This unannounced inspection took place on 11 December 2018.

Rosemary Lodge is registered to provide accommodation and personal care for up to 32 people. Care is provided over two floors and there is a choice of three communal areas for people to use. There were 28 people living in the home at the time of our inspection.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to recognise abuse and understood the actions they should take to report concerns. There were risk assessments and management plans in place to support people safely. Medicines were stored, recorded and administered correctly to ensure people had the medicines which were prescribed for them. There were sufficient suitably recruited, trained and supported staff who were aware of infection control requirements to protect people from harm.

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 provided with food and drinks which met their needs and preferences and enjoyed a sociable mealtime experience. People’s health and wellbeing needs were monitored and other healthcare professionals contributed to their care whenever necessary.

Staff provided kind, compassionate and thoughtful care which promoted people’s dignity and recognised their right to privacy. Relatives were warmly welcomed and involved. People were given opportunities to take part in social activities inside and outside of the home. Staff knew people well and care was reviewed with people to ensure their support reflected the level of care and assistance they required.

People were complimentary about the management of Rosemary Lodge. People and staff and were given opportunities to share their views of the service. There were audits in place to review the quality of care and identify shortfalls. The registered manager was fulfilling the requirements of their role.

Further information is in the detailed findings below.

This inspection visit took place on the 12 May 2016 and was unannounced. At our previous visit on the 17 April 2015, the service was meeting the regulations that we checked but we did ask the provider to make some improvements. This was because people were not always supported by staff to maintain their dignity and privacy and the systems in place to gather people’s feedback required improvement to further develop the service according to people’s preferences. At this inspection visit, we saw that improvements had been made.

Rosemary Lodge provides accommodation and personal care support for up to 32 older people. There were 27 people who used the service at the time of our visit.

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 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 determined the staffing levels following an assessment of people’s needs. People told us and we saw there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. The registered manager had undertaken thorough recruitment checks to ensure the staff employed were suitable to support people.

Staff understood people’s needs and preferences and were provided with training and supervision, to support and develop their skills. The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity in certain areas, capacity assessments had been completed to show how people were supported to make those decisions. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach and supported people to maintain their dignity and privacy and were supported to maintain and develop their social interests. There were processes in place for people to express their views and opinions about the home and were confident that they could raise any concerns with the registered manager. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

We inspected this service on 17 April 2015. The inspection was unannounced. At our previous inspection in March 2014, the service was meeting the regulations that we checked.

Rosemary Lodge provides accommodation and personal care support for up to 32 older people. There were 25 people who used the service at the time of our visit.

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

People were not always supported by staff to maintain their dignity and privacy and the systems in place to gather people’s feedback required improvement to further develop the service according to people’s preferences.

Staff understood how to protect people from abuse and were responsive to their needs. The staff employed were suitable to support people and sufficient numbers of staff were available to meet people's needs. The provider checked that the premises were well maintained and equipment was regularly serviced. Staff received appropriate training to make sure people’s medicines were stored, administered and disposed of safely.

People were supported in a safe way because the manager had undertaken risk assessments and developed care plans which provided staff with information on how to minimise the identified risks. People had equipment in place when needed, to enable staff to assist them and support them to move, safely.

Staff had a good understanding of people’s needs and abilities and the training and support they received supported them to meet the needs of people they cared for. Staff were kind and caring and people were relaxed and chatted easily with staff.

Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for people’s individual dietary requirements.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions.

People knew how to make a complaint if they needed to. They were confident that the manager would listen to them and they were sure their complaint would be fully investigated and action taken if necessary.

The provider’s quality monitoring system included checks of people’s care plans, the premises, equipment and staff’s practice, to make sure people received care and support safely. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence.

We completed this inspection to check whether the home had made improvements to the care and wellbeing of people who used the service. We found that improvements had been made and the service was compliant in the four outcomes we assessed.

Our conversation with one member of care staff and information in two care files showed that staff had received recent training in safeguarding vulnerable people. People we spoke with told us that they felt safe living at the home. Staff were aware of the importance of and procedures for reporting any incidents or allegations of abuse.

