This inspection took place on 2 and 4 July 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

Rosemount care home is situated in the suburb of Edgeley, Stockport. The accommodation is provided over two floors with access by stairs or a stair lift. There is a communal lounge downstairs with a smaller lounge area off the main lounge. There are secure accessible gardens. There had been significant improvements made to the home environment, including new flooring and improvements to the garden. There was a programme of works being followed to further improve the environment.

Rosemount 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 is registered to provide personal care and accommodation to a maximum of 15 people. At the time of this inspection there were 12 people living in the home.

There was a registered manager in post. 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 our last inspection in May 2017, Rosemount was rated as 'Requires Improvement' with some breaches of the regulations identified. At this inspection, we found there had been improvements in some areas but found some continuing and additional concerns.

Medicines were stored safely but some records relating to 'when required' medicines were missing or provided contradictory information. This meant we could not be confident people had received their medicines as prescribed.

Safeguarding concerns the home had reported had been recorded properly but not all safeguarding incidents had been recognised and reported.

People's needs had been holistically assessed prior to admission to ensure the home was able to meet their needs. People and their families had been involved in this process.

Staff had received training to ensure they were able to support people properly. People living in the home were confident staff knew what they were doing and could help them in the right ways.

The staff understood the principles of the Mental Capacity Act 2005 and the importance of gaining consent before providing care and support. People told us staff always asked them before doing anything. We saw staff regularly asking people if they wanted help or a drink.

People living in the home and their relatives praised the caring and polite attitude of the staff.

Staff ensured they supported people to communicate, following the guidelines in their care plans and the knowledge they had built up over time. This ensured people were supported to be involved and make choices.

People were supported to keep in touch with people who were important to them. Visitors were encouraged and welcomed. Some relatives described the home as being like a home from home.

People received person centred care that was responsive to their needs.

People's needs were reviewed regularly and they were referred to other professionals such as the doctor or dietician when needed. People were supported to maintain their health and wellbeing and to attend appointments.

People told us there were plenty of activities if they wanted to do anything. The home organised social activities and events including coffee mornings and visits from nurseries.

Auditing systems had not identified the issues we found during this inspection. Not all notifications had been submitted to CQC. The registered manager had not understood fully which incidents needed to be reported. We have discussed this in more detail in the Well Led se

This inspection was carried out over three days on the 19, 20 and 21 April 2017. Our visit on 19 April 2017 was unannounced.

At the last inspection on 16, 17 and 18 January 2017 we rated the service as requires improvements. At that inspection we identified one regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to good governance.

Following the inspection the provider sent us an action plan detailing how the identified breach would be addressed. This inspection was to check improvements found at the last inspection had been sustained, to see if any further improvements had been made and to review the ratings.

Rosemount Care Home is a residential care home based in Edgeley, Stockport. The accommodation is arranged over two floors accessed via the stairs or a stair lift.

The communal areas include an open plan lounge and a smaller quiet area. There is a garden to the rear of the property, which at the time of this inspection was not fully enclosed. Limited off road car parking is available at the front of the property. No en-suite facilities are available.

Rosemount Care Home is registered to provide care and accommodation for up to 17 older people some of whom may also have a diagnosis of dementia. At the time of our inspection there were 13 people living in the home.

Since the last inspection in January 2017 the manager had registered with the Care Quality Commission (CQC) and was present throughout the three days of inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

During this inspection, we found the majority of improvements that had been had been made at the last inspection had been maintained and further improvements had also been made. However we did identify two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager was responsive to our feedback and was committed to further improving the service delivered to people living at Rosemount Care Home.

At the last inspection we saw the service had improved the recruitment processes to ensure only suitable staff were employed and staff were receiving on-going supervision and an annual appraisal. However during this inspection we saw that a temporary member of non- care staff had been working at the home without going through a recruitment process. This meant that appropriate safety checks had not been undertaken to protect people who used the service from receiving unsafe and inappropriate care. Once this was discussed with the registered manager they immediately stopped this person from working at the home.

