This unannounced inspection took place on 27 June 2018. At our last inspection in May 2016 the service received an overall rating of ‘Good’.

Rosenmanor Limited 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. Rosenmanor Limited provides personal care to people but not nursing care.

Rosenmanor Limited accommodates up to 12 people with mental health needs across three floors in two adjacent and internally connected terraced buildings. Eight people were living in the service at the time of our inspection.

The service had 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.

People continued to be safe receiving care and support from Rosenmanor Limited. People’s risks were identified, assessed and reduced and staff understood their role to protect people from abuse. People received medicines safely and the provider ensured the staff used appropriate hygiene practices around personal care, environmental cleanliness and food safety. There were enough suitable staff available to deliver safe care and support to people.

People received effectively delivered care and support from supervised and trained staff. People’s needs were assessed and reviewed and they had timely access to healthcare services. People were supported to meet their nutritional needs and were supported in line with mental capacity legislation.

People continued to describe the staff who supported them as caring. People and staff shared positive relationships and people were supported to maintain relationships with relatives. Staff protected people’s privacy and dignity and provided culturally and spiritually sensitive support.

The service delivered individualised care to people based upon their personal needs. People had input into their care records which guided staff to meet their needs. Staff were responsive to changes in people’s mental health and supported people to be active. A complaints process was in place and people understood how to use it.

The service continued to be well-led. Rosenmanor Limited had a service manager who ran day to day operations which were overseen by a registered manager who was also the provider. The service sought and acted upon the views of people and staff and the quality of care was audited.

This inspection took place on 29 April & 3 May 2016. Our first visit was unannounced. At our last inspection in July 2014, the provider met the regulations we inspected.

Rosenmanor Limited provides accommodation and personal care for up to twelve people with mental health needs. There were eleven people using the service at the time of our visit.

The home had 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.

People said that the staff working at Rosenmanor were kind and caring towards them. There was a relaxed and friendly atmosphere when we visited.

People were supported to have their health needs met. Staff worked with people to access the GP and other local health services as appropriate to help make sure their individual physical and mental health needs were met. We saw that people’s prescribed medicines were being stored securely and managed safely.

There were systems and processes in place to protect people from the risk of harm and staff were aware of safeguarding procedures. Appropriate recruitment checks took place before staff started work.

Staff received training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People were asked for their consent to the care and support they received.

There was a system in place for dealing with people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take appropriate action.

The registered manager understood their role and responsibilities and positive feedback was received from staff about their leadership. There were systems in place to help ensure the safety and quality of the service provided.

We spoke to three people who use the service. They told us they attended fortnightly residents meetings where they were able to discuss things that happened at the home and other issues that were important to them.

One person told us “Staff treat us with respect and we do the same with them. Staff are very supportive, understanding and listen to what you have to say”.

We spoke to a social worker visiting a person that had recently moved into the home. They told us the providers had made some physical adaptations to the person's bedroom and staff were trying hard to meet the person's needs. Communication with managers was good and they had no concerns about the home.

People told us they had support plans and attended regular appointments with health care professionals. They told us they met regularly with their key workers and were involved in planning their care.

People told us there was always plenty of staff around and they felt safe. They could talk to staff about any concerns they had, staff would take their concerns seriously and would do something about them.

We spoke to four people who use the service individually in a private room. They told us that they were given information about the service before they moved in and had one to one sessions with staff who explained to them the aims of the service.

They told us that they understood why they had been admitted to the home and had been fully involved in drawing up their care plans and risk assessments. They told us they had agreed to consent to treatment as part of the admissions process. They have regular one to one meetings with their key workers to talk about and update what was included in their care plans.

They told us that they usually enjoyed the food provided by the service although some members of staff were better at cooking than others. One person told us that the food was so nice it was addictive. Another person told us they sometimes support staff to cook lunch or evening meals. They all told us that they can go shopping to buy their own food and bring it back the service to cook. People told us they have access to cups of tea, coffee and snack when they wish.

One person told us “managers and staff encourage me to be more independent, I go shopping for food and cook my own meals, this will all help me when I move back into the community”.

People told us they get to see their General Practitioners, care coordinators and other health care professionals when they need to.

They told us that they can talk to staff about their concerns and they were confident staff would always take their concerns seriously and would do something about them.

People told us that the home is always clean and tidy. They are encouraged to keep their bedrooms tidy and to do their own laundry.

People told us that there were always managers around and the registered provider visited regularly. They all said they got on well with the managers and provider and found them to be easy to talk to.

Staff told us they had plenty of training and that the service was good at developing staff. One member of staff told us that they attended regular training seminars after team meetings and found these very useful because they boosted their knowledge.

Croydons Social Services safeguarding coordinator told us they recently visited the service to go through a reflective exercise on a serious concern about a provider protocol the service had been subject to over eighteen months ago. They were told by the provider that from the serious concerns a number of lessons had been learned. Staff supervision and quality assurance visits are taking place, financial governance much better understood by staff. Clear leadership was in place and based on the professional not personal. The safeguarding coordinator told us the home appeared relaxed and nice and they had no concerns whatsoever about the service.

We spoke on the telephone to a forensic placement officer who placed some people at the service. They told us “this was one of the better care homes in the area. There is very good communication between the service and the centre. The care home is spacious and comfortable and is always hygienic, clean and tidy when I visit. Their records on people are very good, the service offers good value for money. The staff, the manager and the registered provider are always courteous and professional. One thing I admire about the service is that they are very honest and up front, if things are not working properly with a person placed there they will always call and ask how can we make this work better”.

Rosenmanor Limited provides care and support for up to twelve people who have mental health needs.

The last inspection of the service was in September 2013 when it was found to be meeting the required standards. This inspection was carried out by the lead inspector for the service over two days with both visits being unannounced. We spoke with seven people using the service, two members of staff and the deputy manager. We looked at the care plans for two people as well as other records held by the provider including those kept for staff recruitment, staff training and health and safety.

Is the service safe?

People we spoke with said that the care staff treated them well and they felt safe. They said, “they try their best”, “the staff help me with what I need” and “I like it here.”

Support plans were in place around important areas such as personal hygiene, medication, activities of daily living and identified health needs such as diabetes. Reports were produced by each person’s key worker providing good detail about recent events including activities, health appointments and other significant events.

The recruitment procedures in place helped to make sure that individuals received support from people who were of good character and risks of harm were minimised.

Is the service effective?

Records showed that staff had received training that helped them do their jobs.

Feedback from external professionals who worked with the service was positive about the support provided and the way staff worked with them to achieve positive outcomes for people using the service.

Is the service caring?

People using the service told us that staff treated them with respect and they were happy living at the home. They said, “they are doing their best”, “the staff are good, helpful” and “the staff are lovely.”

Is the service responsive?

People said they knew how to make a complaint and felt able to approach the staff working at the service.

Is the service well-led?

Rotas showed that the registered manager was either on-call or present at the service for one day a week. People using the service consistently referred to the deputy manager as the person they would go to if they had a concern and they were clearly in charge of the service during both our visits. The provider may wish to review these arrangements as the registered manager should be the person who is in day to day control of the service.

Staff members spoken with said that they received regular supervision and records seen confirmed this.

Quality assurance processes were in place however these could be developed to ensure that specific measurable action plans were being documented following meetings and surveys. This information may assist the service in ensuring that people were able to be fully involved in the running of the home.