The inspection took place on 6 June 2018 and was unannounced. Rose Cottage 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. The home accommodates up to 16 people in one adapted building. At the time of the inspection 15 people were living in the home.

At the last inspection in April 2017 we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. This was because risks associated with skin integrity were not assessed or mitigated. At this inspection we found improvements had been made in this area. We found routine care to be very good, delivered in a friendly and personalised environment. Staff knew people very well. However, we found some issues with how staff were recruited and improvements were needed to medicine management practices and working practices in relation to the Mental Capacity Act (MCA). Because of this the provider continues to be rated as ‘Requires Improvement.’

A registered manager was not in place. A manager was in place who had put in an application to become the registered manager for 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.

People said they felt safe living in the home. Risks to people’s health and safety were assessed and mitigated. Where incidents had occurred, action was taken to help prevent a re-occurrence.

We found there were enough staff deployed to ensure people received the required care and support, although there were periods when staff did not have time for much social interaction with people.

Recruitment practices were not always safe. The required checks and documents were not always completed before recruitment decisions were made.

The premises was safely managed and suitable for its intended purpose. It had been adapted to meet people’s individual needs and requirements.

Most people received their medicines as prescribed, although some practices needed improving to ensure medicines were consistently managed in a safe way. We made a recommendation relating to medicines management.

People received a range of training and support to help ensure they could meet people’s needs. Staff said they felt well supported in their role. We made a recommendation around ensuring the manager kept up-to-date with the latest guidance and best practice.

Improvements were needed to working practices to evidence the service was fully compliant with the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). We made a recommendation regarding this.

People’s nutritional needs were met by the service. People had access to a suitably variety of food. Where nutritional risks were identified appropriate action was taken to protect people from harm.

The service worked effectively with a range of health professionals to help ensure people’s healthcare needs were met.

Staff were kind and caring and treated people well. Staff knew people very well and delivered personalised care and support that met their individual needs. People were listened to and their views were acted on.

People’s needs were assessed prior to admission and a range of appropriate care plans developed. People said their care needs were met by the service.

People’s complaints were taken seriously by the service, appropriately responded to and used to further improve the service.

People, relatives and staff said the service provided good care. We found a friendly and inclusive atmosphere within the home. Care was pers

Rose Cottage is located in the village of Thornton, close to Bradford. It provides accommodation and personal care for up to 16 elderly people at any one time.

The inspection took place on the 5 April 2017 and was unannounced. On the date of the inspection 14 people were living in the home.

A registered manager was not in place. A manager had recently been recruited who was in the process of going through the application process to by the registered manager. 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.

At the last inspection in October 2014, we rated the service ‘Good’ overall. At this inspection, we rated the provider “Requires Improvement” overall. Although we saw some areas of the service had positively developed since the last inspection, such as increased social opportunities and the person centred approach to care, we found issues relating to; a lack of robust risk assessments and lack of evidence of compliance with the Mental Capacity Act. These issues meant we could not rate the service better than ‘Requires Improvement,’ despite there being a highly person centred approach to care and support and a kind, caring and stable staff team.

People and relatives were highly satisfied with the care and support provided by the home. They praised the personalised and individual approach provided by the staff and management team.

People told us they felt safe and secure living within the home. Safeguarding procedures were in place which were well understood by staff.

Overall, medicines were safely managed. People received their medicines as prescribed. However, protocols were required detailing how and when to give ‘as required’ medicines.

Risk assessments and updated care plans relating to pressure area care, nutrition and bed rails were not always in place increasing the risk of harm to people.

The premises were warm and homely and suitable for the intended purpose People were able to personalise their rooms. The building and equipment were kept well maintained.

There were enough staff deployed to ensure people received prompt and timely care. Staffing levels were subject to regular review. Safe recruitment procedures were in place.

Staff received a range of training and support relevant to their role. Staff said they felt well supported by the management of the service.

Improvements were required to ensure the service could evidence it was fully acting within the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLs) legislation.

People had access to a range of suitably nutritious food including regular snacks. People praised the food and said it was tasty with suitable choice. Charts recording people’s food and fluid intake were not always properly completed.

People had access to a range of external health professionals to help ensure their healthcare needs were met.

People and relatives told us staff with very kind and caring. This was confirmed by our observations of care and support. We saw staff knew people very well and provided personalised care and support. All staff, including the management team, showed kindness and compassion towards the people they were caring for.

People were listened to and their views respected by the service.

People’s needs were assessed and plans of care put in place which were understood by staff. People’s individual and varying needs were taking into account to develop plans of care that met people’s emotional and social needs.

People had access to a range of activities which included trips out and maintaining links with the local community.

A system was in place to log, investigate and respond to complaints.

Systems to assess and monitor the service we

Rose Cottage provides accommodation and personal care for up to 16 elderly people at any one time. On the date of the inspection 14 people were living in the home.

A registered manager was in place. 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

Feedback regarding the quality of the service was excellent from people, their relatives, and health professionals. They all said the service was excellent at meeting people’s needs and dealing with any risks which emerged. We found risks to people were appropriately managed.

The premises was maintained to an appropriate standard to keep people safe.

Staff we spoke with had a good understanding of the Mental Capacity Act (MCA) and how to ensure the rights of people with limited mental capacity when making decisions was respected. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People spoke positively about the food and we found a choice of meals was on offer based on people’s preferences. People’s healthcare needs were met and health professionals reported strong links with the service.

People and their relatives reported staff were caring and respectful and treated them well. This was confirmed by our observations on the day of the inspection. Sensitive and dignified end of life arrangements were in place to ensure people were treated well in the end stages of their life.

Some care records required improvement to ensure they reflected people’s current needs. We found some care plans contained inaccurate information which risked that staff did not have access to the most current information necessary to deliver appropriate care.

People, relatives and staff all spoke positively about the registered manager and said they were effective in dealing with any concerns. Systems were in place to continuously improve the quality of the service. This included a programme of audits and satisfaction questionnaires. Complaints were appropriately recorded, managed and responded to.