Roop Cottage Residential Home

Roop Cottage is a care home providing residential care to up to 35 people. At the time of the inspection there were 19 people living in the home.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: People’s choice and independence were not maximised. Where people had a learning disability, there was no engagement with them about where or how they would like to spend their time.

People were not 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 support this practice.

Right Care: Care was not person-centred and did not promote people’s dignity or human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people were leading confident, inclusive or empowered lives. Leadership and management was not robust. There was a high turnover of managers and the manager appointed since the last inspection was no longer working in the home.

Risks to people had not been assessed or addressed and there was little evidence of lessons learned from previous inspections. People had been received into the service without adequate assessment of their risks or care needs. There was limited evidence of action taken to address care and safety concerns raised with the provider since they took over this home. These issues included: leadership in the home, systems to ensure the safe management of medicines, person centred care, risks in the environment, and safe recruitment.

Mealtimes were based around staff availability and not personalised to the times when people preferred them. People were not always supported to have a drink until breakfast after 9am, although many people were awake much earlier. There had been a continuous lack of action from the provider to resolve this since they took over the service in 2021. People’s dietary needs were not safely managed to mitigate risks in relation to malnutrition, dehydration, choking and diabetes.

Staff had received some training, but this was not sufficient to meet the needs of people being cared for at Roop Cottage. No staff had completed training to support people with a learning disability and only 1 member of staff had completed dementia awareness training.

Care provision was not managed around people’s needs and preferences. Some people were not supported to come out of their rooms and there was a lack of meaningful activity. There was disregard for people's privacy, dignity and independence. Recording of people’s care and needs lacked detail and was of poor quality.

Some staff knew people well and had established caring relationships with them. Staff interaction was kind and patient when carrying out care tasks.

At our last inspection of the responsive key question, we recommended that the provider works with relevant partners to ensure staff receive suitable training in end of life care and support, and people have well developed care plans in this area. At this inspection, this recommendation had not been acted upon. No staff had received any training for end of life care and care plans were not reflective of people’s wishes.

During feedback following the inspection, the provider showed us some developing systems and processes, intended to make the management of the service more robust. However, these were in the early stages of development and not yet implemented.

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 11 August 2023). 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted due to concerns received about people being unkempt and remaining in their rooms, poor management of choke risks, dietary needs, weight loss, diabetes, pressure care, privacy, dignity and cleanliness of the environment. A decision was made for us to inspect and examine those risks.

A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with person-centred care, so we widened the scope of the inspection to look at all 5 key questions, which included; safe, effective, caring, responsive and well-led.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

We have identified breaches in relation to person centred care, privacy and dignity, people’s safety, safe recruitment, staff training and management of the service 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

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.

Roop Cottage is a care home providing residential care for up to 35 people in one adapted building, across two floors. At the time of our inspection there were 22 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports the Care Quality Commission to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

Staffing levels were adequate, although staff were not always effectively deployed. For example, night shifts did not always have medicines trained staff. Staff were not always recruited safely and did not have enough training and support for them to carry out their work safely. People were not always kept safe from the risk of infection and the home was not always clean enough. Accidents and incidents were recorded, although it was not always clear what had been done to mitigate risks and reduce incidents.

Staff were not always recruited safely to care for people, and there were not always enough staff with the right skills to meet people’s needs. Medicines were not always managed safely.

People had some involvement in planning their care and future goals, but this was not consistent. Staff facilitated people to attend activities locally. Staff were kind and patient and said they supported people in the least restrictive way possible and in their best interests. People were supported to maintain family relationships.

Medicines were not safely managed. Competency checks were not consistently or thoroughly completed. Some people did not have enough support when they needed creams for their skin. There were gaps in medicine records and controlled drugs were not robustly signed for. There was freely accessible storage of medicines to be returned to the pharmacy.

Staff had appropriate knowledge of safeguarding people from abuse and how to raise concerns with management or the local authority safeguarding team.

