We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 12 May 2017 and was unannounced. The inspection was carried out by one inspector. This was the first inspection of the service since a registration change to the legal status of the provider.

Rosedale House provides accommodation with personal care for up to 23 older people many of whom are living with dementia type illnesses. The home is located in a suburb of the city of Bristol.

There was a 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.

The registered manager and staff team demonstrated their commitment to providing a very caring service. They cared for people with dignity, to further improve and to follow best practice for the care of people living with dementia. The home had a good reputation within the local community and with health and social care professionals.

People were supported to stay safe because any risks to their health and welfare were well managed. The premises were properly maintained and staff were trained in how to support people safely. A full range of pre-employment checks on new staff were completed. These helped ensure that unsuitable staff did not gain employment at the home. The management of medicines was safe and in line with good practice.

People received a highly personalised care which was unique to their individual needs. Care records set out how to provide person centred care for each person. Daily lives for people included activities and hobbies that interested them. People were involved in things they liked and they told us they really enjoyed their days. The environment had been decorated and set out in a way that meant that people living there had their own space that they enjoyed. The home environment was full of unique areas and themes to keep people engaged in their surroundings.

People received safe care as staffing levels were reviewed and adjusted regularly according to the needs of the people who lived at the home. The staffing numbers fully took account of the number of people being looked after and their level of care and support needs. The staff were properly trained and this meant they were able to carry out their roles and responsibilities. It also meant they were able to provide care that was effective. Staff were being well supervised and supported by the registered manager, deputy manager and other senior staff.

People received care and support that met their individual needs. People were encouraged whenever possible to make their own choices and decisions in relation to their daily life. When people did not have full capacity to make decisions for them staff understood what to do to ensure that decisions made on behalf of the person were in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Risks to the safety of people were minimised as the staff had attended safeguarding adults training, and knew how to identify the different types of abuse. Staff also understood the procedure for reporting concerns. Risk assessments were in place that identified the areas where the safety of people may have been at risk.

There was enough suitably qualified staff on duty at any time of the day or night to provide safe care. Staff were recruited by safe

We carried out this inspection on 26 May 2015 and this was an unannounced inspection. During a previous inspection of this service in January 2014 we had identified concerns that people were not consistently involved in how their care was planned and provided or that care and treatment was not always planned to ensure people’s safety. We further found there were no effective systems to monitor the quality of care provided. During this inspection we found the provider had made the appropriate improvements.

Rosedale House provides personal care for a maximum of 23 people. At the time of the inspection there were 22 people living in the home.

A registered manager was in post at the time of 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.

Medicines were not always stored appropriately and in accordance with legal requirements.

The home was clean, however we identified areas where cross infection risks to people could be reduced. We have made a recommendation to the provider about following nationally published guidance to reduce cross infection risks.

People felt safe and staff could respond to suspected or actual abuse. Staff understood the concept of whistleblowing and were aware of external agencies they could report to.

People and their relatives told us the service met their needs quickly. Staff said there were sufficient numbers of staff on duty to enable them to perform their roles effectively and meet people’s needs.

Staffing levels set by the registered manager had been consistently achieved and staff numbers were increased when required. Safe recruitment procedures were completed when new staff were employed.

People spoke positively of the staff at the home and were happy with the standard of care they received. Staff felt they had the knowledge and skills to carry out their role. Staff received regular training. Appraisals and supervisions were completed to discuss performance.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. DoLS applications had been submitted where a need had been identified.

People were provided with sufficient food and drink and positive feedback was received on the standard of food provided. People received support if required and accurate records were maintained when food and fluid intake was being monitored.

Arrangements were made for people to see their GP and other healthcare professionals when required.

Staff had good relationships with people and we observed caring interactions throughout our inspection. People and their relatives spoke highly of the staff at the home.

Where possible, people were involved in making decisions about their care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

People’s privacy and dignity was respected by staff. People received personalised care and staff knew the needs of the people they were caring for. The provider had a complaints procedure and people felt confident they could complain should the need arise.

Activities were arranged for people within the service and the activities co-ordinator ensured the activities were tailored and designed to stimulate people living with dementia.

People knew who to contact in the service and the registered manager was respected by staff and the people at the home. Staff felt they were able to approach the management of the service with ideas or concerns.

The provider had systems to monitor the quality of service provision and staff incentive schemes had been developed to encourage a high standard of care provision.

We found a breach 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 this report.

People told us that they were settled in the home and they appreciated the support they received from staff. One person, for example told us “I’m very comfortable here” and another commented “we’re well looked after”.

We met with staff who were knowledgeable about people’s individual needs. Staff received guidance and training so that they were competent and supported people in a safe way.

People said that they felt safe living at the home. One person told us “if you have a problem you can go to the manager”. Staff knew what action to take if they had any concerns about people’s health or wellbeing. Overall, arrangements were being made to ensure that the service was meeting people’s needs.

The inspection was brought forward due to concerns raised about the care and welfare of named individuals who used the service.

The majority of the people we spoke with who used the service provided positive feedback regarding their experience of the service. Comments included ''I like it here I feel at ease the staff are very good. They ask me how I like things done”. Two people who used the service expressed concerns about not being listened to by staff members.

We viewed four care plans. The planning was centred on the individual and considered all aspects of their individual circumstances. The care plans were detailed and specific to the individual's needs and preferences. Where people were unable to make their own decisions the family members we spoke with told us that they were not involved in regular formal discussions regarding their relatives care.

We found that there was an inconsistent practice regarding reference checks on staff members. The provider was in the process of updating their recruitment policy and staff checks.

Staff we spoke with were knowledgeable about the people they supported and safeguarding procedures. They had received training appropriate to their roles. We found that there was not a consistent support structure in place for staff supervisions.

We found that the provider had inadequate systems in place to regularly assess and monitor the quality of the services provided.