We observed people receiving person-centred care but we found that there continued to be some shortfalls in the written plans of care. This was because some parts of the plans of care were vague and did not include details of exactly what assistance the person required to meet their assessed care needs.

We observed staff giving kind and caring support to people. We saw that people’s privacy and dignity was respected and people were relaxed in the company of staff.

There were systems put in place to monitor the quality and safety of the service delivered. However during this inspection we found shortfalls in the lack of recruitment for a temporary member of non-care staff, missing staff signatures on medication storage records and medicine administration sheets for the application of topical creams and ointment and some care records did not provide a contemporaneous record of care required and delivered to people, although staff were aware of individuals needs and people confirmed their care needs were met.

From looking at the training records and speaking with staff, we found

This inspection was carried out over three days on the 16, 17 and 18 January 2017. Our visit on 16 January 2017 was unannounced.

At the last inspection on 18, 19, 20 and 21 July 2016 we rated the service as ‘Inadequate' which meant the service was placed in ‘special measures.’ At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, fit and proper person’s employed, safe care and treatment, staffing, person-centred care and good governance.

Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed and a monthly update on the implementation of the action plan. This inspection was to check improvements had been made and to review the ratings.

Rosemount Care Home is a residential care home based in Edgeley, Stockport. The accommodation is arranged over two floors accessed via the stairs or a stair lift.

The communal areas include an open plan lounge and dining area. There is a garden to the rear of the property, which is not enclosed and offers limited off road car parking. No en-suite facilities are available.

Rosemount Care Home is registered to provide care and accommodation for up to 17 older people some of whom may also have a diagnosis of dementia. At the time of our inspection there were 12 people living in the home.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission (CQC). Confirmation was received following this inspection that the manager was registered with CQC on 31 January 2017. 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.

During this inspection, we found significant improvements had been made; the manager was responsive to our feedback and was committed to further improving the service delivered to people living at Rosemount Care Home.

We observed staff giving kind and caring support to people. We saw that people’s privacy and dignity was respected and people were relaxed in the company of staff.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

From looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained and future training had been planned.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

Although some areas of the home were tired and dated in appearance, the home was clean and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

Since the previous inspection the service had improved the recruitment processes to ensure only suitable staff were employed and staff were now receiving on-going supervision and dates for annual appraisals had been arranged.

Staff understood how to recognise and report abuse which helped make sure people were protected. People living at Rosemount, the visiting relatives and two healthcare professionals spoken with all said they thought safe care and treatment was provided.

People had access to healthcare services and we saw specialist advice was sought in a timely manner, for example from the district nurse, dentist, optician and chiropodist. People were supported to attend hospital appointments as required.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. People living at Rosem

We last inspected Rosemount Care Home on 8, 9 and 10 March 2016, when we under took a comprehensive inspection, including looking to see if the provider had met the requirement actions made at the previous inspection in September 2015 2015. Both of these inspection reports can be found on the Care Quality Commission website.

During the inspection in March 2016, we found continued breaches of the regulations and one further breach of the regulations. The service was rated inadequate overall, which meant it was placed into 'Special measures.' This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems found.

Rosemount Care Home is a residential care home based in Edgeley, Stockport. The accommodation is arranged over two floors accessed via stairs or a chair stair lift.

The communal areas include an open plan lounge and dining area. There is a garden to the rear of the property, which is not enclosed and limited off road car parking. No en-suite facilities are available.

Rosemount Care Home is registered to provide care and accommodation for up to 17 older people some of whom may also have a diagnosis of dementia. At the time of our inspection there were 10 people living in the home.

At the time of this inspection the service did not have a registered manager in place. The home had been without a registered manager since November 2014. 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 this inspection a manager had been in post since 4 June 2016.

During this inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 seven of which were continued breaches of the regulations and one new breach was found.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Medicines continued to be managed unsafely. We found there were gaps in the recording of prescribed creams and there was not a corresponding plan of care for the use of the prescribed creams. This meant there was a risk that creams had not been applied when required, which could have resulted in unnecessary discomfort to the person.

