This inspection took place on 12 and 17 December 2018. The inspection was unannounced on both days.

We had previously inspected the home in December 2017 and rated it as requires improvement overall. Our key question of ‘caring’ was rated as good and other key questions were rated as requiring improvement. We found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 because the provider had failed to ensure they notified us of other incidents. At this inspection we found this had not improved.

Rosehill House Residential Home 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.

The home provides care and support for people with residential needs and has a maximum occupancy of 27 people over two floors. On day one of our inspection 23 people were living at the home, on day two there were 24 people living at the home, one of whom was receiving respite care and support on a temporary basis.

The home 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found failings in the oversight, monitoring and management of the service which meant people did not always receive safe care and support.

The management of risks was not cohesive or consistent. People did not always have individualised risk assessments in place and these had not always been reviewed regularly.

Medicines were not administered safely. We could not be assured these were always administered as prescribed or stored safely.

Mental capacity assessments and best interest decisions had not taken place for people living with dementia. Consent was not checked or recorded. DoLS applications had been made appropriately.

Staffing levels were sufficient, rotas were in place and gave consideration to staff skills. A dependency tool was used to asses staffing levels.

There was a regular programme of activities and people spoke positively about the activities co-ordinator however some people were left without social stimulation for long periods of time.

Staff received regular and appropriate training and supervision but had not received an appraisal within the last 12 months.

People's needs in relation to the protected characteristics of the Equalities Act 2010 were taken into account at pre-admission. People's communication needs were assessed.

There were safe recruitment policies and procedures were followed.

The service worked and developed links with local community groups and organisations.

Staff told us they felt supported by the management team and people spoke positively about staff.

We found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Where regulations have been breached information about these breaches is at the back of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is completed. Where providers are not meeting fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service.

When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action taken.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This is the first time the service has been in

We carried out this inspection on 19 December 2017. The inspection was unannounced. This meant no-one at the service knew we were planning to visit.

Rosehill House Residential Home 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. Rosehill House is registered to provide accommodation for persons who require nursing or personal care. The service can accommodate a maximum of 23 people. The service is a detached property within its own grounds. At the time of the inspection there were 22 people living at the home.

Our last inspection at Rosehill House took place on 6 and 7 September 2016. The service was rated Requires Improvement overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations. However, at this inspection we found the registered provider was not submitting notifications to the Care Quality Commission every time a significant incident has taken place, This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents. You can see what action we told the registered provider to take at the back of the full version of the report.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had the necessary skills and understanding to support people to evacuate safely in the event of a fire. We saw the registered manager was in the process of completing personal emergency evacuation plans (PEEPs) for everyone who lived at the service. PEEPs are a support plan for people who may need help and assistance to leave a building in the event of an emergency. We recommended the registered manager prioritise the completion of these assessments so associated risks are mitigated in the event of an evacuation.

The staffing numbers were worked out using a dependency tool. This identified the level of dependency for each person, such as low, medium and high dependency. We identified inconsistencies with the quality of people’s dependency assessments. Throughout the day we observed that people received timely care and staff did not appear rushed.

We found systems were in place to make sure people received their medicines safely so their health needs were met. We asked the registered manager to start recording room temperatures to ensure medicines are stored in appropriate conditions. If medicines are not stored properly they may not work in the way they were intended, and so pose a potential risk to the health and wellbeing of the person receiving the medicine.

The service employed a part-time activities coordinator and we saw a programme of activities was offered at the service. We received mixed feedback from people who used the service about the quality of activities provided.

We saw some people who used the service were living with dementia. We identified improvements to the adaptation and design of the service to make the environment more dementia friendly.

People’s care records contained detailed information and reflected the care and support being given. However, we found care records needed more detail about people’s social histories and preferences, such as likes and di

This inspection took place on 6 and 7 September 2016 and was unannounced. A previous inspection, undertaken in July 2014, found there were no breaches of legal requirements.

Rosehill House Residential Home is situated on the outskirts of Dodworth village, near Barnsley. The home is a detached property within its own grounds, providing accommodation and personal care for up to 23 older people. To the front of the property is a large patio/terrace with garden furniture. Ramps are provided to the main entrance at the side of the building. At the time of the inspection there were 22 people living at the home.

Our records showed there was a registered manager registered for the location. However, the provider told us that this manager had not been at the home some time. He said he would take steps to remove this manager’s name from the registration. An acting manager was working at the home. She told us she had been in post approximately ten weeks and had commenced her application to formally register as the manager. Our records confirmed this process was ongoing. A registered manager is a person who has registered with the CQC 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 said they felt safe living at the home and said the staff treated them well. Staff had received training with regard to safeguarding issues and demonstrated an understanding of potential abuse. They told us they would report any concerns to the acting manager. We found some windows did not have restrictors or devices that met with current Health and Safety Executive guidance for care homes. No risk assessments were in place. There were odours in some rooms, although flooring and furniture was being replaced as part of an on-going programme of refurbishment. The laundry area was not suitable and walls in this area were damp and could not be cleaned effectively.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people living at the home. People said they felt more staff would be helpful and we observed that at meal times people did not always get consistent support. It was not clear how staffing levels were directly determined by dependency assessments. Medicines were handled safely and effectively and stored securely.