People and their relatives said they felt safe living at the home. People were mostly 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.

Right Care

Care promoted people’s dignity, privacy and human rights. People were supported when they wanted to eat and helped to make some choices in their day. Staff spoke with people in a caring way. Care plans and risk assessments were not always detailed enough. People were mostly well safeguarded from the risk of abuse and staff understood the procedures to follow if they had any concerns. Risk assessments were in place, but not always reflective of people’s needs or followed by staff. Daily care was not consistently recorded. Fire safety procedures were in place, up to date and known by staff, although some aspects of the fire policy were not implemented. Staff knew their roles and responsibilities in relation to emergency evacuation.

Risk assessments and guidance for staff was not always clear or detailed. Infection prevention and control systems were not robust. For example, some equipment needed through cleaning; there was no evidence of shower heads disinfecting, bathroom bins had no lids. Some aspects of the premises were not sufficiently well maintained and there were some bad odours. Safety checks for the passenger lift were not completed.

Care plans were in the progress of being updated and there were inconsistencies in the quality. Documentation to support people’s daily care needs was poor and did not evidence how people’s care needs were met. Record keeping, such as food and fluid recording was not maintained sufficiently, and did not enable concerns to people’s health to be identified or actioned.

Right culture

Quality checks were not robust enough to maintain and improve the quality and safety of the service. There were missed opportunities to identify lessons learnt when things went wrong. The management team did not provide enough support for staff or encourage their views to be considered.

Management of the home was not robust. There had been a new manager appointed since the last inspection, but they left the service before the inspection was complete. Some staff felt supported by the management team to be able to provide care safely. Quality assurance systems were weak and although some checks were done, these were not effective and did not result in enough changes where needed. Actions identified through audits were not addressed from one audit to the next. Record keeping was not sufficiently organised and at times illegible, to show how risks were being managed. Accidents and incidents were not always evaluated by management to ensure any lessons learned or referrals to other professionals were made.

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 17 August 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 improvements which were beginning to be seen were not sufficiently continued and the provider was in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 remains requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

Enforcement and Recommendations

We have identified breaches in relation to people’s safety, staff recruitment and training and management of the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Roop Cottage is a care home providing residential care for up to 35 people in one adapted building, across two floors. At the time of our inspection there were 20 people using the service.

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

People said they felt safe being supported by care staff. Relatives said staff supported their loved ones safely. Staffing levels were supportive, and staff knew the individual risks to people. Risk assessments and guidance for staff was clear. IPC processes were in place, although staff touched and adjusted their face masks on occasion. The home was clean and well maintained and there were no bad odours. There were some stained carpet areas, although a refurbishment plan was in place to address this.

Care plans were informative and person centred, and documentation was still being developed. Some record keeping, such as food and fluid recording needed to be more meaningful and triggers for action more clearly identified.

People felt they received safe support with their medicines and there were clear procedures in place. Competency checks were completed and staff who supported people with medicines were confident to do so. Staff had appropriate knowledge of safeguarding people from abuse and were confident to raise concerns with management or the local authority safeguarding team. Recruitment procedures were followed although some recording needed to be improved.

Staff felt fully supported by the management team to be able to provide care safely. Quality assurance systems were in place and there were regular checks carried out. Audits needed to be more robustly updated when actions were addressed from one audit to the next. Attention to detail on some records needed addressing.

Fire safety procedures were in place, up to date and known by staff. Roles and responsibilities for all staff were clear. Staff knew who to refer to with any queries or concerns. Staff, people and relatives were confident in the improvements made since the last inspection and in how the service was run.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. We asked the provider to review the care needs for one person who lived at Roop Cottage, against the statutory guidance.

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 inadequate (published 26 March 2022) and there were breaches of regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 16 November 2021. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 Inadequate to Requires improvement based on the findings of this inspection.

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.