We continued to have concerns in relation to staff supervision and appraisals, because not all staff had received regular, formal one to one supervision with their manager and none of the care staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

From looking at the staff training matrix (record) we found there were gaps in staff training. This meant some staff may not be appropriately trained and skilled to meet the needs of the people living at the home.

We found there were still concerns regarding the safe recruitment of staff and ensuring suitable staff were employed because the shortfalls found at the last inspection had not been addressed.

We found that accurate and complete records were not kept in relation to the care and treatment of some people who used the service.

We found risk assessments were not always in place to help manage and reduce the risks to people's health, safety and welfare.

Although some improvements were found for example an audit had been undertaken of people’s care files and medication administration we found that robust systems had not been implemented to monitor the quality of service people received.

We saw and staff told us there were enough members of staff to keep people safe. However we recommended

This inspection was carried out over three days on the 8, 9 and 10 March 2016. Our visit on 8 March was unannounced.

We last inspected Rosemount Care Home on 14 September 2015, when we under took a comprehensive inspection, including looking to see if the provider had met the requirement actions made at the previous inspection in April 2015. During the inspection on 14 September 2015, we found further breaches of the regulations in relation to some parts of the building and premise not being safe, appropriate risk assessments not being undertaken, unsafe management of medicines, there were concerns around poor infection control, obtaining consent from people who use the service and a lack of meaningful activities for people. We also found unsafe recruitment processes, staff employed had not received any formal induction when commencing employment, staff were not receiving supervision or appraisals and there were gaps in staff training. Following this inspection we issued ten requirement notices, which the provider had to send us a report detailing what action they were going to take, and made five recommendations. The service was rated inadequate overall, which meant it was placed into ‘Special measures.’ During this inspection we found limited improvements had been made.

Rosemount Care Home is a care home based in Edgeley, Stockport. The accommodation is arranged over two floors accessed via stairs or a chair stair lift. The communal areas include an open plan lounge and a smaller quiet lounge, both lead into the dining room. There is a garden and patio area to the rear of the property and off road car parking. No en-suite facilities are available.

Rosemount Care Home is registered to provide care and accommodation for up to 17 older people some of whom may also have a diagnosis of dementia. At the time of our inspection there were 10 people living in the home.

The service did not have a registered manager in place. The home had been without a registered manager since November 2014. 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 this inspection the provider had purchased the services of a consultant, who had taken up the role of “acting deputy manager,” commencing 15 February 2016.

During this inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Eight of which were continued breaches of the regulations and one new breach.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Medicines continued to be managed unsafely although we did see some improvements from the last inspection. We were told one person was currently self-administrating some of their medication. A risk assessment had not been undertaken to ensure the person was safely able to self-administer their own medication in accordance with their own medication policy.

We continued to have concerns in relation to staff supervision and appraisals, because as identified at the last inspection not all staff had received regular, formal one to one supervision and none of the care staff had received an annual appraisal, which meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

From looking at the training matrix (record) and speaking with staff we found there were gaps in staff training. This meant some staff may not be appropriately trained and skilled to meet the needs of the people living at the home.

We saw some evidence that staff had completed induction training. However the homes induction was not robust enoug

This was an unannounced comprehensive inspection which took place on 14 September 2015. The service was last inspected on 30 April 2015 when we undertook a focussed inspection to see if the provider had taken action against the requirement actions and warning notice that was issued. During this inspection we found very limited improvements had been made.

Rosemount Care Home is a care home based in Edgeley, Stockport and is registered for up to 14 older people, some of whom may also have a diagnosis of dementia. There were 12 people living in the home on the day of our inspection.

The service does not currently have 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. There was a manager in place who had applied to CQC to register and their application was in progress.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we found the care records for one person who had sustained four falls showed no evidence of what action was being taken to reduce the risk. Environmental risk assessments had not been subjected to formal reviews to ensure people who used the service were safe.

