls are good at looking after me".

We saw that people were cared for in a clean environment and staff we spoke with were aware of the infection control policies in place. We saw staff wearing protective equipment when supporting people who used the service.

We viewed records which showed that staff had received a detailed induction before they started their employment. Staff we spoke with told us that they felt supported by the manager. One member of staff told us, "I feel fully supported and I know that I can always approach the manager if I have any concerns".

The provider had some systems in place to analyse the quality of the service provided and gain the views of people who used the service.