This inspection was unannounced and took place on the 14 and 16 August 2018.

We last carried out a comprehensive inspection of this service on 18 December 2017. At that inspection we found seven breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the person-centred care, need for consent, safe care and treatment in relation to risks within the environment and people’s health and well-being, safeguarding from abuse and staff training and development. We also issued a warning notice with regards to the lack of evidence to demonstrate Good Governance. Due to the breaches found the service was rated Inadequate in the Safe and Well-led domains and Requires Improvements in the Effective, Caring and Responsive domains. The service was given an overall rating of Inadequate and placed in Special Measures.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve all key questions; safe, effective, caring, responsive and well led to at least good.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rookwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

Rookwood is a large Victorian building providing accommodation for people over three floors. An office and laundry are sited in the basement. The home is situated on a main road on the outskirts of Bury town centre. On street parking is available to the side of the home. The home is registered to provide accommodation and personal care for up to 17 people. At the time of our inspection there were 16 people living at the home.

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.

Systems were in place to monitor and review the service. It is recommended that the development of a business improvement plan would help to demonstrate on-going and sustained improvements were being made to enhance the service and experiences of people.

Systems were in place to safeguard people from abuse. Staff were aware of their responsibilities in reporting any issues or concerns so that people were protected.

People were supported by sufficient numbers of staff. Relevant recruitment checks were carried out to make sure people applying to work at the service were suitable.

Action had been taken to ensure that safety and suitability of the environment and equipment so that people were kept safe.

The management and administration of people’s medicines was safe demonstrating people received their medicines as prescribed.

People living at Rookwood were involved and consulted with on decisions about how they wished to be supported. Lawful authorisation was in place for those people being deprived of their liberty.

Opportunities for training and support had been provided. This helps staff to develop the knowledge and skills needed to support people safely.

The home was found to be clean and well maintained with good infection prevention and control systems in place. Communal areas provided a good standard of accommodation for people and suitable aids and adaptations were in place to promote people’s independen

We carried out an unannounced inspection of Rookwood Residential Care Home (known as 'Rookwood' by the people who live there) on 18 December 2017. At the last inspection on 27 August and 1 September 2015 the service was rated Good.

Rookwood provides accommodation for up to 17 people with mental health needs who require support with personal care. At the time of our inspection there were 16 people living in the home. Accommodation is provided over three floors and comprises of three lounge areas, a dining room and kitchen. The home has a sheltered smoking area, which is located in the garden. 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.

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.

The provider and registered manager had not ensured the service was being run in a manner that promoted a caring and respectful culture. During the inspection we found seven people’s care plans had a section called ‘consequences’. We found the provider adopted this method of issuing consequences when people had not followed the rules within the home. This meant people would have their personal items removed such as their televisions, kettle, radio, money and cigarettes for a short period of time. The home was not equipped to manage behaviours that challenge others in a safe and person centred way and issued the consequences as a punishment. Due to the seriousness of this un-safe and undignified practice the Care Quality Commission (CQC) raised a safeguarding concern with Bury local authority safeguarding team.

During this inspection, we found issues affecting the safety of the environment. The provider did not have a risk assessment in relation to legionella. The provider confirmed they had completed routine sampling of the water systems in 2015; however there was no scheme of delegation as to who was responsible to ensure the water systems were safe at the home. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults. The provider had also failed to undertake a risk assessment in respect of the hot radiator within the home, to establish if the radiators required covering. Since the inspection the provider have produced evidence a legionella risk assessment is now in place.

Staff had received training, supervision, and appraisals to support them in their roles. However, we found staff had not received key training in learning disabilities awareness and behaviours that challenge others. Furthermore, we found mental health awareness training had not been completed since 2014 by the majority of the staff, with four staff still waiting to complete this key training subject.

Each person receiving a service had a care plan in place. The risks identified through the provision of care had been assessed. However, we found one person's care plan and risk assessments had not been reassessed when we were informed the person has had a history of choking incidents. As a result we raised a safeguarding referral to the local authority.