A number of windows throughout the service did not have restrictors in place to prevent people who used the service from falling out of them.

Fire drills were not being undertaken in timescales identified in the service own policy and procedure. We found the cellar contained a number of fire hazards. These concerns were reported to the local fire officer the day after our inspection.

The management of medicines continued to be unsafe. Medicine audits were not sufficiently robust to identify concerns we found during our inspection. These concerns included, dates not being recorded when creams and liquid medicines were opened and covert medicines were being given without an appropriate care plan in place.

We continued to have concerns in relation to infection control. Policies and procedures in place in relation to infection control did not reflect current practice. We found two rooms had an offensive odour, we saw a soiled bed rail and stained carpets. We also found that the service was continuing to store hazardous substances in an unsafe manner.

Safe recruitment processes were not followed by the service to ensure suitable staff were employed.

Staff employed by the service had not received any formal induction when commencing employment. Some staff were undertaking duties they were not qualified to do and some staff had not received training in moving and handling.

Staff were not receiving supervisions on a regular basis.

We continued to have concerns in relation to consent. We found mental capacity assessments were not completed for those people who may lack capacity to consent.

We continued to have concerns in relation to the fixtures and fittings within the service. We saw carpets that were badly stained, some curtains were hanging off rails and furniture throughout the service was worn and tired.

The quality assurance systems in place within the service were not sufficiently robust to identify issues and concerns we found during our inspection.

We have made a number of recommendations. These are about how to support people living with dementia, the storage of confidential information, the stimulation of people living with dementia and the implementation and reviewing of care plans.

Staff we spoke with were able to tell us how they would respond if they had concerns about the safety of people who used the service.

Records we looked at showed the service involved a number of healthcare professionals to meet the needs of people.

People who used the service told us staff were kind. Relatives we spoke with told us they felt staff were caring.

Records showed that prior to moving into Rosemount Care Home a pre-admission assessment was undertaken to ensure people’s needs could be met.

Staff members told us they felt supported by the management at Rosemount Care Home and felt they were able to approach them with any concerns or issues.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use of enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We carried out an unannounced comprehensive inspection of this service on 15 December 2014 and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This resulted in us serving three warning notices because service users were not protected against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems to regularly assess and monitor the quality of the service provided.

Service users were not protected against the risks associated with the unsafe use and management of medicines, by means of making of appropriate arrangements for the safe keeping of medicines used for the purpose of the regulated activity.

Service users were not protected against the risks associated with unsafe or unsuitable premises, by means of appropriate measures in relation to the security of the premises, adequate maintenance and the proper operation of the premises which are owned or occupied by the service provider in connection with the carrying on of the regulated activity.

As a result we undertook a focussed inspection on 30 April 2015 to follow up on what action had been taken to address the warning notices.

Focused inspection of 30 April 2015.

The warning notices stated that the provider and manager must become compliant with these regulations by 27 March 2015. We undertook a focused inspection to check that they had met these legal requirements and found that they had made improvements and had met warning notices. However, we also highlighted further concerns.

We looked at how the provider checked on the quality of the service audits and found some audits had been completed such as for medicines management, bedroom checks and the environment. We found that a number of the audits were still not being completed; these included fire doors, care planning, accidents and staff training. We found some were not effective as they failed to identify issues found on our inspection.

We found policies and procedures had been put in place. However, we found that these were not dated and did not reflect best practice guidance such as the medicines policy. This meant that staff did not have access to up to date information in order to perform their role effectively.

We saw that audits were in place for medicines. However during our inspection we were unable to account for a significant number of one particular medicine being unavailable. This matter was later resolved by the manager.

We found that medicine had not been administered safely. As examples we saw that medicines records were signed by staff not giving out the medicines. Information for as needed medicines (PRN) were not available because staff did not have specific instructions on how to give these medicines to meet people’s needs.

Medicines were not given at the correct time in accordance with the manufactures instructions. The timing of some medicines were unclear. It was not possible for the service to make sure that there was a safe gap between administration times placing service users at risk of harm.

