We inspected Roseberry Court on 13 June 2017. The inspection was unannounced, which meant the staff and provider did not know we would be visiting. The last comprehensive inspection of the service was in May 2015 and we found that the provider was meeting the legal requirements in the areas that we looked at and rated the service as Good. At this inspection we found the service was also Good. We have also carried out two focussed inspections of Roseberry Court in May 2016 and December 2016 when we received information of concern.

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities are available within each unit. There is an enclosed garden/patio area for people to use. At the time of our inspection there were 61 people who used the service.

The service had a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present on the day of our inspection, however we spoke with them after our inspection visit.

The registered manager and staff displayed clear enthusiasm to make a positive difference to people's lives. Activities were stimulating, outings and events were well thought through, varied and in plentiful supply. There was a ‘Three wishes campaign’. People who used the service were asked to write down things they wanted to accomplish over the coming year. Staff then worked hard to make sure at least one of their wishes came true. People who used the service told us this had happened and their wishes had been granted. There were meaningful activities for people living with a dementia and thought had been given to the layout of Grace Unit to ensure it enhanced the life of people living with a dementia. Themed areas had been created in corridors which encouraged people to stop, look and interact with the surroundings and others.

People were protected by the services approach to safeguarding and whistle blowing. People told us they felt safe and could tell staff if they were unhappy. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This enabled staff to have the guidance they needed to help people to remain safe. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked.

There were sufficient staff on duty to meet the needs of people who used the service. There was a system in place to ensure that staff recruited had the appropriate skills and experience and were of good character.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

People were provided with a choice of healthy food and drinks, which helped to ensure that their

We carried out an unannounced comprehensive inspection of this service on 7 May 2015 where we found that the registered provider was meeting the legal requirements in the areas we looked at.

We visited the service again on 19 May 2016 when the Care Quality Commission and the local authority received safeguarding concerns in relation to the care of people who used the service and about staff's lack of understanding of positional changes when people were in bed and pressure area care was required. There were also concerns of inconsistency in care records such as positional charts, fluid balance charts and end of life care plans. After receipt of the concerns there was a multidisciplinary team meeting chaired by the local authority to consider the serious concerns protocol and we attended this meeting. At this meeting the multidisciplinary team concluded that there were serious concerns about Roseberry Court. The registered provider developed an action plan detailing the steps they were to take to address the concerns. After the initial meeting the local authority placed a block on all new admissions, however, this was quickly lifted as the registered provider worked swiftly to make improvements. During this time, representatives from the local authority visited the service to review people who used the service and to check for improvements. Following their visits, representatives from the local authority gave us feedback and told us there was much improvement.

The focused inspection on 19 May 2016 was to check the service had sustained improvement. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. At our inspection on 19 May 2016 we found that the registered provider had followed their action plan and improvements had been made in all areas.

At the end of October 2016 the Care Quality Commission and the local authority received further information of concern in relation to the care and welfare of people who used the service. Allegations were made that the call bells used by people to summon the help of staff had been unplugged on occasions, staff ignored people who used the service, medicines had not been given at the right time and there was secondary dispensing of medicines. This is when one care staff member removes the medicines from the original dispensed container, puts this into a pot then gives to another care staff member to give to the person who used the service. Other concerns included people missing meals and inappropriate food being given to people who had been assessed as needing a soft diet. Allegations were made that staff shouted at people and staff were rushing people to bed early.

The local authority is currently undertaking an investigation into the concerns and allegations made. However, we undertook a focussed inspection of the service on 13 December 2016 to make sure people were safe, happy and well cared for. This report only covers our findings in relation to those/this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseberry Court on our website at www.cqc.org.uk”

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities were available within each unit. There is an enclosed garden/ patio area for people to use. At the time of our inspection there were 57 people who used the service.

People told us they felt safe and that staff were kind, caring and attentive. Staff were able to tell us about different types of abuse. Staff were aware of ac

We carried out a comprehensive inspection of this service on 7 May 2015. Following the inspection the local authority received safeguarding concerns in relation to the care of people who used the service, staffs lack of understanding of positional changes when people were in bed and pressure area care. There were also concerns of inconsistency in care records such as positional charts, fluid balance charts and end of life care plans. The local authority shared the safeguarding concerns with the Care Quality Commission. We also received information of concern from a relative regarding the care and welfare of people who used the service and we shared this information with the local authority.