We found that recruitment procedures had improved. This meant that the information checked and collated was consistent to ensure the safety of the people who used the service.

Systems had been put in place to ensure that people who used the service were clear about how their complaint would be managed.

This was a responsive review as we had received a number of concerns; some from representatives of the Local Authority. These related to alleged poor medication practices, insufficient and ineffective moving and handling equipment, poor management of complaints, poor reporting and responding to incidents and allegations of abuse not followed up. We found that the home was aware of the concerns.

At a previous inspection by the Care Quality Commission on 28 August 2013 we found improvements were needed to the procedures for receiving and auditing medicines in the home. We also found there was poor reporting and responding to incidents and allegations of abuse had not been followed up. We asked the provider to send an action plan to us by 26 October 2013 to show how and when the improvements required would be met. We will check the improvements in these areas have been made at our next visit.

At the time of our inspection 26 people were living at the home. We spoke with people that used the service. One person told us: “I love living here. They really look after us”. Another person said “I’ve been here for a few years now. They always give us lots of tea and biscuits if we want them”.

We found that equipment was well maintained and serviced regularly.

We saw that recruitment procedures were not consistently effective to ensure the safety of the people who used the service.

We found that complaints were not managed effectively.

This was a responsive review as we had received one anonymous concern and a second concern from a relative about the service. These related to alleged failure of staff to follow care instructions, poor medication practices, and allegations of abuse not followed up. We found that the home was aware of the concerns and had taken action to address them. However they had not made the necessary safeguarding referrals. This would ensure that allegations of abuse were taken seriously and appropriately investigated.

At the time of our inspection 30 people were living at the home. We spoke with people that used the service. One person told us, "Everyone is lovely; we all get on very well. It is a nice place to live”. People told us that they enjoyed the food they received.

We spoke with staff who worked at the home and found that they received appropriate training to support the needs of people in their care. Staff were knowledgeable about the care and support people needed.

At our last visit to Rosemary Lodge we found that the service was not compliant in two key outcomes. Improvements had been made and the service was compliant in both of the outcome areas. We saw that the provider had improved people’s care plan records so that they accurately reflected the individual care and support they needed. We saw that the manager and deputy manager had introduced appropriate systems to regularly assess and monitor the quality of service that people received.

At our last visit to Rosemary Lodge we found that the service was not compliant in five key outcomes. We looked at these outcomes at this inspection visit. We wanted to know whether the service had made improvements. We found that improvements had been made and the service was compliant in four of the outcomes assessed at the last inspection visit.

We found that more proactive action was needed to ensure improvements were maintained for people that lived at the home.

People were positive about the service they received. People told us that staff were always respectful towards them. One person told us that, “We get asked what we want to do”. Another person told us, “The staff are very friendly. They always speak kindly to me”. People told us that they could ask staff to do anything for them. A further person said, “Two people always come to help me. I have to be hoisted and two staff always does this”.

We found that most people’s care records did not contain sufficient and appropriate information to ensure that people living at the home received the care and support they should.

Information from two care staff told us that they had received training in safeguarding vulnerable people. People we spoke with told us that they did not have to wait for staff to help them.

We found that systems to monitor the quality of the services provided were not robust to ensure that improvements would be made for people who used the service.

We spent time during this inspection talking to the people who used the service. They told us they felt respected and were treated with dignity. There were some areas for improvement.

We looked at the care records for two people who used the service. We found there were improvements needed. Risk assessments and care plans do not contain enough information to guide staff and make sure people are getting the care, treatment and support they need.

Staff that worked in the home are in need of further training. There were shortfalls in staff knowledge around the safeguarding of vulnerable adults.

We found that improvements were needed in the assessment and monitoring of the service provision. The service needed to develop a robust system for audit and analysis that makes sure people's safety and welfare is at the heart of everything they do.

The service will need to provide us with a detailed plan for improvement following this inspection.