Body charts were available in all the MAR folders, that showed were a cream needed to be applied. These had not been completed and there were no instructions as to where, how or when to apply the cream.

Fire checks were in place and being completed. However, fire doors throughout the service were not being inspected. We checked a number of doors during our inspection and found that some of these were not closing correctly.

Fire drills were taking place in the service; however there was no record of who had attended the drill. There was no system in place to check that all staff had been involved in a fire drill.

Personal emergency evacuation plans (PEEP’s) were in place in the service. One care staff member we spoke with knew these were in place but did not know where they were located and another care staff member did not know what these were.

We did not see a fire risk assessment during our inspection as this was not available. We were sent a copy of this after our inspection. We also found other risk assessments had not been put in place for hazards around the service.

We found doors that required locking due to various hazards were left open and accessible.

We found a number of curtains in people’s bedrooms were hanging off the rails, stained bedding and beds.

We spoke with people who used the service on the day of our inspection. One person told us “I like the majority of the girls, they are really grand” and another person told us, “The girls are great, nothing is too much trouble”.

We also spoke with staff members. Two staff members told us “I really like working here; I love the residents and enjoy the job” and “I wouldn’t want to work anywhere else”.

Rosemount Care Home is a care home based in Edgeley, Stockport and is registered for up to 14 older people, some of whom may also have a diagnosis of dementia. There were 13 people living in the home on the day of our inspection.

The inspection took place on the 15 December 2014 and was unannounced. We last inspected the service on the 28 and 29 July 2014 when we found it was not meeting five of the regulations we reviewed. We found that people who used the service were not fully protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse, appropriately respond to and report possible abuse. We also found people were not being cared for in a clean and hygienic environment, appropriate systems and arrangements were not in place to ensure people who used the service received their medicines safely, there were insufficient staff to meet the needs of people who used the service and the provider did not have an effective system in place to regularly assess the quality of service that people received. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make.

During our inspection we found that not all required improvements had been met.

The service does not currently have 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 found some improvements had been made since the last inspection such as in infection control procedures. We found cleaning schedules in place and completed. We found people now received their medicine safely and systems had been put in place to ensure this continued.

Staff told us they had received training in the safeguarding of vulnerable adults and this was confirmed by staff training records we looked at.

We found people’s safety was being compromised in a number of areas. This included fire safety checks, emergency evacuations, how medicines were stored, how well equipment was maintained and the lack of knowledge and skills of staff to meet the needs of people who used the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report

Although people who used the service told us their privacy and dignity was maintained, we observed a lack of understanding in this from staff. We observed staff members walking past a person who was undressing in the main lounge without supporting them or responding to this. We also found people’s privacy and dignity was potentially being compromised by visitors to a flat upstairs occupied by staff. Visitors could only access the flat through the main entrance of the home and bypassing people who used the services bedrooms.

There was a lack of meaningful activities for people throughout the day. We saw people spent most of their time sleeping in chairs or sat reading a magazine. Staff told us they did not have time to spend with people who used the service.

We observed that complaints were not being dealt with effectively resulting in one person who used the service being in a cold room without a working radiator for five days.

We found that people who used the service were at risk of gaining access to cleaning products which had the potential to be hazardous. This was because these products were not placed in a cupboard that was locked so that no unauthorised person had access to it.

During our inspection we spoke with four people living at Rosemount Care Home who told us that they were happy with their care and support. The comments we heard included: “The staff are excellent”; “I get lots of support from the staff” and “I have no complaints about the food. It suits me.”

We observed care within the lounge and dining room areas and we saw that people were cared for in a calm, respectful and supportive manner. Staff members asked people for their permission before carrying out care tasks.

We looked at the systems in place for managing medicines. The systems in place were safe but records were not always completed accurately. We have asked the provider to take action about this.

We found that there was an effective recruitment procedure in place to ensure that appropriate people were recruited to work at the home. Although procedures had been followed there was no evidence to support this. After our inspection the provider wrote to us and confirmed that the appropriate information had been recorded in the files. We saw that there sufficient numbers of suitably qualified and experienced staff on duty to ensure that people’s needs were met.

