Rosemary Care Home is located in Milnrow, Rochdale. It is a service which provides accommodation and personal care for up to 24 older people, some of whom are living with dementia. There were 23 people living at the home on the day of our inspection.

Rating at last inspection:

At the last inspection, in April 2016, the service was rated Good. At this inspection, we found the service remained Good.

Why the service is rated Good:

People continued to have their health needs met. People had access to a range of healthcare professionals, when required. Changes in people's health and wellbeing were responded to.

People, relatives and staff continued to be positive about the registered manager and the running of the home. Staff felt motivated and valued in their roles.

People continued to enjoy positive and respectful relationships with staff. People's independence was promoted, as much as possible. People's privacy was respected.

People were able to express their views and make suggestions, and these were acted on. Complaints were investigated, responded to and used to improve practice.

There were enough staff on duty to meet people's needs. People received their medicines safely.

Further information is in the detailed findings below.

Rosemary Care Home is based in Milnrow, Rochdale and is registered to provide care for up to 24 older people. Accommodation is provided on three floors. All bedrooms are single rooms and are accessible by a passenger lift. Communal rooms are available on the ground floor and include three lounges and a dining room. To the front of the property there is a small garden area and parking for several cars.

This was an unannounced inspection carried out on the 21 and 28 April 2015. At the time of our inspection there were 20 people living at the service.

The home had a manager who was registered with the Care Quality Commission. 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 had previously inspected the home in March 2015. We found the provider was in breach of four regulations in relation to good governance, staffing, recruitment and systems to safeguard people. The provider sent us an action plan, which showed what action they had taken.

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

The management and administration of people’s medicines was not safe and did not ensure people received their medicines as prescribed.

Potential risks to people’s health and wellbeing had not always been assessed to help protect them from harm or injury.

We have made a recommendation that the provider considers a formal process for identifying and deploying appropriate staffing levels to meet the individual needs of people.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

Staff were able to demonstrate their knowledge and understanding about the safeguarding procedures and what action they would need to take to keep people safe. We were aware of issues which had been reported to the local authority. The registered manager was working in cooperation with the local authority to address any issues.

People and their visitors were complimentary about the staff and the care and support offered to their family member. Staff were seen to be polite and respectful towards people, offering assistance when needed.

Opportunities for staff training and development were provided. Staff spoken with confirmed they had completed some training and felt supported by the manager.

People told us they felt safe and received the care they needed. During our inspection we observed staff to be kind and caring towards people and responded to people’s requests.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Relevant information and checks were completed when recruiting new staff. This helps to protect people who use the service by ensuring that the people they employ are fit to do their job.

A programme of redecoration and refurbishment was taking place to enhance the standard of accommodation and facilities provided for people. Hygiene standards were maintained to help minimise the risks of cross infection and checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe.

Suitable arrangements wer

Rosemary Care Home is based in Milnrow, Rochdale and is registered to provide care for up to 24 older people. Accommodation is provided on three floors. All bedrooms are single rooms and are accessible by a passenger lift. Communal rooms are available on the ground and first floors. These include two lounges and a dining room on the ground floor and a lounge / dining room on the first floor. To the front of the property there is a small garden area and parking for several cars.

This was an unannounced inspection carried out on the 2 March 2015. At the time of our inspection there were 22 people living at the service

The home had a manager who was registered with the Care Quality Commission. 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 inspected the home in November 2013. We found the provider was in breach of two regulations in relation to management of medicines and records. The provider sent us an action plan telling us what they intended to do make the improvements needed. We inspected the home again in March 2014 to check improvements had been made. We found the provider was meeting the regulations we assessed at that time.

Prior to this inspection we had received some information of concern about the management and conduct of the service. At this inspection we spent time observing care and support in communal areas, spoke to people, their visitors and staff and the registered manager, who had recently returned to work following a period of absence. We also looked at people’s care files and management records.

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

People were not always supported by sufficient numbers of staff that had been robustly recruited to work with vulnerable people. We found opportunities for staff training and development needed improving so that staff were able to expand their knowledge and understanding in the specific needs of people.

The provider had not taken the necessary steps to ensure people were not being unlawfully deprived of their liberty in line with current guidance. Whilst information was available to guide staff, further training had yet to be completed by staff. Staff spoken with had some understanding of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. This legislation provides legal safeguards for people who may be unable to make their own decisions.

We found systems to monitor, review and assess the quality of service were not in place to help ensure people were protected from the risks of unsafe or inappropriate care. Checks were made to the premises and servicing of equipment. However safe systems were not in place in the event of an emergency such as a fire. Staff training, evacuation procedures and assessments to minimise risks were needed to protect people from potential harm or injury.

The registered manager acknowledged that CQC had not always been notified of incidents in relation to the well-being of people. This information is important and helps us to monitor that appropriate action has been taken to keep people safe.

We found the management and administration of people’s medicines was safe. Further training was needed for those staff responsible for the administration of medication so that practice was safe.

Individual care records were in place for people living at Rosemary Care Home. Records showed that people’s individual preferences were considered and people had regular access to health care professionals so that their personal and health care needs were addressed. Care records had not always been up dated to reflect the current needs of people. This information is important so that staff are provided with clear information about the care and support people need.

We talked to staff about how people were protected from harm. Staff were confident in describing the different kinds of abuse and signs which may suggest a person might be at risk of abuse. They knew what action to take to safeguard people from harm.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Menus were being reviewed so that people preferences were included.

Routines were relaxed, with people spending their time as they chose. Whilst some activities were made available people and their visitors felt these could be improved upon offering more variety to their day.

During our visit we saw examples of staff treating people with respect and dignity. People living at the home and their visitors were complimentary about the staff and care and support provided. People and their visitors were confident they were listened to and the registered manager would act on their comments or concerns.

During our inspection we spoke with five people who lived at the home and two visitors. People told us; “The staff are very nice” and “I’m happy, I like it here”. A visitor said; “The care seems better, staff seem more motivated”. We saw that staff were patient and supportive when assisting people. Staff appeared to have a good understanding of people’s individual needs and routines.

Care records did not provide detailed information about the individual needs and wishes of people, to clearly direct staff in the safe delivery of people’s care and support.

Suitable arrangements were in place to ensure people’s nutritional needs were met.

Improvements were needed in relation to the safe storage and administration of medication so that people were not place at risk of harm.

Work to improve the standard of accommodation had been identified and planned for. This will ensure that people are provided with a good standard of accommodation in which to live.

Relevant checks had been carried out to show that new staff had been safely recruited. Some records were not completed in full detailing when and by whom decisions were made about their suitability.

Arrangements for on-going staff training and development were in place so that staff had the knowledge and skills needed to meet the varying needs of people living at the home.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service.

Following our inspection in November 2013 we identified that improvements were needed in relation to the management of medication and records of the care provided at the home. Following our visit we received an improvement plan from the manager advising us of the action to be taken to make the improvements needed. During this inspection we looked to see what improvements had been made.

Due to unforeseen circumstances the manager was not available to assist with the inspection. Therefore, confirmation of an updated fire risk assessment and gas safety certificate could not be provided.

We found that adequate systems were in place with regards to the safe administration of medication. However we found that not all staff responsible for medicines understood their responsibilities in the safe storage of items so that people were not placed at risk.

We saw that information about the individual needs and wishes of people had been clearly detailed in the new care plans. Information provided staff with details of people’s routines, preferences, likes and dislikes, as well as how they wished to be cared for. Plans had sufficient information to guide staff in the delivery of people’s care and support.