This inspection took place on 21 and 23 May 2018 and was unannounced on the first day. At the last inspection in October 2015, the provider received an overall rating of Good.

Rockliffe House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Rockliffe House supports up to 35 older people, some of whom may have sight impairment or be living with dementia. Communal rooms consist of a lounge, a dining room and a conservatory. There is also a small seated area in a walkthrough space near patio doors, which lead out to the garden and an area for people to smoke. Bedrooms, bathrooms and toilets are located over two floors accessed by two passenger lifts. At the time of the inspection, there were 34 people living in Rockliffe House.

The service had a registered manager. A registered manager is a person who has registered with the 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.

During the inspection, we had concerns about areas of the environment and equipment that required cleaning, tidying, repairing and in parts repainting. There were no cleaning schedules for day time domestic staff. Night care workers completed some cleaning tasks but there was no checking system to oversee work had been carried out by either day or night staff. The registered manager and provider were aware of areas in the environment that they wanted to improve; following the inspection, the provider told us these would be completed in the next six to twelve months.

There was a lack of understanding about the Mental Capacity Act 2005. This had impacted on the quality of capacity assessments and applications for deprivations of liberty. There were also shortfalls in the recording of best interest decisions and some people who used the service had signed documents when they were assessed as lacking capacity to understand them. Despite this, staff were clear they had to ask people for consent before carrying out care tasks and people who used the service told us they were able to make their own decisions and choices.

The quality assurance system was not effective in identifying shortfalls in the environment and other areas of service provision. The monitoring and analysis of accidents and incidents had not taken place since the member of staff allocated this task had left the service. This meant that lessons could not be learned in order to reduce accidents and incidents.

The provider and registered manager had not notified CQC of several incidents that affected the safety and welfare of people who used the service. This is a requirement of their registration.

The provider and registered manager had not completed a request for information called a ‘Provider Information Return’. This would have assisted us in planning the inspection. We also noted some policies and procedures and documents were in need of updating.

These issues were breaches of regulations and you can see what action we have told the provider to take at the back of the full version of this report.

Staff knew how to safeguard people from the risk of harm and abuse. There was an inconsistency in how management dealt with incidents that occurred between people who used the service. Sometimes these were referred to the local safeguarding team but we found several instances when they had not contacted the team for advice and to make them aware of incidents.

People had assessments and care plans produced which helped to guide staff when they supported them. The assessments included areas of risk and were held with the care plans so staff could locate them quickly. Som

At the last inspection on 25 October 2013 we issued a warning notice for the management of records and compliance actions for concerns relating to the management of medicines and staffing numbers. During this follow up inspection we found that improvements had been made in all three areas.

We found that medicines were managed appropriately and people received their medicines as prescribed. The treatment room was clean and tidy and medicines were stored safely.

We found there had been an increase in the staffing numbers. This ensured there was sufficient staff on duty at all times to meet the current needs of people who used the service. Staff confirmed the numbers of staff had increased in the evenings which had made a difference to the support they were able to give to people. Comments from staff included, “The extra staff has made a big difference. We have more time in the evenings and don’t feel rushed” and “We do have enough staff; a lot of people are independent and don’t need a lot of support.”

We found records used in the home had improved. These included care records and those used for managing the service. Comments from staff about records included, “Recording has improved; the files are set out much better” and “We have better recording and know more about what is going on. We follow through more and when we do evaluations we go through all the daily reports.”

We have asked the local authority to check out something we noted in one of the records.

We received information of concern regarding staffing levels and the management of medicines. We were also due to complete a follow up inspection to check progress on compliance actions issued at the last inspection on 23 July 2013. We decided to complete an inspection with colleagues from the local authority safeguarding and commissioning teams to look at the concerns and combine this with following up the compliance actions.

There had been improvements in the arrangements for managing people’s personal allowance and recording expenditure. Receipts were maintained, which helped to evidence expenditure when staff went to the shops for people. This helped to protect people from the risk of financial abuse.

There were shortfalls in the management of medicines including how they were stored and processes for returning them to the pharmacy. We could not be sure that all the people who used the service had received their medicines as prescribed, as there were some gaps in recording.

We found there was insufficient numbers of staff at specific times to support the needs of people who used the service.

We found there had been improvements in the way personal allowance was recorded and a specific behaviour management plan had been completed since the last inspection. However, we found other records such as staff rotas, personal care entries and medication records had not been completed accurately or consistently.

We spoke with seven people who used the service, two visitors, three staff and both providers.

People told us they were treated with dignity and respect and they could make choices about their lives. Comments included, “It really is a nice place here and has a pleasant atmosphere. There is not one thing wrong I can say about this place” and “I get myself washed and dressed and if I can’t do anything I just ask. I come and go as I please.”

People told us their health needs were met. Records showed they had access to health professionals for advice and treatment. Comments included, “We are looked after well and treated kindly.”

We found systems in place for recognising potential financial abuse and the procedure used to manage and record finances did not fully protect people from the possibility of abuse.

We found people received medicines as prescribed, although some minor recording issues were to be addressed.

The service provided people with a safe and homely environment. People told us they were happy with their home and liked the large bedrooms and garden.

We found there were sufficient staff to support people who used the service. Comments included, “If I can’t do something I ask and they come as quick as they can” and “The staff are excellent and it’s a friendly atmosphere.” A relative told us the staff had been very thoughtful and knew their relative's needs well.

We found some of the records used in the service were not accurate and up to date.

Rockliffe Court is situated in a residential area not far from the city centre of Hull. The service has shared and single bedrooms over two floors. There are various communal areas, a dining area and a large garden. The building is accessible to people with mobility difficulties. Car parking is provided to the rear of the building.

The last inspection was completed on 7 January 2014 and the service was compliant in all areas assessed. This inspection took place on 16 and 19 October and was unannounced.

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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered provider had not fully understood their responsibilities in relation to DoLS; they had failed to identify who met the criteria for DoLS and to submit applications to the local authority as required. This meant that people who used the service may be unlawfully restricted. These issues meant that the registered provider was not meeting the requirements of the law regarding the need to obtain lawful consent for the people who used the service. We discussed our concerns with the registered manager and registered provider who confirmed they would address this issue without delay.

Meetings were held for people who used the service and relatives which were used as a forum for people to raise concerns, ask questions or make suggestions about the overall running of the service. When suggestions were made for example the addition of more meaningful activities; the registered manager took action without delay.

Medicines were ordered, stored and administered safely. People received their medicines as prescribed from staff who had completed relevant safe handling of medication training.

Staff understood the need to respect people’s privacy and maintain their dignity. During the inspection we observed numerous positive interactions between the people who used the service and the staff who supported them. People were treated with kindness and compassion. It was evident staff were aware of people’s life histories and knew how care and support was to be provided in line with their preferences.

A quality assurance system was in place that consisted of audits, checks and service user feedback. When shortfalls were identified action was taken to improve the level of service.

Staff were recruited safely. Checks were undertaken to ensure prospective staff were suitable to work with vulnerable people. We saw that there was a very low turnover of staff at the service.

We found safeguarding systems were in place at the service. Staff had completed relevant training and knew what action to take if they had any concerns. This helped to ensure the people who used the service were safeguarded from the risk of harm and abuse.

People’s nutritional needs were met. Staff monitored people’s food and fluid intake and took action when concerns were identified. Referrals to healthcare professionals were made in a timely way when people’s needs changed or developed. We saw that people were provided with a freshly prepared, varied and balanced diet of their choosing.