This inspection took place on 28 September 2017 and was unannounced. At our last inspection in 2 August 2016, we rated the service as Requires Improvement because we found shortfalls in safety and management. At this inspection, we found that improvements had been made and we have now rated the service as Good.

Rosewood Lodge is registered to provide care and accommodation for 19 older people some of whom may have dementia care needs. On the day of our visit, 19 people were using the service. The service offered support with end of life care. However, at the time of our inspection, there was no one who required this type of care.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

The premises were clean. Regular maintenance and health and safety checks were carried out. Risk assessments were in place for people to ensure potential risks to them were known and managed, such as falls and any health care needs.

People and relatives commented the service was a safe place. People received their medicines on time from staff that were trained to administer them.

There were enough staff on duty to meet people's needs. The provider had made changes to the staffing structure to ensure there was suitable numbers of staff available at all times. Staff on duty had received training to ensure they communicated with people effectively and had the skills to respond to their needs.

The provider carried out the appropriate checks on all new employees before they started working at the service.

The provider involved staff, people and relatives in the development of the service. There was a relaxed atmosphere and people felt comfortable with staff and the management team.

Staff received training in safeguarding people and were able to describe the actions they would take if they had any concerns about possible abuse. The provider also had a whistleblowing policy which staff were aware of and said they were confident they could use.

Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met. The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff had an understanding of how to support people who lacked capacity and received training in the Mental Capacity Act 2005.

Staff received regular support through supervision meetings with the registered manager. Their work performances were reviewed on a yearly basis.

People were treated with dignity and their choices were respected. Staff encouraged people to be as independent as possible.

People received personalised care and support, to ensure their individual needs were met. They were encouraged to participate in activities or pursue any hobbies and interests.

People and relatives were able to make complaints or raise concerns and have them investigated. Their feedback was obtained through questionnaires and surveys.

The provider had systems in place to monitor the quality of the service provided to people. Audits and checks were carried out by the registered manager to ensure the service was safe for people and staff.

The inspection took place on 2 August 2016 and was unannounced. At our previous comprehensive inspection on 8 January 2016, the service had not met legal requirements relating to staffing, infection control, person centred care, maintaining premises and equipment and quality assurance. They were rated inadequate in safe. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Rosewood Lodge provides care to 19 people some of whom may be living with dementia. On the day of our visit there were 19 people using the service.

There was a registered manager in place on the day of our visit. 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 Rosewood Lodge had made significant improvements and now met seven out of the nine regulation breaches we found at the last inspection. These included improved understanding of the mental capacity act, maintenance of a clean and safe premises and equipment, providing more person centred activities, safe infection control practices and more positive interactions between staff and people. Although, we found improvements, there were still areas that needed further work on to fully improve and they needed more time to embed and sustain changes made.

People told us there were usually staff around them to help. We saw that staffing was consistent, however, we noted that the skills mix of staff on duty could be further improved to ensure people’s needs were met.

People told us they felt safe and that staff treated them with dignity and respect. Staff had undergone safeguarding training and were able to recognise and report abuse or discrimination.

There were procedures in place to ensure people were kept safe should a medical emergency or a fire incident occur. Staff were aware of the procedures to follow in the event of a fall or any other incident. The registered manager monitored monthly incidents in order to identify any patterns and implement prevention strategies.

Staff including volunteers underwent an induction. Staff told us they were happy with the current training, appraisal and supervision in place. They were aware of the Mental Capacity Act (2005) and how it applied in their practice.

People were supported to eat a balanced diet. Except one person, all people said that the current diet met their cultural specific needs. Another relative told us the current menu was not suitable for their relative.

Care plans were comprehensive and included people’s social, physical and emotional support needs. Activities interest’s assessments were now in place with an external activities person coming once a week.

People said they would make a complaint to the manager. We reviewed the complaints log and found complaints were responded to in a timely manner but also noted a theme around meals. The complaints procedure had been put in pictorial format to make it easier for people to understand

People and staff told us the service was well run with the exception of one relative who thought there could be more flexibility. The culture was shifting from task orientation to person centred care.

There were systems in place to monitor the quality of care delivered. However, some policies such as the safeguarding and Mental Capacity did not reflect current guidance. We have made a recommendation to seek further guidance.

The inspection took place on 8 January 2016 and was unannounced. The service met the three legal requirements inspected at our last follow up inspection in October 2014.

Rosewood Lodge provides care to 19 people some of whom may be living with dementia. On the day of our visit there were 18 people using the service.

There was a registered manager in place on the day of our visit. 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 told us they felt safe living at the service. However, we found shortfalls in the current infection control measures and found that the premises were not always maintained in order to keep people safe. Risk assessments were in place for people but were not always up to date for the environment which could leave people at risk of falls. In addition policies were not up to date and care plans were not always individualised to ensure people received person centred care.

Staff were supported by regular supervision and yearly appraisals in order to identify and developmental needs so they could be supported to deliver appropriate care. We found shortfalls in the training and induction program. Although staff had attended training they had limited understanding of the requirements of the Mental Capacity Act 2005 and dementia care. This affected how they responded to people.

Staff turnover was very high and did not ensure continuity of care for people. Staffing levels were maintained at three staff to nineteen people. However, we found that staffing numbers were not determined by people’s needs and level of dependency on staff, but by numbers of people using the service. This left people at risk of falls and waiting for prolonged periods especially during the afternoon.

People told us they were respected and that they could raise complaints if they needed to. However we found discrepancies in the complaints logged and found that the service’s policy was not always followed to ensure that complaints were acknowledged and responded to in a timely manner.

