The inspection was unannounced, and took place on 12 June 2018. The location was previously last inspected in November 2017. At that inspection concerns were identified in relation to safe care and treatment, but the overall rating was “good.”

Rotherwood 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.

Rotherwood is located in Rotherham, South Yorkshire. It is can accommodate up to 27 people who have needs associated with those of older people. There were 26 people living there at the time of the inspection.The home is in its own grounds in a quiet, residential area, but close to public transport links.

At the time of the inspection, the service did not have 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 and associated Regulations about how the service is run. A manager had been appointed prior to the inspection and had applied to register with CQC, however, at the inspection we were informed that this manager had left and work was under way to recruit a new manager.

Throughout the inspection staff spoke with people with warmth and respect, and took steps to uphold their dignity. People told us their experience of care was good, and praised the staff. People gave us positive feedback about the mealtime experience and told us they were offered a good range of options at mealtimes.

Medicines were not safely managed; people did not always receive their medication in accordance with the prescriber’s instructions, and there was insufficient information for staff about when “as required” medication should be administered.

Risks were not always appropriately assessed to ensure people were cared for safely, and sufficient numbers of staff were not always available.

The arrangements in place for obtaining and acting in accordance with people’s consent did not meet legal requirements.

Activities were available in the home, however, sometimes short staffing impacted upon activities.

The arrangements in place for monitoring the quality of the service were not robust enough to identify or address shortfalls in service quality.

The inspection took place on 23 November 2017 and was unannounced. The last comprehensive inspection took place in January 2017, when the service was rated requires improvement. We found that the registered provider was not always meeting the requirements of the Mental Capacity Act 2005. The registered provider sent us an action plan indicating what action they would take to address this breach. This inspection took place to check if improvements had been made. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Rotherwood’ on our website at www.cqc.org.uk.

At this inspection we found the registered provider had taken appropriate actions to meet the requirements of the breach. The registered provider was meeting the requirements of the Mental Capacity Act 2005. Staff gained consent from people prior to completing care tasks.

Rotherwood Care Home is situated on the outskirts of Rotherham close to local shops and public transport. It provides accommodation for up to 27 people who require personal care. Care is provided for people who have needs associated with those of older people.

At the time of our inspection 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.

We looked at care records and found risks associated with people’s care had been identified. Appropriate risk assessments were in place to ensure risks were minimised.

Staff we spoke with knew how to recognise and report abuse and told us they would inform the registered manager if they had any concerns. They were confident that the registered manager would take appropriate actions to ensure people were safe.

We observed staff interacting with people and found there were enough staff available to meet people’s needs in a timely way.

We found some concerns regarding the management of medicines. The service could not always evidence the medicines had been stored at the correct temperature. We also found some medicines had not been recorded correctly in line with the current guidelines for storing controlled medicines.

We completed a tour of the home with the registered manager and found the laundry/sluice area was not clean and needed further attention to ensure the area was fit for purpose. The registered manager had begun work in this area and intended to complete this action.

Staff were knowledgeable and had the skills and support to carry out their roles and responsibilities. Staff received training and support from the management team.

People received a well-balanced diet which met their needs and their preferences. Meals looked appetising and people enjoyed them. Snacks and drinks were also available throughout the day.

People had access to healthcare professionals when required.

We observed staff interacting with people who used the service and found they were kind, caring and compassionate. People and staff shared appropriate and friendly banter and there was a lot of laughter which showed people were happy. Staff respected people’s privacy and dignity and were respectful in their approach with people.

The registered manager had developed a new care planning system and had received good feedback from visiting professionals. We looked at care records and found they reflected people’s current needs.

People were supported to follow their interests and take part in social activities which were appropriate and met their needs.

The provider had a complaints procedure and people were encouraged to talk with the registered manager and staff about any concerns.

People told us the registered manager was supportive and they felt able to approach them. People felt they were listened to and their comme

The inspection was unannounced, and took place on 5th January 2017. The home was last inspected in December 2015, where concerns were identified in relation to how medication was managed, how staff were supported and the lack of a registered manager. At this inspection we found these issues had been addressed.

Rotherwood is a 27 bed service providing residential care to older people with a range of support needs including dementia. It provides accommodation on either a long term basis, or on a short term respite basis including assisting people to rehabilitate following injury or illness before returning to their own home.

Rotherwood is located in the East Dene suburb of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to the town centre and public transport links.

