The inspection was completed on the 21 and 22 June 2018 and was unannounced. At the time of this inspection there were 47 people living at Rose Martha Court.

Rose Martha Court 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 care home accommodates up to 76 older people and people living with dementia in one adapted building.

Rose Martha Court is a large purpose built building situated in a residential area in Leigh on Sea and close to all amenities. The premises is set out on two floors and is unitised [Lavender, Sweet Pea, Forget Me Not and Primrose], with each person using the service having their own individual bedroom and adequate communal facilities available for people to make use of within the service.

At the last inspection on the 10 and 11 August 2017, the service was rated ‘Requires Improvement’. Four breaches of regulatory requirements were identified pertaining to Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-Led’ to at least good. At this inspection, we found the service had improved their rating to ‘Good’.

A registered manager was 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.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs to ensure theirs’ and others’ safety. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines. This meant people received their prescribed medicines as they should and in a safe way.

Staff received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction based on their level of experience in a care setting and competencies. Staff felt supported and received appropriate formal supervision at regular intervals and an appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect, dignity and to maintain their independence.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Care plans accurately reflected people’s care and support needs and people received support to have their social care needs met. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions. People had their nutritional and hydration needs

At our previous comprehensive inspection to the service on 30 June 2016, 1 and 4 July 2016 five breaches of regulatory requirements were made in relation to Regulation 9, Regulation 12, Regulation 14, Regulation 16 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider shared with us their action plan in August 2016 and this provided detail on their progress to meet the required improvements. At this inspection we found not all of the above regulations had been complied with, namely Regulations 12 and 17.

Rose Martha Court provides accommodation and personal care for up to 76 older people and people living with dementia.

This inspection was completed on 10 and 11 August 2017 and there were 60 people living at the service.

A registered manager was 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.

Whilst improvements were noted since our last inspection in relation to some aspects of care provision, care planning arrangements, people’s nutritional and hydration needs and complaints management; quality assurance checks and audits carried out at service level were not as robust or effective as they should be. The registered manager had not recognised the issues we identified during our inspection including where people were put at risk of harm or where their health and wellbeing was compromised. The registered manager was unable in some instances to demonstrate how they identified where improvements to the service were needed and lessons learned.

Suitable measures were not always in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Significant improvements were required in relation to medicines management so as to ensure the supply, administration and recording of medication was appropriate. Robust procedures and processes that make sure people are protected from abuse and improper treatment had not at all times been considered and followed by the registered manager of Rose Martha Court.

Where staff’s care practices and performance required improvement, suitable arrangements were not always in place to ensure staff received refresher updated training. Improvements were needed to ensure where appropriate newly employed staff completed the ‘Care Certificate’ or an equivalent robust induction, particularly where newly employed staff had limited experience within a care setting or had not attained a National Vocational Qualification. Suitable arrangements were not in place to ensure staff received regular supervision and an appraisal of their overall performance.

Although people’s comments about staffing levels were variable, our observations showed that the deployment of staff was suitable to meet people’s needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected.

The dining experience for people was generally positive and people were complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions. People told us that their healthcare needs were well managed; however improvements were required to ensure staf

Rose Martha Court provides accommodation and personal care for up to 76 older people. Some people also have dementia related needs.

The inspection was completed on 30 June 2016, 1 July 2016 and 4 July 2016 and was unannounced. There were 62 people living at the service when we inspected.

A registered manager was 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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk, pressure mattresses were not correctly set in relation to people’s weight and bedrail assessments had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits.

Although people did not think that there were sufficient numbers of staff available to meet their needs or their relative’s needs, our observations showed that staffing levels were suitable at the time of this inspection. However, staff did not always have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated. People’s comments about the care and support they received were variable. Whilst some staff’s interactions with people were positive and staff had a good rapport with the people they supported, this was in contrast to other observations. These showed that some staffs practice when supporting people living with dementia required further improvement and development.

The implementation of staff training was not as effective as it should be so as to ensure that staff knew how to apply their training and provide safe and effective care to the people they supported. Although staff had received appropriate training relating to manual handling and dementia awareness, staff did not recognise the importance of safe manual handling procedures and the significance of good person centred care for people living with dementia.

The dining experience was not always positive and person focussed. Consideration by staff was not always well-thought-out to ensure that eating and drinking was an important part of people’s daily life or treated as a social occasion. Where instructions recorded that people should be weighed at regular intervals, this had not always been followed. Records of the meals provided and fluids taken had not always been maintained in sufficient detail to establish if people’s dietary needs were being monitored, managed or encouraged where this was required.

