Rosebery Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rosebery Manor provides facilities and services for up to 95 older people who require personal or nursing care. The service is purpose-built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called The Oaks. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle. On the day of the inspection there were 74 people living at Rosebery Manor.

The registered manager had recently left the service although continued to be employed by the provider. A new manager was in post and had begun the registration process. 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 10 August 2017 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following concerns relating to the care people were receiving we completed a further inspection Rosebery Manor on 24 May 2018 where seven breaches of legal requirements were identified. These were in relation to a lack of consistent leadership and management oversight, risks to people's safety not always being identified and acted upon, people’s medicines not being managed safely and accidents and incidents not being adequately monitored. In addition, we found that sufficient, skilled staff were not always deployed, complaints were not always recorded and responded to, people’s dignity was not always being upheld and people’s care was not always person-centred.

Following this inspection, we issued warning notices in relation to safe care and treatment and good governance. As a result of our concerns Rosebery Manor was placed into special measures. 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 significant improvements had been made in all areas of the service and no breaches of legal requirements were identified. The overall rating for the service is requires improvement. We could not improve the rating for well-led and safe from inadequate to good because to do so requires consistent good practice over time. We will check whether these improvements have been sustained during our next planned comprehensive inspection.

People told us they felt safe living at the home and staff understood their responsibility to identify and report any concerns of potential abuse. Staff received safeguarding training which was regularly updated. Risks to people's safety were identified and assessed.

There were enough staff to meet people's needs and regular agency staff were used where required. New staff were appointed through safe recruitment and selection processes. Accidents and incidents were reported and action taken to minimise risks and identify trends. People received their medicines in line with their prescriptions and safe systems of medicines management had been developed. Staff understood their responsibility to protect people from the risk of infection and followed appropriate infection control procedures. People lived in a safe environment which was suited to their needs and contingency plans were in place to ensure people received their support in the event of an emergency.

People’s needs were ass

The inspection took place on 24 May 2018 and was unannounced.

Rosebery Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rosebery Manor provides facilities and services for up to 95 older people who require personal or nursing care. The service is purpose built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called The Oaks. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle. On the day of the inspection there were 86 people living at Rosebery Manor.

At our last inspection on 10 August 2017 four breaches of regulations were identified. The concerns found related to risks to people's safety not being adequately managed, safe medicines practices not being followed, safeguarding concerns not being reported in a timely manner, the lack of effective quality assurance systems and the failure to notify CQC of significant events in line with statutory requirements.

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 and Well-led to at least good. At this inspection we found three repeated breaches of regulations relating to the management of the service, how people were kept safe and the failure to submit statutory notifications. In addition, we identified concerns relating to the deployment of staff, responding to complaints, treating people with respect and dignity and providing person centred care.

There was no registered manager 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. The last registered manager had left the service in April 2017. A manager had recently been appointed who supported us to access information during the inspection. The manager informed us they had begun the process of registering with CQC and our records confirmed this was the case.

There was a lack of consistent leadership of the service. There had been five managers in post in the last year. In addition, there had been changes to other key roles. This had led to a negative culture across the service. Quality assurance systems were not always effective in ensuring improvements to the service happened in a timely manner which protected people from risks. Records regarding the care people required were not always up to date and accurately maintained. The complaints log did not contain details of all complaints made and not all complaints had been responded to.

Medicines management systems were not robust which meant people were at risk of not receiving their medicines in line with prescription guidelines. Risks to people’s safety were not always known to staff. The providers policy regarding people receiving night checks was not consistently followed which put people at risk of harm. Sufficient skilled staff were not always deployed and people told us that the high use of agency staff impacted on the care they received. Staff did not always receive the training they required to support them in their roles. Agency staff did not receive supervision to monitor and develop their practice. Permanent staff supervision had improved within recent months. We will continue to monitor this to ensure that systems are embedded into practice.

People did not always receive person centred care and where people’s needs changed this was

The inspection took place on 10 August 2017 and was unannounced.

Rosebery Manor provides accommodation, care and support for up to 95 people who require support with personal or nursing care. The home is set over three floors. The second floor provides care and support to people who are living with dementia, this unit is called The Oaks. The other areas of the home provide care for people requiring ‘assisted living’. Some people lead a mainly independent life and use the home’s facilities to support their lifestyle. On the day of the inspection there were 89 people living at Rosebery Manor, 62 people required personal or nursing care.

There was no registered manager 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 and associated Regulations about how the service is run. An interim manager had been employed at the service since April 2017 whilst recruitment took place. The interim manager supported us during our inspection.

We carried out an unannounced comprehensive inspection of this service on 3 November 2016. After that inspection we received concerns in relation to safeguarding concerns not being identified and appropriately recorded to the local authority and the Care Quality Commission (CQC). As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to safe and well led key areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosebery Manor on our website at www.cqc.org.uk”

Safeguarding concerns had not always been reported to the relevant local authority to ensure thorough investigations took place in order to keep people safe. Staff had not consistently recognised the signs of potential abuse which had therefore not been reported internally or to external authorities. There had been a number of incidents between people which had not been reported and action had not always been taken to protect those concerned.

Risks to people’s safety and well-being had not always been comprehensively assessed and monitoring systems in place to manage risks were not always effective. Accidents and incidents were not recorded and addressed to minimise the risk of them happening again. People’s medicines were not always managed safely and medicines errors were not always investigated.

There was a lack of management oversight in the service. The manager was unaware of a number of incidents which had taken place in the service over recent months. Quality assurance systems were not effective in ensuring concerns were identified and addressed in a timely manner. Records were not always completed accurately and were not always accessible by the manager of the service. The provider had failed to ensure that the CQC were notified of significant events in the service in line with their legal responsibilities.

