We inspected Rose Farm on 29 June 2017. This was an unannounced, responsive inspection, following the receipt of some information of concern. The service is located in the village of Styrrup, in South Yorkshire and is registered to provide accommodation and personal care for up to 54 people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 42 people living at the service.

At our last inspection on 24 November 2016 concerns were identified relating to risk assessments and safety plans, which did not always contain sufficient information and had not been updated to accurately reflect changes. Risks to people were not always sufficiently monitored. Checks on pressure relieving equipment were not documented and some areas of the home and equipment were not clean. We were also concerned that internal quality monitoring systems had failed to identify these shortfalls. However we did not consider these shortfalls constituted a breach of regulations. We asked the provider to take action to address these issues and ensure people were cared for in a way that protected them from risk of harm. At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day of the 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.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The service was clean, well maintained and readily accessible throughout. There we

This unannounced inspection took place on 24 November 2016. Rose Farm is run and managed by RS Care Homes Limited. The home provides accommodation and personal care for up to 54 older people and people with dementia. On the day of our inspection 38 people were accommodated at the home.

The home had a registered manager 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.

At our inspection on 12 November 2015, we asked the provider to take action to ensure that people were cared for in a way that protected them from risk of harm but did not restrict their freedom and independence. Action had been taken by the provider to seek legal authorisation for restrictions placed on people.

Risks to people had been identified. However, risk assessments and safety plans did not always contain sufficient information and had not been updated to reflect changes.

Risks to people were not always sufficiently monitored. Checks on pressure relieving equipment were not documented and some areas of the home and equipment were not clean.

People were protected from the risk of abuse as management and staff understood their role in keeping people safe from harm. People were also supported by sufficient numbers of staff.

People received their medicines from trained staff and the storage and administration of medicines was safe.

People were supported by staff who had received training and were supported by the management team to ensure they could perform their roles and responsibilities effectively.

People were encouraged to make choices and decisions. If there was doubt as to whether people had the capacity to make decisions, a capacity assessment had been carried out and a best interest decision made. The registered manager had applied for authorisations to deprive people of their liberty if required.

People told us they found the food satisfactory and that people’s dietary requirements were known and catered for. People received support to maintain their hydration, nutrition and healthcare.

People were treated with dignity and respect. We saw staff were kind and caring when supporting people and people were given information and choices.

We found that staff were knowledgeable about people’s needs and preferences but that this information was not always recorded. People benefitted from a range of activities which they were supported to engage with as they wished.

People and their relatives felt able to approach the management team with any concerns they had although were not always aware of different feedback mechanisms within the home.

At our inspection on 12 November 2015, we asked the provider to take action to ensure they were monitoring service provision to identify where improvements were required. We found that management systems were in place and when issues were identified these had been addressed. However, systems were not always effective in identifying issues such as lack of information in care plans and cleanliness.

People told us that the management of the home were visible and approachable and staff felt supported and motivated. We observed that the staff worked well as a team.

We inspected this service on 9 February 2016. Rose Farm is run and managed by RS Care Homes Limited. The service provides accommodation and personal care for up to 54 older people and people with dementia. On the day of our inspection 44 people were using the service.

We carried out an unannounced comprehensive inspection of this service on 12 November 2015. Breaches of legal requirements were found. We issued a warning notice in relation to one of these breaches.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rose Farm on our website at www.cqc.org.uk.

The service had a registered manager in place 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 and associated Regulations about how the service is run.

At the last inspection on 12 November, we asked the provider to take action to ensure that the principles of the Mental Capacity Act (MCA) were being adhered to. The MCA is in place to protect people who lack capacity to make certain decisions because of illness or disability.

We found that improvements had been made in relation to the service ensuring that people’s rights were protected and the requirements of the MCA were being adhered to. Applications had been made to the appropriate authority if this was required under Deprivation of Liberty Safeguards (DoLS). DoLS protects the rights of people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed.

