Archived: Roop Cottage Nursing and Residential Home

Roop Cottage Nursing and Residential Home is a residential care home providing personal and nursing care to 26 people at the time of the inspection. The service can support up to 35 people. The accommodation is over two floors, with communal lounge and dining areas on both floors, and there is a passenger lift.

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

The environment of the home was safe. Appropriate checks and were undertaken to ensure the home was safe. Equipment was serviced regularly. There were good policies and procedures to support robust infection prevention and control. Staff adhered to these processes and the registered manager undertook frequent checks on compliance.

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.

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

Rating at last inspection

The last rating for this service was good (published 8 August 2017).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the fabric and maintenance of the building, in particular the deterioration of the premises. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Roop Cottage Nursing and Residential Home 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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection was in June 2016 and the service was rated ‘requires improvement’ at that time. This was because the premises were in need of refurbishment and better cleaning and medicines were not always managed well. Some risk assessments had not been reviewed and some equipment had not been sufficiently assessed for safety. The provider had addressed most aspects of the concerns, although progress was slow to refurbish the premises and there was still further work required to bring them to a better standard of repair and décor.

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.

There was a welcoming, friendly atmosphere and people told us they were happy living at Roop Cottage. There had been some improvements to the premises and décor since the last inspection and the registered manager had prioritised main areas such as bathrooms and we were advised this work was ongoing, subject to the provider’s agreement. We have made a recommendation the provider improves the premises.

People said they felt safe and there were routine safety checks carried out. Individual risk assessments for people were in place and had improved in detail and accuracy since the last inspection.

Staff understood how to ensure people were protected against possible abuse and they knew how to report any safeguarding concerns.

People said they received their medicines on time, and systems for managing medicines were safely in place.

Staff felt supported in their role, there was clear direction for the team and there was regular staff training and supervision.

People enjoyed the meals and the food and drink provision was suitable for people’s needs.

Staff interaction with people was kind and caring and staff knew people well. People were encouraged to retain their independence and they told us they felt this was their home.

The activities staff knew people’s needs and individual interests. Activities provided meaningful engagement for people on an individual basis and in groups where appropriate.

Care records were maintained with sufficient information for staff to understand all aspects of people’s care needs and these were regularly reviewed. Care practice reflected what was written in people’s care records.

People knew how to make a complaint and there was a system for recording complaints and compliments.

The registered manager was experienced in providing care at Roop Cottage. People, relatives and staff felt supported and they were confident their views were valued. Systems were in place for monitoring the quality of the provision. The registered manager was aware of the strengths of the service and the areas to improve.

Roop Cottage provides accommodation, personal care and nursing for up to 35 people, some of whom may also have physical disabilities. The accommodation is provided over two floors and there is a passenger lift.

The home has 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 2008 and associated Regulations about how the service is run.

Staff were aware of individual risks to people and supporting people to manage their own risks whilst promoting their independence. Some risk assessments in individual care records, such as falls, had not been reviewed since April 2016. Some equipment was not sufficiently assessed for safety, such as bed rails.

Staff had a secure knowledge of safeguarding and how to identify the signs of possible abuse. Staff were confident to raise concerns with appropriate authorities should they consider a person may be at risk. Staff understood the whistleblowing procedures to report any poor practice should they become aware of this.

People were supported to have their medicines when they needed these, but there were some weaknesses in the administration process and the times of medicines being given were pre-printed on the records, which was not always accurate in practice.

Premises and equipment showed signs of wear and tear and were in need of refurbishment or replacement. This meant some areas were difficult to keep clean and posed a risk of infection.

There were cleaning schedules in place, although cleaning practice was not robust enough to ensure all areas were sufficiently clean, particularly bathroom areas.

Staff felt motivated and supported through supervision, regular training and effective teamwork. However, staff worked 13 hour shifts and this meant they did not feel as effective at the end of their working day.

People's rights and choices were promoted well and staff understood the legislation around the Mental Capacity Act (2005) and how this impacted upon people's care. Staff were kind, caring and patient in their approach. People were treated with respect and they said they felt very well cared for.

People's dietary needs and choices were supported appropriately; people enjoyed the meals and said they always had enough to eat and drink.

Care plans were person centred and activities were meaningful to individuals, with many opportunities for outside experiences as well as one to one support. Some detail in care records was conflicting, although regular reviews were evident.

Communication and teamwork were strong within the home and staff turnover was low. The registered manager had an accurate oversight of strengths and clearly understood the areas to improve, although improvements were not always implemented.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out the inspection with our five questions in mind; 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.

Is the service safe?

We found the premises were safe, accessible, visibly clean and well maintained. We discussed people's security with the manager and she explained unauthorised access was monitored to make sure people were safe. We saw furniture was appropriately maintained and in suitable condition, although there were two carpets still in need of replacing. We saw people easily accessed toilet and bathroom facilities and moved freely around the premises. The design and layout of each floor was similar and enabled people's autonomy and safety.

Is the service caring?

Staff spoke with people in a patient, caring manner and there was evidence of good relationships between them. Where people were confined to bed, staff made regular checks to ensure their well-being and offered drinks or music to listen to. Staff we spoke with were enthusiastic about their work and all said they enjoyed caring for people.

Is the service effective?

We spoke with three visitors who came to see people living in the home. Two of the visitors we spoke with told us they were happy with the standard of care provided. They said the staff were approachable and kept them informed about their family members' care. Another visitor said they thought the care could be better and they had expressed their concerns to management on occasion.

Staff had regular opportunities for training to be more knowledgeable in their role. However, some staff shifts were thirteen hours in length, which may reduce the effectiveness of staff's abilities to care for people properly.

Is the service responsive?

We saw people's wishes were respected with regard to when they wanted to get up and go to bed. For example, we noticed some people chose to stay in bed until mid-morning whilst others got up earlier and sat together in the lounge. One person told us they sometimes liked to stay in bed longer in the mornings and another said they preferred to stay up and watch television in the evenings.

Staff told us if they had concerns about a person's health they would refer these to senior staff so that people received appropriate care and support.

Is the service well led?

We saw the manager was involved in people's day to day care and she utilised her skills as a nurse to monitor their health. We saw the manager discussed people's health needs with care staff during our inspection. The manager told us she liked to be present in the home as much as possible in order to keep in touch with people, relatives and staff. We found there were suitable quality assurance measures in place so people's care and well-being was monitored effectively. The manager told us she carried out periodic reviews of care and practice to ensure people were supported and their needs met.

We spoke with health care professionals who visited the home. They spoke positively about the service provided. They told us they were confident in the staff's abilities to meet people's needs.

People also told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them. One person told us. "I have settled very quickly because the staff have made me very welcome and are very good."

People were protected from the risk of infection and appropriate guidance had been followed. However the environment was in a poor state of repair. Carpets and furniture were stained and marked and not well maintained.

People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. This was because training was not up to date and staff had not been appraised.

There was an effective system to regularly assess and monitor the quality of service that people received.