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 and associated Regulations about how the service is run.

At the inspection, we found that staff spoke to people with warmth and respect, and day to day procedures within the home took into account people’s privacy and dignity. The home was undergoing a programme of improvements to make the environment more suitable for the needs of people with dementia.

Staff had received training to enhance their understanding, although we noted a small number of staff still required this training. Medicines were stored and handled safely, although we noted some areas for improvement, which the provider addressed immediately.

Where people were at risk of injuring themselves or others, there were appropriate risk assessments in place to guide staff in relation to caring for people safely. Recruitment procedures were sufficiently robust to ensure people’s safety.

The service was not always effective, as improvements were required in the way consent was obtained and recorded, and in the way the service responded when people did not have the capacity to consent to their care.

Mealtimes were observed to be comfortable and pleasant experiences for people, and people told us they enjoyed their food.

The home had an activities coordinator whose role involved designing and leading an activities programme for people using the service. We observed activities taking place and saw that people appeared to enjoy this.

There was a formal complaints procedure in place, and we saw that where complaints had been received the provider carried out a thorough investigation and responded to complainants in a timely manner.

The home’s manager understood the responsibilities of their role, and they were supported by an operations manager who also had a good knowledge of the home and the people living there.

The management team were accessible and were familiar to people using the service. The provider had a thorough system in place for monitoring the quality of service people received.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

We saw people using the service were treated with respect and dignity by the staff who supported them. Care and support was delivered in a safe way by staff who had received appropriate training.

The home was clean and fresh throughout. We saw that since our last inspection a more effective system had been introduced to reduce the risk and spread of infection.

People were protected from unsafe or unsuitable equipment. We saw where people needed specific equipment as part of their care delivery, for example to help with their mobility, it was available. Where staff used equipment to help people they did so in a safe and appropriate manner.

We saw checks took place to ensure the service was operating safely.

Is the service effective?

People’s health and care needs were assessed on a regular basis. We saw people who used the service and their relatives had been involved in planning care and these were reviewed and updated regularly.

Staff had received appropriate professional development. We saw they had access to a varied training programme that helped them meet the needs of the people they supported.

We saw most staff had received an annual appraisal of their work, which included a training and development plan. Formal staff support sessions had also been carried out on a regular basis.

Is the service caring?

People said they were supported by kind, caring and friendly staff who were aware of their needs and preferences. We saw staff interacting with people positively. They encouraged them to be as independent as they were able to be, while providing support as needed. A visitor spoke positively about the care and support provided to their relative.

People we saw looked well-presented and cared for. We spoke with seven people who used the service and a visitor who all said they were happy with the care provided and complimented the staff for the way they cared for people.

Care files contained adequate information about people’s needs and preferences. Staff were aware of the content and followed the guidance.

Is the service responsive?

We saw, and were told, that people’s needs had been assessed and where necessary a review of their care plan had taken place so it could be updated to reflect their changing needs. A visitor told us how they had been involved in reviewing their relatives care.

The home has a complaints procedure which was available to people using and visiting the service. No complaints had been recorded since our last inspection.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. We saw audits had been completed by the manager and where shortfalls had been noted action taken to address them. However there were some areas still needing attention.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed and facilities provided were suitable.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure. The ones we sampled had been updated since our last inspection and reflected current best practice.

People told us they received the care and attention they needed in a relaxed and caring way. They said staff respected their choices and they were happy with how their care was delivered. We saw care plans contained good detail about people’s needs and preferences; however, they did not always reflect recent changes that had taken place.

People were provided with a choice of suitable and nutritious food and drink. They told us they enjoyed the meals they received saying they provided variety and choice.

The system in place to reduce the risk and spread of infection was not always effective.

There was a system in place to ensure people received their medicines promptly and in a safe way, but records were not always completed correctly.

There were enough qualified, skilled and experienced staff to meet people's needs.

There were systems in place to gain people’s views. However checks carried out to make sure staff were following company policies were not always used effectively.

Records were not always accurate or up to date. Although each person had a care plan in place they had not always been reviewed and changed as needed. We also found shortfalls in monitoring and assessment documentation.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said, "The staff are good at involving people and keeping us up dated on changes in my mother's care."

We spoke with six people who lived at the home and four visitors. Their comments indicated that people received the care and support they needed and they were happy with how staff delivered care. When we asked one visitor about the care their relative had received they said, "It's sound." Another person told us, "The care is very good."

