This unannounced comprehensive inspection took place on the 20 November 2018. The inspection team consisted of one inspector, one assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Rosemary Lodge Rest 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. Rosemary Lodge Rest Home can accommodate up to 29 people. At the time of our inspection 21 people were using the service. Some people living at the home were living with Dementia.

At our last inspection in March 2017 we identified improvements were needed to improve the quality and safety of the service provided. We judged the provider to be in a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. Following the inspection, we asked the provider to complete an action plan to show us what they would do and when by to improve the key question(s) of safe, responsive and well-led to at least "good." The provider sent us their action plan in and we looked at their action plan as part of this inspection.

This inspection took place on 20 November 2018 to follow up on our previous findings. We returned on this occasion to check that the provider was taking the necessary action to improve the quality of care and reducing the risks to people. During this inspection the service demonstrated to us that improvements have been made and the service was no longer in breach of regulations. Systems for the governance of the service were more robust and the action plan we received from the provider following our previous inspection had been addressed.

There was a registered manager in post at the time of this 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 2008 and associated Regulations about how the service is run.

Despite the noted improvement in the management of the home we were made aware of some issues that needed to be addressed or considered further from talking to people and sampling records. People and staff were positive about the leadership skills of the registered manager. Audits and quality checks were undertaken on a regular basis and any issues or concerns addressed with appropriate actions. The registered manager led by example and encouraged an open and honest culture within their staff team. People were supported to express their views. The registered manager and their staff team worked together with other organisations to ensure people's wellbeing.

People received care that made them feel safe. People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Potential risks to people had been assessed and were being managed by staff. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond promptly to people's needs. People received medicines safely and as prescribed. The environment was clean and systems were in place to audit infection control practices.

All feedback that we received from people about the staff was that they had the knowledge and skills to deliver effective care and that relevant training was provided. People told us they saw their GP and health specialists whenever necessary. People told us they were satisfied with the food provided and we saw suitably prepared meals being served. People were supported to have maximum choice and control of their

This inspection took place on 22 and 23 March 2017 and was unannounced. At the last inspection in January 2016 we found that the provider was meeting all of the regulations but improvements were needed to the systems for audits and quality assurance. This inspection found a breach of Regulation 17 of the Health and Social Care Act as the provider did not have robust systems in place to monitor the quality of the service.

The home provides care and accommodation for up to 29 older people, some of who were living with dementia or have additional mental health needs. Nursing care is not provided. The accommodation is provided in both single and shared bedrooms. On the day of our inspection there were 23 people living at the home.

The service has 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 that whilst there were some systems in place to monitor and improve the quality and safety of the service provided, these were not always effective and did not identify if the service was consistently compliant with the regulations and meeting people’s needs. The checks undertaken had failed to identify concerns raised in our inspection. You can see what action we told the provider to take at the back of the full version of this report.

We saw that risks to individual people were not always well managed so that people were protected from harm. One person had a significant trip hazard in their bedroom that posed a significant risk to them and staff on a daily basis. Admission procedures needed to be improved to determine if a person’s needs could be fully met before they moved in to the home.

People using this service told us that they felt safe. There were systems for making sure that staff knew how to report any allegation or suspicion of poor practice.

There were sufficient numbers of staff to meet people’s needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. People’s medicines were managed, stored and administered safely.

Staff were appropriately trained and skilled to provide care and support to people. The staff had completed relevant training to make sure they knew how to provide care to people that was safe and effective to meet their needs. The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service. People’s human rights and liberty was being maintained.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. Staff were aware of people's needs arising from their medical conditions.

Staff showed kindness and compassion to people who used the service. People told us that staff treated them with dignity and respect. Staff working in this service understood the needs of the people for whom they provided care and support.

Some people told us that activities of particular interest to them were provided. However the activities offered on occasions may not be engaging for all people in the home.

People knew how to make complaints and the registered provider had arrangements in place so that people were listened to.

Throughout our day we saw the registered manager interacted with people who used the service, they were responsive, friendly and supportive in meeting people’s needs. Discussion with the registered manager showed that they knew people’s needs well. All of the staff we spoke with told us that the registered manager was approachable.

This inspection took place on 6 January 2016 and was unannounced. At the last inspection in January 2015 we found that the provider was not meeting all of the regulations. They sent us an action plan about how they would improve.

The home provides care and accommodation for up to 29 older people, some of who were living with dementia or have additional mental health needs. Nursing care is not provided. The accommodation is provided in both single and shared bedrooms. On the day of our inspection there were 24 people living at the home.

The service has 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 using this service told us that they felt safe. There were systems for making sure that staff reported any allegation or suspicion of poor practice and staff were aware of the possible signs and symptoms of abuse.

