This inspection started on 24 July 2018 and was unannounced. This meant the provider and staff did not know we would be visiting. A second day of inspection took place on 22 August 2018, and was announced.

The service was last inspected in May and June 2017 and was rated requires improvement. At that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to governance and management processes. We took action by requiring the provider to send us action plans setting out how they would improve the service.

When we returned for this inspection we found that the provider was still in breach of this regulation. We also identified additional breaches of regulation in relation to medicine management, person-centred care and premises and equipment.

This is the third time the service has been rated as Requires Improvement.

Roseleigh Care 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. Roseleigh Care Home accommodates up to 50 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with a dementia. At the time of our inspection 40 people were using the service.

There was 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. At the time of our inspection the registered manager was on planned long-term leave. The deputy manager had been acting as manager since the beginning of July 2018.

Medicines were not always managed safely. The premises were not always clean, suitable for the purpose for which they were being used or adapted for the comfort and convenience of people living at the service. Records of decisions made under the Mental Capacity Act 2005 or in people’s best interests were not effectively recorded. People did not always receive person-centred support. Care plans sometimes contained limited information and were not always person-centred. The provider’s quality assurance and governance processes were not always effective.

Plans were in place to support people in emergency situations. Risks arising out of people’s health and care needs were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored to see if improvements could be made to keep people safe. People were safeguarded from abuse. Staffing levels were monitored to ensure enough staff were deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were supported with food and nutrition. People were supported to access external professionals to monitor and promote their health. Staff were supported with training, supervisions and appraisals.

People spoke positively about the support they received, describing staff as caring and kind. Relatives also described the support people received as caring. People were usually treated with dignity and respect. People told us staff supported them to maintain their independence. Policies and procedures were in place to support people to access advocacy services where needed.

People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our

We carried out a comprehensive inspection of this service on 18 February 2016. Breaches of legal requirements were found. Senior management had visited the service on a regular basis, however did not keep a record of their visit. Surveys with people who used the service and / or relatives had not taken place in 2015. In addition supervision with staff was not happening as often as stated in the registered provider’s policy and the content of staff supervision did not ensure competence was maintained. At the inspection in February 2016 we rated the service as ‘Requires Improvement’.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a further comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

We inspected the service again on 24 May and 14 June 2017. The first day of the inspection was unannounced, which meant the staff and provider did not know we would be visiting. We informed the provider of our visit on 14 June 2017. At this inspection we found the provider had followed their plan and legal requirements had been met. However, we identified different breaches of legal requirements and rated the service as ‘Requires Improvement’.

Roseleigh Care Home is purpose built and can accommodate up to 50 people. The service provides care for people with mental health conditions and people living with a dementia. There are two separate units. The ground floor of the service accommodates people who have mental health conditions and people living with a dementia. The first floor of the service accommodates people living with a dementia. Within this unit there are five ‘time to think beds’. These beds can be occupied by older people living with a dementia who are medically fit for discharge from hospital. Assessment, care and support is provided at the service for a maximum of 6 weeks. At the end of this time the person’s ongoing needs are reassessed and they either return home with or without a package of care or remain at the service permanently (if a bed is available) or alternatively find another care home. At the time of the inspection there were 37 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 Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. People subject to DoLS had this recorded in their care records. However, mental capacity assessments were not decision specific and best interest decisions were not recorded.

There were systems in place to monitor and improve the quality of the service provided, however, these were not effective and had not detected the further areas we identified as requiring improvement. The provider visited the service on a regular basis, however did not make actual checks on systems and documents to ensure the effective running of the service. Audits had taken place, however action plans were not put in place identifying improvements needed or if work had been completed.

These findings constitute a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and s

We inspected Roseleigh Care Home on 10 and 18 February 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of the date of our second visit.

Roseleigh Care Home is purpose built and can accommodate up to 50 people. The service provides care for people with mental health conditions and people living with a dementia. There are two separate units. The ground floor of the service accommodates people who have mental health conditions. The first floor of the service accommodates people living with a dementia. Within this unit there are seven ‘time to think beds’. These beds can be occupied by older people living with a dementia who are medically fit for discharge from hospital. Assessment, care and support is provided at the service for a maximum of 6 weeks. At the end of this time the person’s ongoing needs are reassessed and they either return home with or without a package of care or remain at the service permanently (if a bed is available) or alternatively find another care home.