The premises were generally in a satisfactory state of repair and were clean and fresh. One person said they were "Thrilled to bits" with their room. We saw there were some areas that needed attention but most of these were already being addressed.

Appropriate background checks had been carried out on staff before they started to work at the home. This included ensuring staff underwent Criminal Records Bureau (CRB) checks. Although staff told us they had received an induction to the home when they started working there this had not always been thoroughly recorded.

We saw the complaints procedure was displayed in the home and people told us they felt confident taking any concerns to the manager or any of the staff.

People who used the service spoke positively about the staff that worked with them. One person said, “Staff work hard and are lovely. We are well fed and watered. Staff put their arm around us - they must have been trained. You can tell they have been trained.” Another person said, “Staff are very good. You couldn’t wish for anybody any better.”

People we spoke with were aware of meetings in the home for residents and relatives and had attended these. A person we spoke with said, “The home is well run.” Another person told us, “I am satisfied with everything. It’s the next best thing to being in your own place.”

People we spoke with were happy in the home and felt they were respected and involved. A person told us that they had given their consent to the services they received in the home. A relative told us that the provider also treated things confidentially.

A person told us they had received no information about the service. However, from other checks we made, we found information about services was shared with people and made available to them. People could engage in activities of their choice.

People we spoke with made mainly positive comments about the care they received. A person said, “I think it’s great! It’s service and everything, you can’t complain. I’ve got my family with me all the time.” Another person told us, “I’m stopping here the rest of my life!” A relative told us that their relative got help with their personal care.

Another person told us, “They helped me walk!” A relative told us about the person they were visiting being in the home for respite, and about “the very good work” that the home had done to regain and maintain their relative’s mobility.

People told us they felt safe in the home. People were guided and supported appropriately in taking their medicine and were not rushed. One person taking their medicine told us, “I don’t like it; but they couldn’t be doing anything different.”

People had opportunity to make known their views about the service provided through surveys.

This inspection was carried out on 8 and 11 December 2015 and it was unannounced on the first day. At the last inspection, in May 2014, the service was judged compliant with the regulations inspected.

Rotherwood Care Home is situated on the outskirts of Rotherham close to local shops and public transport. It provides accommodation for up to 27 people who require personal care, nursing care is not provided. Care is provided for people who have needs associated with those of older people.

The service did not have a registered manager in post at the time of our 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. The regional manager told us that they were looking to appoint a new manager in the near future. Since the registered manager left in September 2015 the service has been supported by the regional manager and another registered manager that works in another home owned by the provider.

People told us they felt safe living in Rotherwood. One person said, “Staff are here for you, they make you feel safe. It’s nice living here.” There were procedures to follow if staff had any concerns about the safety of people they supported.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. 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 balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made. For example, we saw visitors to the home included the district nurse, advanced nurse practitioner, chiropodists, dieticians and doctors visited people when needed.

The arrangements for handling and administrating medicines required some improvements to ensure it was safe and people received their medicines as prescribed. We found the drugs store room needed some attention to ensure it was suitable for the storing of medication. There was no suitable arrangement for hand washing to prevent cross infection. We found some of the systems to record and store medication was not sufficiently robust. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Most staff were recruited safely, however the regional manager was unable to locate two staff members’ files that we asked to see. You can see what action we told the provider to take at the back of the full version of the report.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People were able to access activities. We saw posters advertising the Christmas party which was due to take place later in December. Regular entertainment took place each month which included ‘Lost Chord’ and movement to exercise classes.

We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. One person said, “It feels like home living here.” Another person said, “Staff are always there when you need help.”

We found some people who used the service were living well with dementia. However, we have made a recommendation that the provider consider best practice guidance in relation to the flooring, lighting and throughout the communal areas of the home, and the use of contrasting colours on the corridors. This will enable people to orientate themselves around the home

Some areas of the home required improvements to ensure they were fit for purpose. The kitchenette used throughout the day was dirty. Equipment within the kitchenette required a deep clean to help prevent and control the risk of cross infection. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us it had been a difficult period without a manager but they said the regional manager and the manager from another home had given support when needed. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it. We noted from the records that some concerns had been raised by the local council commissioners.

The systems to monitor and improve the quality of the service were ineffective. The regional manager was not able to produce audits that were completed by the registered manager before she left employment. You can see what action we told the provider to take at the back of the full version of the report.