There were sufficient numbers of staff to meet people’s needs. We saw that pre-employment checks had been carried out for staff. These checks are important and ensure as far as possible that only people with the appropriate skills, experience and character are employed.

There were some improvements needed to the systems of administering medication but we saw that this was usually done safely and that some recent improvements had been implemented.

Staff were appropriately trained and skilled to provide care and support to people. The staff had completed relevant training to make sure that the care provided to people was safe and effective to meet their needs. The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service. We did not find anyone being unlawfully deprived of their liberty.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. Staff were aware of people's needs arising from their medical conditions.

Staff showed kindness and compassion to people who used the service. People told us that staff treated them with dignity and respect. Staff working in this service understood the needs of the people for whom they provided care and support.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

The registered manager encouraged feedback from people who used the service and their family members, which she used to make improvements to the service, where needed. Systems to monitor and improve the quality of the service were in place but further improvements were needed as they were not always effective.

At the time of our last inspection, we found that the provider had not been compliant with regulations regarding safeguarding people that use services and cleanliness and infection control. The findings of this inspection identified that improvements had been made in these areas.

There were twenty two people living at the home at the time of our visit. We spoke with seven of these people, two relatives and the staff that were supporting them. We observed the care and support received by people who, due to their medical conditions, were unable to speak with us. We saw that staff supported people in a respectful manner and offered them choices of how and where they wanted to spend their time.

People told us that they were happy with how their care and support needs were being met and that staff were available when they needed them. A person told us “I wasn’t feeling very well yesterday and the staff looked after me really well."

People told us that they felt safe living at the home and that they would speak to staff if they had any concerns. A person told us “I would talk to any of the staff if I was worried or wasn’t happy about something.”

People using the service and their relatives were involved in monitoring the quality of service provided.

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they did not have any concerns about the quality of care provided.

There were twenty five people living at the home at the time of our visit. We spoke with more than half of these people and the staff that were supporting them. We spoke with five visitors that were at the home.

People told us that they were happy living at the home and that they were satisfied with how their care needs were being met. People told us “All of the staff are so kind and caring;” and “I love having a shower. I had one yesterday.”

During our visit we observed the care and support being provided at the home. We spent time sitting in the lounge and the dining room and we saw that most staff supported people in a respectful manner. We saw that the staff greeted people by their preferred names and offered them choices of how and where they wanted to spend their time.

During our review, we requested information about the quality of the service provided at the home from local authority staff involved in monitoring the home. At the time of writing this report, we had not received any feedback from them.

This inspection took place on 5 and 8 January 2015 and was unannounced. At the last inspection on 18 April 2013 we found that the provider was meeting the requirements of the regulations we looked at.

The home provides care and accommodation for up to 29 older people, some of who were living with dementia or have additional mental health needs. Nursing care is not provided. The accommodation is provided in both single and shared bedrooms. On the day of our inspection there were 25 people living at the home.

A manager was registered with us but they had not been employed by the provider since April 2014 and so were no longer managing the home. 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. There was a new manager in post but they had not applied to register with us.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place but the provider had previously investigated an allegation against a member of staff without first informing the local authority as required. The provider told us they had learned from this and would ensure that in future the appropriate authorities would be informed of any allegations related to safeguarding people.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We looked at whether the service was applying the DoLS appropriately. Staff did not fully understand their roles and responsibilities with regards to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) but action was in progress to address this and ensure that staff received the necessary training to improve their understanding.

We saw that appropriate pre-employment checks had been carried out for new members of staff. These checks are important and ensure as far as possible that only people with the appropriate skills, experience and character are employed.

Improvement was needed to the staffing arrangements to make sure there were enough staff to meet people’s needs. The provider and manager told us that they had recently agreed that an additional cook, laundry assistant and two care staff were required. We were informed that recruitment to these positions was underway.

Risk was assessed but management plans were not always detailed enough. This meant that people were not always properly protected from harm. Care provided was mainly centred on providing for people’s personal care needs. There was a lack of consistent planning of a programme of activities and stimulation that was relevant and tailored to meet the individual needs of people.

During our inspection we received some negative comments about the environment. We were informed by the provider that some of the communal areas had recently been repainted and that further improvements were planned for 2015.

Staff showed kindness and compassion to people who used the service. However, people’s privacy and dignity had not always been protected.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective. We found that the systems in place had not identified some areas that required improvement that had a direct impact on people using the service or placed them at risk of receiving inappropriate care. The arrangements in place did not comply with the law. You can see what action we told the provider to take at the back of the full version of this report.