There were sufficient staff deployed to meet people’s needs and people did not have to wait for care. However, people told us that the high use of agency staff was a concern to them. We have made a recommendation regarding this. This is because although enough staff were caring for people agency staff may not know everyone of their individual needs and preferences and this affects the care they receive. Robust recruitment practices were followed to ensure that staff employed were safe to work in the service.

People had the opportunity to contribute to the running of the service through forums, resident meetings and annual questionnaires. Where concerns or improvements had been suggested these had been implemented. Staff felt supported by the management of the service and felt their views were listened to.

During the inspection we found three breaches of the Health and Social

This inspection took place on 3 November and was unannounced. Rosebery Manor provides accommodation, care and support for up to 95 people who require support with personal or nursing care. The home is set over three floors. The second floor provides care and support to people who are living with dementia, this unit is called The Oaks. The other areas of the home provide care for people requiring ‘assisted living’. Some people lead a mainly independent life and use the home’s facilities to support their lifestyle. On the day of the inspection there were 91 people living at Rosebery Manor, 62 people required personal or nursing care.

At our inspection in September 2015 we found that people were not always receiving safe care as risks to people’s safety were not adequately controlled and safe medicines systems were not followed. We also found concerns regarding how the service was managed as records were not updated or accessible and quality assurance systems were not effective. At this inspection we found that improvements had been made in all areas although there were some continued concerns regarding medicines management.

There was a registered manager in post who supported us throughout 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.

Safe medicines management systems had improved but there were still a few gaps in staff recording what medicines were given or refused. We have made a recommendation that improvements to this system are continued.

People were protected from avoidable abuse and harm as staff knew what action to take in the event of suspected abuse. Risks to people were identified, assessed and managed safely. Accidents and incidents were monitored to minimise the risk of reoccurrence. Staffing levels had improved and were sufficient to meet people's needs and robust recruitment processes were in place. Staff received an induction into the service and completed on-going training to develop their skills in their role. Supervision had increased and was provided to staff to monitor their performance.

People were complimentary about the food provided and staff monitored people’s dietary needs. There was a wide range of nutritious foods available and people were encouraged to give feedback regarding their preferences. People were supported with their healthcare needs and staff consulted with external healthcare professionals to get specialist advice and guidance when needed.

Staff knew people well and positive, kind and caring relationships had been developed. People and their relatives were involved in decisions regarding their care and support and consent was gained by staff prior to care being given. People were treated with dignity and respect and were encouraged to maintain their independence. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed.

Care plans were comprehensive and provided detailed information to staff about people's care needs and how they wished to be supported. People were supported by staff who knew them well. A range of activities was planned which focussed on people’s hobbies and interests.

The provider had a complaints policy in place which was shared with people and their relatives. Complaints had been investigated and responded to and action was taken to identify trends. People were asked for their views about the service through a range of forums, feedback cards and questionnaires. Results showed positive improvements had been made within the service.

Staff felt the home was well managed and that the registered manager was accessible and approachable. The range of quality assurance systems had improved and were now in place t

Rosebery Manor provides accommodation, care and support for up to 95 people who require support with personal or nursing care. The home is set over three floors. The second floor provides care and support to people who are living with dementia, this unit is called The Oaks. The other areas of the home provide care for people requiring ‘assisted living’. Some people lead a mainly independent life and use the home’s facilities to support their lifestyle. On the day of the inspection there were 71 people living at Rosebery Manor, 65 people required personal or nursing care.

The inspection took place on 7 October 2015 and was unannounced. This was the first inspection of the service since it had registered.

There was a registered manager 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 and associated Regulations about how the service is run.

Suitable arrangements were not in place to ensure that medicines were managed safely. Gaps were present in some medicine recording and medicines remained in the packets when staff had signed to say it had been administered. Medicines stored in people’s rooms were not always secure and temperatures of storage areas were not consistently monitored.

People told us that there were not always enough staff at busy times of the day to meet their needs, people told us they sometimes had to go to bed earlier than they would like or had to wait to be supported.

Risk assessments for people were not regularly reviewed to ensure staff had the most up to date information. People could be at risk of harm from developing pressure wounds as staff did not ensure they turned or repositioned people as often as they should.

Staff received trained in safeguarding adults and knew how to report any concerns. They were aware of the whistleblowing policy and how to access guidance.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean environment that was suitable for their needs.

Staff did not always receive supervision in line with the provider’s policy. However, regular staff meetings were held and staff were encouraged to raise issues for discussion. Staff received necessary training and support to enable them to do their jobs.

People told us they enjoyed the food and were always offered a choice. We saw that meals were prepared using fresh ingredients and people were regularly consulted about the menu options. However, some staff were not aware of people’s dietary needs such as diabetes and gluten free diet.

There was a positive and caring atmosphere in the home. Staff interacted with people with kindness and respect and promoted their independence. They told us the registered manager was approachable and listened to their concerns. People told us they were supported to attend medical appointments and we saw evidence that health professionals were involved in people’s care.

Care plans were in place to guide staff in providing care. However, plans were not regularly reviewed and were difficult to access. The electronic recording system used was not always accessible to staff meaning that records were inconsistent and not update to show continuity of care. A comprehensive assessment process was in place and people’s life histories, likes and dislikes were well documented.

A range of activities were provided for people and people told us they were encouraged to develop their interests with the support of staff. Community activities were offered on a regular basis and visitors were always welcome.

Audits to monitor the quality of the service were not always effective in identifying shortfalls and systems were not in place to gather feedback from relatives and professionals involved. People living at the service had been asked to complete satisfaction questionnaires which were in the process of being analysed. There was a complaints procedure in place and we saw that complaints had been responded to in a timely manner. The registered manager had not notified the Care Quality Commission (CQC) of a number of incidents which had recently occurred in the service.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.