Rosemary Park Nursing Home 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. Rosemary Park accommodates and provides nursing care for up to 73 people in one adapted building. The building is set out in four living areas, each with their own lounge and dining rooms.

At the time of our unannounced inspection on 28 November 2018 there were 62 people living at the service, all of whom were living with dementia or a mental health condition. Some people had a history of failed placements in other services.

There was 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. The registered manager assisted us with our inspection.

At the last inspection in August 2015 we rated this service as Good in each of the domains. We found at this inspection some aspects of the service had not sustained this rating and as such we have re-rated the service in Effective, Responsive and Well-Led to Requires Improvement.

Staff were not following the principles of the Mental Capacity Act 2005. People had restrictions on their liberty without the legal procedures being followed. For example, we found a lack of decision-specific capacity assessments in place. Some care plan documentation for people was not up to date and did not include specific information. Activities were organised for people to attend, however we heard that some people wished more was going on or wanted activities that were individualised for them. We have issued a recommendation to the registered provider in respect of both areas.

Risks to people had been identified and action taken to help keep people safe. Staff were knowledgeable in their responsibility around safeguarding people from abuse and where people had accidents or where there were incidents, steps were taken to prevent reoccurrence and lessons learned. People received the medicines they required.

People lived in a clean environment that provided equipment suitable for their needs and was checked for its safety. Staff could describe to us what they would do in the event of an emergency, such as a fire. Staff received regular supervision and were trained and competent in their role in general as they had access to an education department which provided mandatory and specialised training. Staff went through a robust recruitment process before commencing in the role.

People told us they enjoyed the food and we found that where people were at risk of malnutrition, or they had specific dietary needs, these were responded to. People’s needs were assessed prior to moving into the service and in the event they required additional input from other healthcare professionals, this was provided to them.

People lived in an environment that was kind, caring and respectful. Staff showed people individual attention and spoke fondly of them. People were known to staff and encouraged to maintain relationships with those who were important to them.

Relatives and professionals told us they felt the service was well managed. Arrangements were in place to quality check the service and people, relatives and staff had the opportunity to be involved in the service. Senior management had good management oversight and the service worked with external agencies to help improve people’s care. The registered manager met their requirements of registration. There was a complaints policy in place and complaints were investigated and responded to.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities

On this occasion we inspected Rosemary Park Nursing Home. St Magnus Hospital was inspected in July 2011, the report of that visit can be seen on our website www.cqc.org.uk

The majority of people who lived in Rosemary Park Nursing Home were living with dementia and were unable to tell us about the quality of care they received. To enable us to be able to access people’s wellbeing we spent time sitting with them observing the care they received. We also observed the level of staff interaction with them. We observed that the staff were attentive to people’s needs.

We talked with two visitors while they visited relatives. We also talked to two of the people who lived in the service. The people we spoke with told us that they liked living there and that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person said that the staff were, “Nice people, they treat me well.”

We saw that staff were supported through supervision and that they received training essential for caring for people living with dementia and mental heath care needs. When we talked with staff we found that they were knowledgeable about the people they supported. The service had a process in place whereby they sought the views of people who used the service and their relatives. There were appropriate safeguards in place to protect people from abuse.

This visit looked at the outcome areas in St Magnus Hospital and we spoke to people who were accommodated at St Magnus Hospital. We looked at each of the 4 wards in the hospital, which included New Park House, which opened 3 weeks before our visit

We spoke to people and they told us that they were treated well by the staff. They said that the staff ask them if they want any support and that there was always someone around to help.

One person described staff as respectful and polite and said that he can ask for support if he needs it. Another person told us that he knew what medication he was taking and knew that he could refuse to take his medication but understood the procedures that would follow his refusal. Another person said that he had been given an award for his art work, which was displayed in the communal area.

People told us that they were able to make their own decisions about what activities they would like to take part in. One person said that he would like to have more books and suggested that a mobile library visits. Another person told us that he likes to do crosswords and said that staff supports him with this.

People told us that they liked St Magnus and said the environment was first class. One person said how much he liked his room and that he had everything he needed.

We spoke with staff during the visit and they told us that staffing levels were sufficient to meet people’s needs. Staff also told us that they talk to people about the support and assistance they are giving and that there are good handovers at the beginning of each shift.

We also spoke to the family liaison officer and she told us the staff are very good and commented “this place is amazing”. She said that staff are knowledgeable and well trained and that patients are asked about everything and are treated with dignity and their privacy is respected.

We rated the core services at St Magnus Hospital as Outstanding because:

• The ward environments were safe; all areas were exceptionally clean and very well furnished.
• The hospital had a stable leadership team. Senior managers and clinicians were approachable and inspired their staff teams.
• The hospital was very well resourced with nursing and other clinical staff to meet safely the needs of the patients. Staff completed all risk assessments and care plans with patients and carers, and regularly reviewed and updated them.
• Many patients had complex physical health problems. Patients had very good access to physical healthcare. Some of the nurses were qualified general nurses, others received training in physical health conditions, and a GP visited the hospital site twice a week.
• Staff were knowledgeable of the Mental Health Act and Mental Capacity Act and applied the Code of Practice principles well for both. Advocates assisted patients at multidisciplinary care reviews.
• Staff were fully committed to working in partnership with patients and carers. Carers were involved in all aspects of care and treatment and were supported by hospital staff. Carers were invited to attend hospital training sessions for example, dementia awareness training.
• Staff were extremely caring of patients and visiting clinicians remarked on how well treated the patients were.
• There was a full range of facilities for patients including a therapy suite, a gymnasium, and a sensory room. All meals were prepared on–site by the chef and his team using local produce.
• Staff had access to an on-site education department that was accredited to provide a range of health and social care certified qualifications.
• Sickness rates were below 1%. There were no qualified staff vacancies. Staff felt empowered and motivated to do their jobs well and felt supported by their managers.
• Senior managers had developed initiatives to retain and develop their own workforce. This included sponsoring staff to complete nurse registration for both mental health and general nursing, and had recently sponsored five senior support workers to become associate nurses. Psychiatrists were supported to pursue relevant special interests for example, gaining experience in neuropsychiatry.
• Subsidised short-term accommodation and subsidised transport was provided for staff.