Care plans did not include people's goals and aspirations. We found no evidence documented of people's setting goals and being supported to achieve them.

Activities on offer to people were limited. We received a negative response from people in relation to activities at the home. There was no plan of activities available. This meant

People living in the home told us they were cared for very well. Staff were helpful and kind. All the staff knew what they wanted and treated them well. They were supported to access other health and social care services they needed. Comments such as, “I’m all right here”, and “I am well cared for” were made.

People told us there were no rigid routines they were expected to follow such as the time they went to bed. They usually pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. They always knocked on their door and waited to be invited in. They had their own key for their room. They could have visitors when they wanted and staff made them welcome.

People said staff were respectful when they spoke to them. They responded to all requests for assistance in a timely manner. They said they got the help they needed and described staff as "very good” and "very nice". One relative who sent written comments direct to the service said, “The care that he receives has been priceless and I am very grateful for that.”

People told us they were confident to raise issues of concern with the manager if ever the need arose. There were arrangements in place to safeguard people and staff had been trained in adult protection.

People said they were very pleased with all their care and support they received and were very happy living in the home. Relatives who sent written comments stated, “It’s a comfortable, clean and happy home.” “The overall impression of the home is very friendly and relaxed. “Calls are always answered and dealt with.” “I cannot find fault in the service and dedication of the staff and owners.”

This was an unannounced inspection which took place on 27 August and 1 September 2015. We had previously carried out an inspection on 9 September 2013 when we found the service had complied with all the regulations we reviewed.

Rookwood provides accommodation for up to seventeen people with mental health needs who require support with personal care. Sixteen people were living at Rookwood at the time of our visit.

Rookwood is a large semi-detached property on a sited on a main road close to Bury town centre. The home has good transport links into Bury and Manchester and there is a large park opposite and there are shops and other amenities close by.

The service had a manager who was registered with us. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People we spoke with either told us they felt safe or indicated they did so. They said, “I think it is very nice here and I feel safe.” and “Well I don’t feel unsafe!”

Recruitment processes in the service were sufficiently robust to help ensure the protection of vulnerable people from the risks of unsuitable staff being recruited. We found staffing levels were appropriate to meet the needs of people who used the service.

There were systems in place to ensure the safe administration of medicines and effective control of infection practices.

Staff had received the training they needed to support people safely and effectively.

People told us that they liked the food that was offered. One person told us, “The food here is great but I don’t like liver so they make me something else.” Another person said, “I like the food. I am a diabetic so I have to watch what I eat. They help me manage it well.”

People had the access they needed to health and social care professionals. A doctor gave feedback to the home’s recent quality assurance review. They commented “Very high quality home with extremely responsive owners/staff. Residents are well cared for. Highly recommended.”

During our inspection the atmosphere was relaxed and friendly. One person who we spoke with said, “The peace here is the most important thing to me. I don’t like too much commotion.”

We saw that people were able to come and go as they pleased. Everyone had a key to their bedroom to ensure their right to privacy was maintained. People also had access to a ‘hands free’ telephone so they could take calls in private.

People who we spoke with told us they liked to do their own thing. People said “I like to spend most of my time in my room reading.” “I go into Bury shopping. I like to buy clothes and meet my friends in a café.” “I go to see my brother and other family.”

There had been no complaints made about the home.

Prior to our visit we contacted the local authority safeguarding and commissioning teams and no concerns were raised by them about the care and support people received from Rookwood.

All the people we spoke with told us the registered manager was approachable and would always listen and respond if any concerns were raised.

Responses received from a recent quality assurance review were positive with comments from professional visitors stating, “During my time visiting the home I have been impressed with the care provided and the staff response to any changes they identify in my clients.” A relative commented, “We have always been happy with Rookwood. [My relative] is extremely happy living there. When we visit we have always been offered a drink and treated courteously. The management and staff are lovely and are all happy to listen to you if needed. We know [relative] is in good hands.”