The people we asked told us they were not clear about how they would make a complaint but they also told us that they had no need to complain. There was an effective complaints procedure in place and complaints were dealt with in line with the company’s policy.

The unannounced inspection visit on 05 March 2013 was carried out to check if improvements had been made following the previous review of compliance, where we found gaps in; care plans and reviews, infection control measures, staff supervision, environment improvements that were needed, and quality assurance. During the course of the inspection, we found that there had been some improvements made in all these areas.

At the time of the inspection there were twelve people living at Rosemount Care Home. During the course of the inspection we met and spent time with four people who used the service and spoke with three relatives. One person said: “I like living here its home from home, it’s not swish like some places but it suits me.” Another person said: “Listen, you don’t hear bells here every five minutes and that’s because the staff know us and our routines.” We also spoke with a relative who told us: “You can’t fault them (the staff), really you can’t, they are kind and they genuinely care about people.”

We spoke with two carers, the registered manager, maintenance person, the domestic staff member and the chef. Staff told us they felt well supported by the manager and had received staff supervision and training since our last inspection.

We completed an unannounced inspection visit on 13 August 2012, to Rosemount Care Home. We spoke with five people who used the service and three staff members as well as the manager during the course of our inspection.

The people we spoke with told us they had no concerns about the staff respecting their privacy or dignity. One person told us: “Everyone here is lovely. The staff are all very nice, very caring, you don't need to worry about living here at all."

Another person told us: "I get up when I like, I structure my own day as I like it, it's not regimented, no one day is the same, just as it would be at home really."

We saw that staff engaged with people in a very person centred way while we were observing care. One person who lived at the home told us: "Staff are easy to talk to," and said they: "never felt rushed" and chose when to wake and when to retire of an evening.

We found that there were areas where the service could improve which included detailed care plan and risk assessment documentation, staff training updates, quality monitoring and maintaining regular health and safety checks.

An inspector visited this service on 28 and 29 July 2014 to carry out an unannounced inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

During this inspection visit we observed that people were treated with respect and dignity by the staff and people told us they felt safe living in Rosemount Care Home.

Each person had an individual care file that included risk assessments and a care plan that described how to meet individual care needs.

During our visit to Rosemount Care Home we found a number of concerns around the staffing of the home. We found that only one member of care staff was on duty during the night to support the 12 people currently using the service and 14 people when the home was full. We were told that there was an on call system in operation but it was rarely used. The last time anybody was called using the on call system was in May 2014 when somebody fell and needed to go to A&E for treatment. The manager confirmed that a number of people required the assistance of two care staff to ensure safety with moving and handling. We discussed our concerns with the manager and the provider of the service at the time of our visit.

During this inspection visit we saw shortfalls in the standards of cleanliness and hygiene in the home.

Improvements were needed to the way in which medication was recorded to ensure that people received their medication as prescribed by their GP.

Staff training records indicated that the majority of staff were not up to date with safeguarding adults training. The lack of this training means that staff may not understand the signs of abuse or the aspects of the safeguarding process relevant to them which could place people at risk.

Is the service effective?

Prior to people being admitted into the home the manager visited the person to carry out an assessment of their needs to ensure the home could meet all of those assessed needs. The manager said that if possible people were encouraged to spend some time at the home having lunch and meeting staff and other people living at the home before a decision was made about moving in.

Staff told us told us that the staff team all worked well together and provided a high standard of care.

Is the service caring?

The atmosphere in the home felt relaxed and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at the home indicated that they were happy and had everything they needed.

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the district nurse and we saw that people attended hospital appointments. This meant the provider sought relevant professional advice and guidance appropriately.

Is the service well-led?

The service was led by a manager that is registered with the Care Quality Commission.

The manager was described by staff as approachable and supportive.

Improvements were needed to the systems in place to enable the manager to monitor quality and identify risk. This would help to ensure that people received a safe and effective service.