After receipt of the concerns there was a multidisciplinary team meeting chaired by the local authority to consider their serious concerns protocol and we attended this meeting. At this meeting the multidisciplinary team concluded that there were serious concerns about Roseberry Court. Other meetings were held to manage and monitor the serious concerns about the service. The registered provider developed an action plan detailing the steps they were to take to address the concerns. After the initial meeting the local authority made the decision to place a block on all new admissions and the registered provider agreed and complied with this, however, this was quickly lifted as the registered provider worked swiftly to make improvements. During this time representatives from the local authority visited the service to review people who used the service and to check for improvements. Following their visits representatives from the local authority gave us feedback and told us there was much improvement.

We undertook a focused inspection on 19 May 2016 to check the service had sustained improvement. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. At our inspection on 19 May 2016 we found that the registered provider had followed their plan and improvements had been made in all areas. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseberry Court on our website at www.cqc.org.uk”

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities were available within each unit. There is an enclosed garden/ patio area for people to use. At the time of our inspection there were 59 people who used the service.

The home had a registered manager 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 2008 and associated Regulations about how the service is run. The registered manager was on sick leave at the time of the inspection; however a registered manager from another home in the organisation was managing the service on a day to day basis.

At the time of the inspection there wasn’t any person who used the service who was nearing the end of their life; however we were shown a standard set of end of life documentation which was to be used by staff at the service. This included positioning charts, body mapping charts and food and fluid charts. The end of life plan had space to record information important to the person such as any wishes, a personal cleansing care plan and any relevant risk assessments. Management and s

We inspected Roseberry Court on 7 May 2015. This was unannounced which meant that the staff and registered provider did not know that we would be visiting.

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities were available within each unit. There is an enclosed garden/ patio area for people to use.

The home has a 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.

There were systems and processes in place to protect people from the risk of harm. People were protected by the service’s approach to safeguarding and whistle blowing (telling someone). People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. People told us that staff treated them well. Staff were aware of the different types of abuse and action to take if abuse was suspected. Checks of the building and maintenance systems were undertaken to ensure health and safety.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the care and support needed; this included the person's likes, dislikes and personal choices. We found that risk assessments were detailed and contained person specific actions to reduce or prevent the highlighted risk.

Staff told us that they felt well supported and they had received supervision on a regular basis. We saw records to confirm that this was the case. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We saw records to confirm that staff had received an annual appraisal.

Staff had undertaken training in fire safety, first aid, health and safety, infection control, safeguarding and dementia. Any shortfalls in training had been identified and training had been planned.

People, relatives and staff that we spoke with during the inspection told us that there were enough staff on duty to ensure that people’s needs were met. During the day there were 11 staff on duty shared between three units until 2:30pm. After that time this reduces to 10 staff until late evening. At night there were six staff on duty shared across the units. We were told that staffing levels were flexible depending on need.

Staff had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff had an understanding of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions.

At the time of the inspection, there were some people who used the service who were subject to a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Staff had a good understanding of DoLS.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. People who used the service and relatives told us that staff were very caring, showed compassion and were patient.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and they were encouraged to take part in activities. People told us that they were happy with the activities provided by staff at the service.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. This helped to ensure that the service was run in the best interests of people who used the service.

Roseberry Court provides care and accommodation for up to 63 older people, some of whom may be living with a dementia.

An expert by experience spoke with people who used the service, relatives and staff. The inspector spoke with people who used the service and staff. We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People told us that they felt comfortable in raising a concern or complaint with the manager or staff.

The inspection team was made up of one inspector and an expert by experience. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that their rights and dignity were respected.

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

People were cared for in safe, accessible surroundings that promoted their wellbeing.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and there was evidence to show that these had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Is the service effective?

People’s health and care needs were assessed and where possible people and their relatives were involved in writing the plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends were regularly asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

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

Is the service responsive?

People knew how to make a complaint if they were unhappy. Discussion with the manager and operations manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with 12 people who used the service and two relatives. We also spoke with the manager, the operations manager, the head chef, the head of care, the activity co-ordinator and with care staff.

People who used the service told us that they were very happy with the care and service received. One person said, “People treat me with such kindness.” Other people said, “Staff can’t do enough for you.” “Care couldn’t be better.” “Happy with the care I get.”

People told us that they were happy with the food that was provided. One person said, “Excellent food, good choice.” Another person said, “We even get supper.” People told us that they felt safe. One person said, “I sleep better here than at home.”

