Archived: Roxburgh House

Updated 20 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 15 and 16 September 2015. The first day was unannounced and the second day announced. This inspection was undertaken to follow up on previously identified breaches to ensure action had been taken to make the required improvements.

The inspection team consisted of two inspectors, a pharmacist inspector and an expert by experience. An expert-by-experience is a person who has experience of using or caring for someone who uses this type of care service.

We reviewed the information we held about the service. We looked at information received from other agencies involved in people’s care such as the local authority, the local clinical commissioning group (CCG) and the local fire service. The local authority told us they had been monitoring the service’s progress against a list of requested improvement actions. We analysed information on statutory notifications received from the provider. A statutory notification is information about important events which the provider is required to send us by law.

We spoke with six people who used the service and three relatives. We also spoke with the cook, the cleaner, and three care staff including a senior carer, the deputy manager, the registered manager, the area manager and the provider.

We reviewed four people’s care plans to see how their care and support was planned and delivered. We looked at other records related to people’s care and how the service operated, including medicine records, staff recruitment records, the provider’s quality assurance audits and records of complaints. We observed care and support being delivered in communal areas and we observed how people were supported to eat and drink at lunch time.

Many of the people living at the home were not able to tell us, in detail, about how they were cared for and supported because of their complex needs. However, we used the short observational framework tool (SOFI) to help us to assess if people’s needs were appropriately met and they experienced good standards of care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us

Updated 20 November 2015

We carried out an unannounced inspection of Roxburgh House on 15 and 16 September 2015. Roxburgh House provides accommodation and personal care for up to 36 older people who may have dementia. Nineteen people were living at the home at the time of our inspection.

The service had 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 and associated Regulations about how the service is run.

At our previous comprehensive inspection in November 2014, we found three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. There was a breach in ensuring sufficient numbers of staff to meet people’s needs safely. There was a breach because people did not always consent to their care and support. There was a breach in meeting the legal requirements for assessing and monitoring the quality of service provision and because risks to people were not always properly managed at the home. As a result of the third breach, we imposed a Warning Notice for the service to make improvements. We undertook a focused inspection on the 14 April 2015 to check that the service had made the improvements related to the Warning Notice and found that the requirements of the Notice had been met. However there remained three existing breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008.

Following our inspection in November 2014, the registered manager sent us an action plan outlining how they would make improvements. During this inspection we found there had been some progress in addressing the actions required following our last two inspections, but sufficient improvements had not been made. We found the registered manager and the provider had not acted in accordance with their action plan.

The provider had not ensured that effective quality assurance processes were in place in order to assess and monitor the quality and safety of the service people received. This meant that a number of shortfalls in relation to the service people received had not been identified.

The provider did not always follow best practice guidance and we found that improvements had not been carried out as requested by other agencies such as the local authority and the local clinical commissioning group.

During the inspection we found there were significant staffing vacancies and staffing arrangements were not sufficient to enable staff to manage risks and meet people’s needs safely. We observed instances where staff were not available to meet people’s needs.

We observed instances where people were put at risk because risks to their health and safety were either not identified or were identified but not managed properly.

The provider did not make sure the premises were properly maintained and kept clean. There was no effective system to prevent and control the risks of infection and improvements were needed in managing medicines.

People felt safe with care staff and staff followed the provider’s procedures to protect people from the risks of abuse. People were positive in their comments about the staff, however we observed people were not always treated with compassion and their privacy and dignity was not always maintained. Staff were aware of their responsibilities under the Mental Capacity Act (2005), however improvements were still required in staff asking for people’s consent. Staff received training in all key areas of practice, however there was no evidence to confirm that training improved the way people were supported. Staff did not always respect people’s choices.

Care plans were sometimes not sufficiently detailed to support staff in delivering care in accordance with people’s preferences and needs. There were limited social activities which did not always reflect people’s interests and hobbies.

People were supported to maintain their health and were referred to health professionals where appropriate. People were offered a choice of nutritious meals, however support for people with complex needs was not provided consistently to allow them to eat their meals safely.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service will therefore be placed in ‘Special measures’.

While we were considering the options for enforcement action against the provider, the provider sent us an application to de-register the service. The provider assured us they were already working with the local authority to support people to move to suitable, alternative homes.