People’s records were not always accurate and did not always reflect current needs. People were not always lawfully deprived of their liberty.

We found short falls to the leadership and quality assurance systems as they had failed to pick up inadequate training, poor infection control practices and maintenance of the service. In addition some staff told us they felt the culture of the service was punitive.” Policies were not always up to date and could impact of the care delivered especially around safeguarding and mental capacity.

We found several 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 this report.

We inspected following concerns raised by an anonymous source which related to the safety of people using the service. Concerns alleged poor infection control and inappropriate manual handling. We visited on 28 October 2014 and spoke to seven people and three staff including the manager. We reviewed three peoples care files and five daily care records and found that people received individualised care.

The provider was providing a safe and effective service which was meeting the needs of the people living at the home. Staff were aware of safeguarding procedures in place and knew where to report any concerns. There were infection control systems in place to minimise the risk and spread of infections. Appropriate risk assessments were in place and updated as and when people's condition changed.

Staff were caring and responsive to the needs of the people they looked after. We saw staff interacting with people in a polite manner and calling people by their preferred name. We were told that one of the people was in hospital and staff were going to visit and check on progress as often as possible.

The service was well led with the team knowing how and when to escalate through a system comprising of a manager, senior care staff, carers, a cook and domestic staff. We were told and saw evidence of regular resident meetings and involvement of both people and their relatives in choosing activities, food and care plans.

At the time of this inspection Rosewood Lodge was providing care and support to 19 people, some of whom had a diagnosis of dementia. We spoke with 5 people living at the home to obtain their views of the support provided. We also spoke with the home manager and two members of staff.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. Comments from people included, "I like it here. Staff are very nice" and "I'm very happy here. We are never left on our own."

Systems were in place to make sure managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. We found risk assessments had been undertaken to identify any potential risk and the actions required to manage and minimise the risk had been put in place. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The manager told us that no applications had been made to deprive people of their liberty but staff understood how to submit one and follow the correct process. This meant people would be safeguarded.

Is the service effective?

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind manner and there was a relaxed and friendly atmosphere.

Care files we checked confirmed that initial assessments had been carried out by the staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required and regular equipment checks were carried out to ensure they were fit for purpose. Staff were provided with training to ensure they had the skills to meet people's needs. Managers' were accessible to staff for advice and support and we saw people being able to access the manager as needed.

Is the service caring?

People who used the service and their relatives said staff treated people respectfully. Relatives in the quality survey said, "Our [family member] has been treated with dignity." During our observation we saw friendly interactions between staff and people who used the service and there was kindness in the staff's tone of voice when speaking with people who were agitated. Interactions between staff and people who used the service were relaxed and unrushed. We found staff understood the need to recognise and respect the diversity and human rights of people who used the service.

Is the service responsive?

Staff told us the care and support provided was flexible to the person's individual needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed and updated in the care plan. People knew how to make a complaint if they were unhappy. One person who used the service said, "I have no complaints at all."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There were good relationships with local GPs and other care providers to ensure the needs of the people who used the service were met.

All people spoken with said they could speak to the staff at any time and we observed people coming to see the manager during the inspection. They were greeted in a friendly way and encouraged to share their thoughts.

Staff had regular meetings and were kept updated about any information during the daily handover sessions. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information. The service carried out a yearly 'Quality Assurance Survey'. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.

The service had a quality assurance system in place. Monthly and weekly audits were completed regarding such as the environment and equipment maintenance. This ensured a timely response could be given to any issues and the service could maintain and improve quality at all times.

We carried out this inspection after receiving anonymous information of concern in relation to the respect and dignity of the people who use the service and cleanliness and infection control at the home.

We spoke with seven people who used the service, two night care staff, three day care staff and the manager. People using the service were consistently positive about their care. One person told us, "staff always speak in English and are very polite." We saw that people were able to choose when they got up in the morning and went to bed in the evening. People’s care records showed that the staff followed their wishes about this.

We observed the home to be clean and odour free on the day of the inspection. People using the service said the home was clean and they were happy with the standards of hygiene. One person said, "always very clean here. The staff wear gloves." We reviewed infection control policy and practice in the home. Staff had access to guidance and training on infection control and appropriate personal protective equipment and hand washing facilities. The manager monitored infection control practice in the home.

More information can be found in the main body of the report.

We spoke with four people who used the service and six members of staff. We observed people using the Short Observational Framework for Inspection (SOFI). The people we spoke with told us they were happy with the care they had received. One person said, "the staff are very good. They just don't walk past you, they say hello." Another person said, "the staff are always helping you. We saw that staff had a good rapport with people living in the home. We saw people enjoying activities and chatting with staff.

Accommodation was furnished, decorated and maintained to a good standard. The home was clean and odour free. Each person we spoke with said they thought the home was clean and said they were happy with standards of cleanliness.

We looked at staff files and saw that the service followed procedures when recruiting new staff. Checks were in place to ensure that only appropriate people were employed.

People using the service said they could talk to staff or the manager if they had any concerns or complaints. They also felt confident that staff members would resolve their problem. One person said, "you can complain in the [residents] meeting and it is dealt with straight away."

People and their relatives commented positively about Rosewood Lodge. One person told us that Rosewood Lodge was a “marvellous home” and that “the girls are very kind”. Another person told us that the environment was “very clean and well organised”.

One person told us “I am happy with the support I am given with my healthcare. I like the food and the staff are very good”. Another told us, “since coming here, my appetite has been much better. They really do look after us well in here, we don’t have any complaints”.