Archived: Roberta House

Roberta House is a residential care home providing personal care to 16 people most of who are living with Korsakov’s syndrome and had a history of alcohol dependence.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection one person was in receipt of personal care.

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

People told us they felt safe living at Roberta House. However, we found when safeguarding incidents occurred, staff did not follow correct processes and reporting procedures. Although managers took action to investigate concerns, they did not inform the Local Authority safeguarding team or the Care Quality Commission (CQC) as required.

Managers did not always understand and comply with their regulatory responsibilities. We found some care plans were out of date and did not contain the level of detail need. Audits and quality assurance processes did not identify and act on the issues identified during our inspection.

The provider had identified that an additional staff member during the day would be beneficial to help meet people’s needs. They were in the process of recruiting new staff members to cover this post.

People’s care was based on their needs and preferences. People were supported to do things they enjoyed. People were independent and chose how to spend their time. Complaints were responded to appropriately.

People were involved in their assessment to ensure the service could meet their needs. Staff had received the training and support required to enable them to fulfil their roles. 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.

People told us they were happy living at Roberta House and liked the staff team that supported them. We observed people be supported to express their opinions about their care. People and staff had positive relationships based on mutual trust. Staff understood people’s conditions and needs well and were responsive to these.

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 17 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safeguarding incidents and quality assurance processes 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was carried out on the 18 January 2017 and was unannounced.

Roberta House is registered to provide accommodation and personal care for up to 16 people. Most people were living with Korsakov’s syndrome and had a history of alcohol dependence. Korsakov’s syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The outcome is that people have short-term loss and have difficulty acquiring new information or learning new skills. People required support with processing and retaining information. The service supported them to be as independent as possible.

The service is situated close to another care home service run by the same provider and shares staff and management with the other service.

The service had a registered manager in post. A registered manager is a person who is 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 management team had identified that some necessary training had not taken place and regular one to one meetings when staff could reflect on their practice were overdue. Sometimes, in extreme circumstances, when people exhibited behaviours that could be challenging the staff were directed to physically intervene but they had not received the training to do this safely. There was a plan in place to rectify this, but it had not yet been completed; so this was an area for improvement.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. The gas certificate for the service was out of date. The registered manager immediately booked someone to come and check it was safe. Regular fire drills were completed.

People were actively involved in writing their support plans and risk assessments. They identified goals to work towards and these were consistently met. An in-house cognitive behavioural therapist worked with people to help them understand their condition and how it impacted on their lives. Cognitive behavioural therapy is a talking therapy that can help you manage your problems by changing the way you think and behave.

People took part in a variety of activities inside and outside of the service. Some people organised their own activities, and arranged themed nights based on their individual choices and interests. Complaints were investigated and responded to promptly.

Staff knew how to recognise and respond to protect people from abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

People were supported to make decisions about their lives and gave consent when able. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant local authority, in line with guidance.

People were supported to eat and drink a range of healthy and nutritious food. Food was prepared at the provider’s other service and was served warm. Food appeared home cooked and appetising.

Risks relating to people’s health, mobility and behaviours had been assessed and minimised where possible. People received their medicines when they needed them. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. Staff followed guidance and advice given by health care professionals.

People told us that staff were kind and caring. Staff knew people well and people were supported to be as independent as possible. People were treated with dignity and respect.

People and staff told us they thought the service was well led. Staff told us they were supported by the registered manager and there was an open and inclusive ethos within the service. The provider told us the aim of the service was to, “Promote independence” and, “Ensure everyone is able to achieve their full potential.”

The registered manager and the provider were experienced in working with people living with Korsakov’s syndrome and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager and other senior staff regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care.