We could not improve the rating for effective from requires improvement because to do so requires consistent good practice over time. We will check this during or next planned comprehensive inspection.

This unannounced inspection took place on 12 November 2015. Rose Farm is run and managed by RS Care Homes Limited. The service provides accommodation and personal care for up to 54 older people and people with dementia. On the day of our inspection 47 people were using the service.

The service had a registered manager in place 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 and associated Regulations about how the service is run.

At the last inspection on10 February 2014, we asked the provider to take action to ensure that they obtained consent from people in relation to the care that they received. This was because the principles of the Mental Capacity Act 2005 (MCA) had not been consistently applied. This meant that people were not protected by legislation designed to ensure that their rights were protected.

On this inspection we found that decisions were still not being made in accordance with legislation to ensure that decisions were being made appropriately.

Decisions had been taken within the service which did not evidence that all other less restrictive options had been explored. This meant that people were at risk of measures being put in place which were disproportionate to the risk of harm posed.

People received their medicines from trained staff who followed correct administration procedures but improvements were required in the management of medicines.

We found that staffing levels were sufficient, however during busy times at the service people were not always given the support they required in a timely or unhurried manner. As a result of this, people did not always receive the support they required with their nutritional intake. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People were treated in a caring and respectful manner but systems were not effective in ensuring that people had been involved in planning their care. Care plans were not always in place or showed sufficient detail or up to date information about the support people required. Staff were knowledgeable about people’s likes and dislikes and their support needs.

People who used the service and their relations knew who to speak with if they had concerns and felt that these would be responded to. However, we found that not all concerns had been addressed in a timely manner.

Systems were in place to monitor the quality of service provision; however we found that these systems were not always effective in ensuring that issues which had been identified were addressed. Where external agencies had identified areas that required improvement, timely action had not been taken.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with seven people who used the service and three relatives and asked them for their views. We also spoke with two team leaders, a senior care worker, three care staff and the registered manager. We met with the general manager and two directors at the end of the inspection. We looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people were not fully involved in planning or reviewing their care. We asked four people if they had discussed their care plans with staff and they all said they had not. One person told us, “Nobody asked me to sign anything.”

We found people received care and support that met their needs. A person who used the service told us, “I have had good care so far, my clothes are washed every day and the food is good.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A relative told us, “They look after the medication and make sure she (their relation) takes it.”

We found there was an effective system for identifying and responding to any complaints or comments made. A person who used the service told us, “The staff sort things out the best they can, they are all very helpful.”

We spoke with four people who told us that they were happy living at Rose Farm. One person told us they had lived there for two years and would never want to move.

All the people we spoke with told us there were always plenty of staff on duty who took time to talk with them if they were worried about anything.

One person told us “The staff are excellent. The care I receive is wonderful, as is the food. There is always plenty of good, home cooked food.”

We observed that people seemed very relaxed and content and this was confirmed by those we spoke with.

On the day of our visit to Rose Farm there were 47 people living at the care home.

We spoke with five people and each person said they were happy living there and it was comfortable. One person told us: "It's very nice, but not my home, I'd like to be living in my own home, but that's not possible anymore." Another person said that: "There are some very kind staff, and they work very hard to look after us."

None of the people were very clear about what information the staff wrote in their files, and one person said: “The staff write things down, but I’m not sure what.” A further discussion showed that no one was particularly bothered about the staff writing in their care files, and that they ‘trusted’ the staff to record things properly.

We spoke with three people who lived at the home about being safe. We asked each person if they felt safe, or had any concerns about the care they were receiving. We were told that there were no concerns, and all of the people we spoke with said that they felt quite safe.

We spoke with a number of people about the staff. No one we spoke with knew anything about the recruitment processes that were in place, however people said similar things about the staff, for example: “that there were some very kind, caring and lovely” staff.

Discussions showed that the manager has daily contact, and that people are able to talk about any issues that they have. Observations as we went around the building, showed that people knew the manager, and were comfortable talking to her.