Not all of a person’s care and support needs has been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. The needs of people approaching the end of their life and associated records relating to their end of life care needs were either not recorded or contained minimal information. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for peo

A single inspector carried out this inspection. Below is a summary of what we found.

At the time of our inspection there were 60 people using the service. As part of this inspection we spoke with ten people using the service, three visiting relatives, six staff and the registered manager. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included six support plans, daily support records, four staff files and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had detailed policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

The staff team were skilled and experienced. Staff we spoke with said they had been properly recruited and trained for their roles. Staff told us that they received good support from the management team.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People's care records showed that care and treatment was planned in a way that was intended to ensure people's safety and welfare. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by cheerful and attentive staff. We saw that care workers showed patience and understanding when supporting people. A person who used the service we spoke with told us, “The staff are all very good, I’m happy here.” Another person told us, “I like it here, everything is done for me by the staff who are all nice and always smiling.”

A relative we spoke with told us, “The staff are very approachable and listen to our views, they are also caring and always busy making sure our relative’s needs are being met.”

The responses and views of people who used the service and their relatives were asked for as part of regular quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people’s wishes.

Is the service responsive?

Where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the healthcare support they needed. This included seeking support and guidance from care professionals, including doctors and community nurses.

People had the opportunity to enjoy a range of activities and were able to get out and about in the local and wider community.

A person who used the service we spoke with told us, “There are nearly always staff around, they check if I’m ok and need anything, if I tell them if I’m worried about something they try to help me.”

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times.

A relative we spoke with told us, “I’m satisfied with the care my relative receives in this home, the staff are good at understanding my relative’s needs and the managers and staff are good at keeping me updated about my relative’s health.”

As part of this inspection process we spoke with the registered manager, team leader and three members of staff. It was positive to note that improvements had been made by the provider in relation to our previous inspection in September 2013. This referred specifically to consent to care and treatment, safeguarding, medicines management, supporting staff, quality assurance, complaints management and records.

People's health and personal care needs were assessed and there were care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. People told us that they liked living at Rose Martha Court and that they found the staff to be kind and caring. Our observations suggested that people living at the service were happy, that they felt safe and were well cared for. It was evident that the people who used the service had a good relationship and rapport with the staff who supported them.

Improvements were required in relation to ensuring that peoples' care records contained all of the information necessary for care staff to follow and that this was easily accessible. We also found that improvements were required to ensure that the home environment was safe for people living at Rose Martha Court.

As part of this inspection we spoke with six people who used the service, seven members of staff (excluding the manager and deputy manager) and reviewed seven people's care records.

Throughout our inspection the atmosphere at Rose Martha Court was observed to be calm and relaxed. Staff interactions with people who used the service were noted to be positive and it was evident that staff had a good knowledge and understanding of people's care and support needs.

Each person was noted to have a care plan in place detailing their care needs and how they were to be supported by staff. Records also showed that people who used the service were supported with their healthcare needs. Robust systems were in place to ensure that staff were recruited properly and that they received a comprehensive induction.

Whilst we acknowledge that there were a lot of positives as detailed above, improvements were required in relation to consent to care and treatment, ensuring that people who used the service had an accurate record maintained about their care and support needs; and training, supervision and appraisals for staff.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) .

People we spoke with told us that staff treated them with respect and that so far as possible they were involved in making decisions. One person told us that they were supported to continue enjoying their hobbies since moving into the home. People told us that they were involved in making decisions about the range of activities provided in the home.

One person told us that staff often enquire as to how they are and the manager regularly pops in for a chat and to see that they are happy with everything. Another person told us: ‘’Staff are always very kind and always have time to listen to me.’’

People we spoke with told us that they were happy with the choice of food available to them and the arrangements for mealtimes. One person told us: “We are eating much better” since they moved into Rose Martha Court. People told us that there was always hot and cold drinks, biscuits and sandwiches available if they were hungry.

People told us that they enjoyed the meals provided. People said that they had a choice of two meals at lunchtime and that they could change their minds about their choice of food even when the meals were being served.

None of the six residents knew of any instances of abuse and they all felt that it would not

happen because the staff are too caring. They told us they would see the manager if they

had any concerns. People we spoke with told us that they felt safe and well looked

after at Rose Martha Court.

Each of the six people we spoke with told us that staff were available when they needed assistance. People told us that staff were attentive and quick to offer help when needed.

None of the six residents could remember if they had a care plan but all knew their records

were “kept in the office”