Rosenmanor Limited

Rosenmanor Limited is a residential care home providing accommodation and personal care to up to 12 people. The service provides support to people with mental health needs in 2 adjoining properties on a residential street. At the time of our inspection there were 5 people using the service.

People’s experience of using this service and what we found

The provider’s quality assurance processes did not always lead to shortfalls being identified and addressed. This meant risks to people’s safety were not always resolved in a timely manner. We found risks to people from tripping hazards, rusting garden furniture and uncovered radiators which the provider’s safety audits did not identify.

People’s individual risks were assessed and mitigated. Care records provided staff with the information they required to keep people safe. Staff were trained to recognise abuse and to report any safeguarding concerns. People’s medicines were stored appropriately and administered as prescribed. The environment was clean. Safe food hygiene and infection prevention and control practices were followed.

People’s needs were assessed and their care records noted their preferences for care and support. People ate well and were supported with the involvement of a range of healthcare professionals. Staff received regular supervision from the newly appointed locality manager and told us they felt supported in their roles. The environment of the care home (both indoors and externally) had improved since our last inspection.

People told us the staff were caring. Staff recognised people’s cultural and spiritual needs and promoted their independence. Staff supported people to maintain the relationships that were important to them.

People received personalised care and participated in regular reviews of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The managers and staff worked in partnership with healthcare professionals, local authorities, voluntary mental health services and education providers to meet people’s needs and preferences. The views of people, relatives and staff was gathered through meetings and feedback was used to make changes to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 September 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of regulations related to people’s safe care and treatment and the governance of the service.

This service has been in Special Measures since 6 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 02 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the effectiveness and governance of the service.

We undertook this unannounced comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosenmanor Limited on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified continuing breaches in relation to people’s safe care and treatment and the governance of Rosenmanor Limited at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rosenmanor Limited is a care home providing personal care and support to people with mental health needs. There were eight people living there at the time of the inspection, six of whom were receiving personal care. The service can support up to 12 people.

People’s experience of using this service and what we found

The provider’s systems to ensure the care people received was good enough were inadequate. The registered manager was also registered as manager at two other care homes which they also owned and they split their time across the services. Our inspection findings showed this system was inadequate as they lacked the necessary managerial oversight of Rosenmanor Limited. They also had a poor understanding of their role and responsibilities. Although some audits were in place these were ineffective as they had not identified or resolved the many concerns we found. In addition, the provider had not notified us of significant incidents as required by law, such as police incidents, to help us monitor the service.

People were not always protected from the risk of avoidable harm. Risks relating to the premises were not always appropriately assessed and some risks to people were not assessed at all. These risks included risk of falls from windows that lacked suitable restrictors; a risk of burns from radiators which were uncovered across the service; a risk of a water borne infection which had not been assessed; an open waste pipe with an open drain which could allow vermin to enter in the dining room; risk of infection or injury from rusty radiators, some of which were crumbling. Some building work looked unsafe or unsuitable including a new office extension where the provider had attached an external wall to the middle of a window in the dining room. Infection control risks were not always well managed. We observed blinds in an en-suite black with dirt. Mops and buckets were stored outside, uncovered and exposed to the elements and creatures. Medicines management was not always safe and the provider could not account for all medicines as procedures to monitor stocks were lacking.

The provider did not always operate safe and effective recruitment practices to ensure staff working with vulnerable people were suitable. The provider did not always obtain suitable references for all staff to check their previous work performance. There were enough staff to support people safely.

People were not always safeguarded from abuse as the registered manager and staff did not fully understand their responsibilities to keep people safe. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. A health and social care professional told us a person had been unlawfully detained since March 2022 as the provider had not ensured legal authorisation to detain them was in place. In addition, the provider had not obtained legal authorisation to administer a medicine to them covertly.

The provider had not ensured people were treated with dignity and respect. Two people had bedroom doors with glass panels in them which meant anyone standing outside could see inside. The registered manager told us this had been the case since the service re-opened in September 2021 yet they had neglected to act. We found a person had been sleeping on a mattress wrapped in the plastic covering it was delivered on. They told us it they would prefer it was removed and the registered manager had been unaware of this concern. Staff interacted with people in a caring manner and knew the people they were caring for. Care was personalised to meet people’s needs and preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was good (report published July 2018). The service was dormant following a fire in 2019 until September 2021.

Why we inspected

The inspection was prompted in part due to anonymous concerns received about the standards of care. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosenmanor Limited on our website at www.cqc.org.uk.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, recruitment, safeguarding, privacy and dignity, good governance and notifications. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

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.

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.

The recovery and rehabilitation team said the home managed some very challenging service users however they had a positive experience of working with them. One person using the service said 'I definitely get good support from staff with my medicines. They make sure I take it and make sure I collect it from the recovery and rehabilitation centre'.

All of the people using the service we spoke to said they felt safe living at the home. They said there was always a member of staff around when they needed someone. The local authority's safeguarding coordinator said they had no current concerns about the home.

A member of staff said they had completed all of their mandatory training. Another member of staff who had recently started working at the home said they had received relevant training and completed an induction. Both said they received supervision and attended regular team meetings.

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.