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.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help registered providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. Senior management visited the service on a regular basis; however, records of these visits were not available to confirm this. This meant we could not determine what checks had been completed during the visit. The registered manager said the findings from the visit and any actions needed were discussed. Surveys for people who used the service and / or relatives were not completed in 2015 by the registered provider

Effective supervision with staff was not happening as often as it should be. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff.

Risk assessments for people who used the service were insufficiently detailed. They did not clearly identify what the risks were. This meant that staff did not always have the written guidance to keep people safe. Accidents and incidents were monitored to identify any patterns or trends.

People and relatives told us there were enough staff day and night to meet the needs of people who used the service.

Medicines were managed safely for people and staff responsible for the administration of medicines had their competency to handle medicines checked.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However, we did note on the first day of the inspection that the water temperature of a sink in an area accessible to people who used the service was too high. By the second day of the inspection the registered manager had taken action to address this.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. We saw that staff had received an annual appraisal.

Staff understood the requirements of the Mental Capacity Act (2005) and

At our last inspection in 13 November 2013, we found that care records did not always provide information to ensure care was delivered appropriately.

We wrote to the provider and asked them to make improvements. The provider wrote to us and told us that they had taken action to address the concerns.

At this inspection we reviewed the actions the provider had implemented. We spoke with the registered manager and discussed record keeping.

We looked at the care records for two people living at the home, four acute care pathways and distressed behaviour records. We saw that improvements had been made and care records were regularly reviewed.

During the inspection we looked at a range of records and saw that records were accurately completed and fit for purpose.

At our last inspection in May 2013 we found that care records did not always provide information to ensure care was delivered appropriately. We also found that the safety and suitability of the premises had not been adequately maintained. We wrote to the provider and asked them to make improvements. The provider wrote to us and told us that they had taken action to address the concerns.

At this inspection we reviewed the actions the provider had implemented. We spoke with the registered manager and discussed the management of care and welfare of people living at the home. We looked at the care records for four people living at the home. We saw that improvements had been made to the care plans. The manager had put in place an audit tool to monitor the quality of the care plans and ensure they were regularly reviewed.

We looked around the home and saw that concerns we raised about the environment had been addressed. The manager told us there was a plan in place to continue to update the environment.

During the inspection we saw that records were not always accurately completed and fit for purpose and we included Outcome 21 in the inspection.

During the inspection we spoke with four people who used the service. We also spoke with the manager, two senior carers and three care staff. People told us what it was like to live at this home; described how they were treated by staff; and their involvement in making choices about their care. One person said, "I have lived here for four years, I like it the staff are very good.”

We observed the staff being attentive, respectful and interacting well with people. We saw that staff communicated well with people, we observed them laughing and joking with with people. We visited the service at the evening time; many people were in the lounge watching the football match on the television.

We reviewed the medication systems and found processes for the administration and management of medicines were being followed.

We found that the safety and suitability of the premises had not been adequately maintained.

We saw that there were suitable staffing arrangements in place and staff felt supported by the management team.

We found that processes were in place to assess and monitor compliments and complaints.

We found that care records did not always provide information to ensure care was delivered appropriately.

During the visit we spoke with 12 people who used the service and one relative. As it was a routine visit, we asked specifically about the choices individuals were offered, what the care was like and what people thought about the staff. Some of the people experience difficulty expressing their views so we used a specific technique called a short observational framework for inspectors (SOFI) to observe staff practices and the quality of interactions.

People told us that they found the home to be well-run and staff were competent at meeting their needs. We heard how people were involved in deciding how their needs were met and that people felt comfortable raising issues with the staff and manager. People said ‘’They are really good here, and the manager is good at her job", ‘’The staff are absolute gems’’ and ‘’I can’t fault them they are all really helpful, kind and attentive."

Throughout the inspection we found that staff constantly took the time to talk to people, engaged individuals in activities and in a sensitive manner explained how they were going to help people meet their care needs. We found that staff treated people with respect. All the people told us that the staff respected their choices and enabled them to live fairly independent lifestyles. They told us that the staff were caring and attentive and helped them whenever they needed help. We found that staff were very courteous to people and ensured people were able to make various choices. Staff said they always tried to ensure that people's wishes were met.