Most people told us they were happy with the standard and range of food and drink provided at the home and could request alternative dishes, if they wished. Kitchen staff had knowledge of specialist dietary requirements. Staff did not always support the social side of the meal time experience.

Staff confirmed they had access to a range of training. The provider had recently appointed an independent training company to support staff across all their homes. Staff told us, and records confirmed that regular supervision took place. The acting manager told us records she had reviewed suggested there had been no recent annual appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The acting manager had a full record of people who had been subject to a DoLS or for whom a DoLS application had been made. Some reference was made in care plans to taking decisions in people’s best interests, although details regarding the least restrictive option were not always clear. We have made a recommendation about this.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff.

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff demonstrated an

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Rosehill House is a residential care home which was providing care and support to 22 people at the time of our inspection. A number of people living at the home had dementia. As part of the inspection we spoke with three people who lived at the home, four members of staff, one relative and the home manager.

This was a follow up inspection to check that improvements had been made in the management of medicines and assessing and monitoring the quality of the service since our previous inspection on 23 April 2014. At the previous inspection we found staff had not always signed the Medication Administration Record (MAR) when they had administered medication. The manager had audited the MAR sheets and identified that this was of concern but had not taken any action. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

The manager of Rosehill House submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At this inspection three people who used the service gave positive feedback about the care and support they received. They told us staff gave them their medication as prescribed and when they preferred.

We spoke with one visiting relative who told us, “My [family member] is a thousand times better since coming here. The GP has carried out a review of their medicines and their health has improved to the extent that you wouldn’t think they were the same person.”

We checked the MAR sheets for people living in the home. We found MAR sheets had been signed by the member of staff administering the medicines in all cases.

A senior staff member told us the manager carried out frequent medication audits so that any errors were identified promptly. We saw evidence of this. We also saw evidence that where staff had not signed MAR sheets they were formally supervised and informed that if they continued to not sign MAR sheets appropriately further disciplinary action would be taken.

Although improvements had been made, we identified with the manager other areas that needed monitoring such as the security of medicines at all times when medication was being administered to people and reviewing arrangements for the storage of medicines before their return to the pharmacy.

Staff training records evidenced staff received medication training to ensure they were competent in their role to safely manage medicines.

Is the service well-led?

At this inspection we found there were systems in place for auditing of the service. For example, medication, the environment, infection control, care plans and complaints. We saw the home manager had carried out regular audits and where appropriate taken action so that the quality of the service was improved.

People who used the service told us they were asked for their feedback on the service they received and that they had filled in a ‘customer satisfaction survey’.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

Rosehill House is a residential care home which was providing care and support to 19 people at the time of our inspection. A number of people living at the home had dementia. We spoke with five people who lived at the home, five members of staff, three relatives, the area manager and the home manager.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and staff understood their role in safeguarding the people they supported. Care and treatment was planned and delivered in a way that was intended to promote people's welfare. Staff used risk assessments. There were risk assessments in place with people’s planned care. These gave details of how individual risks to a person could be removed or minimised.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

We looked at the system in place for the safe handling of medication. We found staff had not always signed the Medication Administration Record (MAR) when they had administered medication. The manager had audited the MAR sheets and identified that this was of concern but had not taken any action. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. We have asked the provider to tell us what they are going to do to ensure medication is handled safely, securely and appropriately.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet people's needs. People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

In the main people were treated with respect and dignity by the staff. During our SOFI observation we did observe some staff speaking about people who used the service, in the dining room, where they could be heard by others. One member of staff asked another, "Has she been good this morning?" referring to a person who used the service. Another staff member was seen pointing at a person who used the service and saying loudly, "She has to see the nurse today for her injection". This meant that people's privacy and dignity were not maintained at all times.

People we spoke with told us staff were, "Very caring" and "Always willing to help me". A relative said, “I visit my relative regularly and the staff are lovely to my relative. I think this home is Top of the Tree”.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We observed staff treating people with kindness and helping them with their daily activities such as personal care and social activities. We saw staff taking a person out to attend a dental appointment and taking a person for a walk to the shops.

People knew how to make a complaint if they were unhappy. One relative said, “We always tell them if anything’s not right and they listen and then put it right”.

Some people required specialised diets for health or personal reasons. We found the service provided food and drinks specifically requested by people. People told us, “The food is good and I only have what I like and suits me” and “If I ask for something they try their best to get it for me”.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service carried out a yearly ‘Quality Assurance Survey’. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends and healthcare professionals. This showed people had the opportunity to share their views.

The service had a quality assurance system. Monthly and/or weekly audits were completed regarding such things as care plans, the environment, staffing and infection control. Records seen by us showed the shortfalls identified in the medication audits over a number of months, had not been addressed. We have asked the provider to tell us what they are going to do to ensure they identify, assess and manage risks relating to the health, welfare and safety of people who use the service.