People told us that they felt comfortable and spoke to staff if they were concerned or had a complaint. One person said, “Would go to the horse’s mouth.” A relative we spoke with said that they were not aware of the complaints procedure but that they would speak with a care staff member who was in charge if they had a problem. The relative told us that they had not needed to raise any concerns with staff in the last five years.

The activity co-ordinator told us that “We are one big happy family; everyone knuckles down to help when an activity is planned.”

The head chef told us about a dining experience that they had created on the second floor for those people living with a dementia. At tea time staff took people who used the service to their rooms to freshen up. People who used the service, who were able, then helped staff to set the tables. During this time staff talked to people about the meal. People were given a drink and encouraged to converse with each other. Food was then served whilst soft music is played in the background. We were told that this experience was started for people who lived with a dementia as they were at the highest risk of weight loss. The head chef told us this had helped people to gain weight and to be discharged from the dietician.

You can see our judgements on the front page of this report.

We spoke to people using the service but their feedback did not relate to this outcome.

We found the home had improved the medication records and systems to make sure people’s medication was managed in a safe way.

During the inspection we spoke with six people who used the service and two relatives. We also spoke with the manager, the operations manager, the senior operations manager, the activity co-ordinator, the office administrator and two care staff. People and relatives told us that they were happy with the care and service received. One person said, “I get on well with staff, they are like friends really.” Another person said, “It’s very nice here and I’m settled. I can put my telly on or listen to my radio whenever I want to. If I need help I have a buzzer and they come and help me.”

We used a number of different methods to help us understand the experiences of people who used the service, because some people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two relatives who said, I am happy with everything.” Another relative said, “I’m quite impressed with the home and staff are good at communicating with me.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that appropriate recruitment procedures were in place.

We spoke with two people who used the service. One person told us, "It's ok here, I can't complain. I get the care that I need." They also told us that there had been a meeting the week before, when staff had told them about new activities that were planned. They also said, "There was a little concert last night, but I didn't go. Others told me it was very nice." Another person told us, "It's boring in here, there is nothing to do. They do things such as bingo, but I'm not interested. I didn't go to the concert last night, as it's not my sort of thing." We observed that staff treated people as individuals and there was a stimulating atmosphere with a high level of engagement between staff and people living at the home. The manager, who had recently started at the home, told us that they were in the process of further developing the activities delivered within the home to meet people's needs.

We found people expressed their views and were involved in making decisions about their care and treatment. Also care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We spoke with six people who use the service. They told us they were treated well and that staff were nice. One person said “I am well looked after” another told us “anything you want they are there for you.” One person told us “there’s not a lot to do”, however another told us they went out in the mini bus every week to the pub for lunch and had taken part in chair activities that morning which led to a “sing-a-long.”

We observed staff interacting well with people. We saw staff singing along to music and encouraging people to join in. We saw one member of staff brought in newspapers and magazines for people to read. We observed one member of staff sat and read through a magazine with one person when she was getting restless. We saw that these interactions had a positive impact on people’s wellbeing. We saw that not all of the people were involved in activities; therefore for some people this interaction was limited. It was clear from talking to staff that they were aware of people’s needs and support required, however we found this was not always documented sufficiently in the care records.

The visit took place because we were following up concerns we had raised during the last

inspection in October 2011. Therefore when talking with people we concentrated on

these specific areas.

We spoke with nine people. Comments included “I like all the girls”, “I’m fed up with sandwiches at tea time”, “I have my favourite staff, some of the girls are very young” and “There is pies and peas tonight which will be nice”.

People also told us "There is nothing to do here. It's wicked just sitting here doing nothing" and “I sometimes get bored.” However, another person told us “I go out every week in the minibus for lunch, I really enjoy it.” One person told us “I know there are meetings and I sometimes go to them.”

Two relatives told us they were pleased with the home. They said when they visited they were always offered a drink and felt welcome. Staff were always helpful and chatty.

People told us that they were “very happy here”, that the “staff couldn’t do anything more for you” and that the “girls are great”. One person told us they had “only been here three weeks but have settled in already”.

The relative we spoke with said that the home was generally very good, however they had been concerned at times about there not being enough staff in the lounge area. In addition, their relative’s clothes seemed to go missing from the laundry on a regular basis. The home had not invited them to the regular reviews of care, but they had felt able to provide views about the care through feedback forms.

People that we spoke to during our visit, told us "I'm happy with the care" and "staff are lovely". When asked if they felt safe living at Roseberry Court Care Home people said "Yes, I feel safe" and "I like it here".

People showed us their rooms and said "it is nice and clean".

They said they felt involved in decisions about their care and activities.