Follow up

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

Roop Cottage is a care home providing residential and nursing care to up to 35 people in one adapted building, across two floors. On day one of our inspection there were 22 people living in the home and on day two of the inspection there were 19 people living in the home.

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

Risks to people’s safety were not always assessed, monitored or managed effectively. Parts of the home which may cause harm to people were left unsecured and fire safety procedures were not adequate. Infection control measures were in place; however, they were not always effective. Staff were seen not wearing Personal Protective Equipment (PPE) appropriately and did not always follow government guidance. The systems in place to ensure people received their medicines as prescribed were not effective. Accidents and incidents were not consistently recorded or analysed, which meant staff could not learn from these events.

Staff were not provided with relevant training to ensure they had the right skills and knowledge to support people safely. Where there were systems and processes in place to monitor and improve the quality of the service provided, these were ineffective as they had not identified issues found at this inspection. The provider did not have a clear understanding of their regulatory responsibilities and failed to take enough action in response to the previous inspection, which led to ongoing breaches.

People and their relatives spoke highly of the care and support they received and gave positive feedback about the approachability of the home manager. Staff also told us they felt supported by the home manager.

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 inadequate (published 18 November 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and we found the provider remained in breach of regulations.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with infection prevention and control measures, as well as the deployment of staff and the management of the service, so we widened the scope of the inspection to become a focused inspection, which included the key questions of safe and well-led.

During this inspection, we also checked whether the provider had followed their action plan to confirm whether they now met legal requirements.

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 remains inadequate. This is based on the findings at this inspection.

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.

Enforcement

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 the management of infection control, medicine management, risks to people and oversight of the home.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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 six 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.

Roop Cottage is a care home providing residential and nursing care to up to 35 people. On both days of our inspection, there were 26 people living in the home.

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

We found an absence of systems for managing visitors to the home during the pandemic as checks to ensure individuals were safe to enter the home were not being carried out. People and staff were not part of a regular programme of COVID-19 testing. Staff were seen not wearing PPE appropriately or not wearing it at all.

Medicines were poorly managed and systems were disorganised. Medicines were not stored safely and there was an absence of some records needed to ensure this process was safe. One person missed their morning medicines on day two of our inspection.

Care provided by staff was task based and we saw occasions where areas of the home were unsupervised. There was a lack of organisation and leadership evident throughout the inspection.

Mealtimes were not personalised to the times when people preferred them and there had been a lack of action from the provider to resolve this. We saw people waiting for two hours for their breakfast, which meant a late lunch before an early dinner.

Two people identified as a risk to each other's safety had been involved in safeguarding incidents. Despite concerns about this being raised in the staff handover, these two people spent long periods of time in each other's company.

Risks to people had not been addressed and there was an absence of lessons learned. The kitchen area was not locked and was left unsupervised at a time when pots of food and water were boiling and a knife could be accessed.

A faulty fire door leading to a flight of stairs had not been identified as a risk. Staff knowledge around the number of people living in the home and who had a choking risk varied. Knowledge around how to meet people’s dietary needs was not evident.

The provider did not have an overview of which people were under a ‘Do not attempt resuscitation’ order, or DoLS applications and authorisations. People were not 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 support this practice.

The management team told us they were aware of some of these issues, but they had not addressed the areas which needed to be prioritised. Both floors of the home lacked leadership and direction. Staff did not feel supported and said there had been a lack of communication from the management team.

Some concerns have been identified around maintaining people’s privacy and dignity. People we spoke with said the staff were caring and tried their best. Relatives we spoke with were aware of the recent change of ownership and indicated they wanted to give the new provider a chance.

People engaged well with the activities programme which was run by a coordinator who shared a genuine interest in making this enjoyable for people.

We have made a recommendation about the provider supporting people to plan their end of life care needs and wishes.

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

Rating at last inspection

This service was registered with us on 30 June 2021 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 3 February 2021.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention and control as well as staffing levels. 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.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of infection control, medicine management, risks to people, care routines not being person-centred and management oversight of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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.

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.