We issued a compliance action following our last inspection on 13 May 2013. This was because we found that not all staff had received formal one to one supervision or a yearly appraisal. We also found no evidence of the induction completed by some ‘newer’ members of staff, although staff told us they had worked alongside other more experienced members of staff before they started to work unsupervised.

Following the inspection the provider submitted an action plan detailing the actions they intended to take in order to achieve compliance in this area.

We visited the service on 12 August 2013 to check that improvements had been made to requirements relating to supporting workers. We found that staff received appropriate professional development and were able to obtain further relevant qualifications. We saw that relevant documentation relating to staff was now recorded.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "this is a warm and friendly place to live", "it's okay here", "I'm happy" and "the staff are very kind to me."

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people in the communal areas of the home. This meant we were able to observe people's experiences of living in the home. We found that care and support was offered appropriately to people.

Each person living at the home had a care plan. We found that the information in these was detailed and up to date. This meant that the delivery of care to people was safe, effective and appropriate.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

We found that not all staff had received formal one to one supervision or a yearly appraisal. We also found that some 'newer' members of staff had no evidence that they had completed an induction, although staff told us they had worked alongside other more experienced members of staff before they started to work unsupervised.

The home had an effective complaints system available. We found that comments and complaints people made were responded to appropriately.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said,

"I'm fine here, no problems," "It's a wonderful home," "It's great," "The staff are the best" and "It's smashing."

We spoke with four health professionals that were at the home carrying out a review of each person's needs. The health professionals were part of the 'Care Home Review Team' which is a proactive group that spends one day each week carrying out a full review of each person's care. They said that there was good communication between themselves and the staff at the home and that the staff had welcomed their input.

People that were able told us that overall they were happy living at the home.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said,

"I didn't like it here at first and I couldn't settle, but now I'm settled the staff look after us and get our meals ready, which is everything." "It's a wonderful home." "It's great; we all look out for each other, we're like family." "The staff make sure we're OK." and "It's smashing."

We spoke with one relative. They spoke very highly about the home and the care that was provided. They told us "I have nothing but praise for the home and the staff. We looked around at other more elaborate homes but that's not what we wanted. Here it's homely and friendly and we could not have wished for anything better for our relative."

We spoke with one health professional that visited the home on a regular basis. They said they felt the care offered at the home was good. They also said that there was good communication between themselves and the staff at the home. They said they had no worries or concerns about the way people were being supported and cared for in the home.

We spoke with Barnsley Local Authority, Contracting, Commissioning and Safeguarding

and they told us that they had not identified any concerns at the home.

A number of people who live at Rosehill House have conditions that mean they have

dificulty talking with people and therefore have varied methods of communication.

Some people were able to express their views clearly, others were not able to

verbally communicate with us. Due to people’s communication needs, during the site

visit we sat with people in communal areas and observed them closely. This meant

we were able to ascertain whether their needs were met.

We observed that staff treated people with dignity and respect. We saw there was lots of friendly and informal banter and conversation between people who lived in the home and staff. When people needed support and attention this was provided by staff in a timely manner.

We spoke to one person who told us they felt safe, that their needs were being met and that they got on well with the staff.

A number of people who live at Rosehill House have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving.

We observed that staff treated people with dignity and respect.

We were concerned that there was not always a trained member of staff on duty, during the night, to administer medication. On the day of the site visit staff were attending training, so that they would be able to administer medication. This meant that people would be able to take medication when it was required at any time during the day or night.

Over the last 12 month’s there had been a number of incidents that had been investigated under safeguarding procedures. This was to make sure people living at the service were safe. All, but one of these issues were resolved. The manager’s were awaiting a date to meet with Barnsley Local Authority Safeguarding so that the outstanding issue could be concluded. Following safeguarding meetings, actions were given to the provider to address the concerns. The safeguarding team told us they were satisfied that the provider had taken the necessary action and that people living in the home were safe.

A significant amount of work had been completed to improve the information in people’s care plans. However further work was needed to ensure that care plans reflected people’s current health and welfare needs. We saw that some information in care plans was out of date or contradictory.

In the main, the environment at Rosehill House was homely, pleasant and clean. Some decorating and repair work had recently been completed. However the area in the entrance hall and one lounge had a malodour. The business support manager told us that new carpet had been ordered for this area. The new carpet was due to be fitted in the next few weeks. We found areas of concern surrounding the environment that did not require major refurbishment work but were examples of poor housekeeping and lack of staff awareness in keeping the physical environment safe.

The majority of staff had completed mandatory training. Staff said they were due refresher and updated training in some areas. We spoke to one member of staff who had recently moved from being a college student on placement, to become a bank carer. This person had not completed any training provided by the service, only that provided by college. The person’s understanding of topics such as safeguarding was limited. The service must provide all staff with relevant training, so that they can carry out their role to a high standard and not put people’s health, safety and welfare at risk.