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We are carrying out a review of quality at Roxburgh House. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 15 September 2020

During an inspection looking at part of the service

Roxburgh House is a residential care home providing personal to 14 people with a variety of needs. People’s needs include, physical disabilities, dementia, learning disability or long term mental health conditions. The service can support up to 22 people in one adapted building.

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

There was a lack of leadership at the service and the quality of care people received had not improved. The provider and staff did not share a sense of direction or vision and values. Robust plans had not been put in place to drive change and the lack of progress had not been recognised. Checks and audits were not robust and had not identified shortfalls we found.

People’s views and opinions had not been used to improve the service. Some people had raised concerns but these had not been addressed. Others did not raise concerns as they were not confident, they would be addressed.

People continued to be at risk from the spread of infection, including Covid 19. The vacancy for a cleaner had not been filled and the post had not been covered.

Staff were not deployed to a sufficient level to meet people’s needs. People had to wait assistance at times. Care staff were required to completed domestic duties and this took them away from people. Staff had not completed practical refresher training in key skills such as moving and handling. Medicines were not consistently well managed and recorded.

People told us they were bored at times. There was no programme of activities or occupation and people spent their time doing nothing. People had asked to go out but had not been supported to do this.

Preadmission assessments remained inadequate and care had not been planned with people when they began to use the service. Risks had not been identified for everyone and action had not been planned to mitigate risks.

Staff were recruited safely.

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 25 January 2020) and there were multiple breaches of regulation. 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 the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to confirm the provider was now met legal requirements because we were not assured they had acted to improve the service. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to 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 Roxburgh House 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 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 low staffing levels and staff training, risk management, medicines, lack of oversight by the provider and registered manager, not acting of feedback, inaccurate records and failure to notify CQC of significant events at this inspection.

Full information about CQC’s regulatory response to the more se

Inspection carried out on 14 November 2019

During a routine inspection

About the service

Roxburgh House is a residential care home providing personal care to 18 older people and people living with a physical disability at the time of the inspection. The service can support up to 22 people.

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

People living at the service had a wide range of needs. Most people were happy living at the service but others felt areas of the service could improve. We found the service was not clean and people were not protected from the risk of infection.

The provider and registered manager did not have a good oversight of the service. They had not completed effective checks on the quality of the service and were unaware of shortfalls we found.

Staff were not always recruited safely and there were not always enough staff to meet people’s needs. Staff had not been held accountable for the poor cleanliness at the service. New staff completed an induction.

The management of people’s medicines required improvement. Guidance was not available to staff about some medicines and some records were not complete.

Risks to people had been identified and staff had been trained to provide the care people needed. However, on one occasion we noted staff did not move a person safely.

Assessments of people’s needs were not always accurate, however people did receive the support they needed.

People were not protected from the risk of fire as an exit gate was locked and flammable items were not stored safely. Staff were confident to use evacuation equipment. Action had been taken after accidents and near misses to stop them from happening again.

People had not been offered the opportunity to discuss their end of life preferences. However, people did receive support to have a comfortable and pain free end of life.

People were protected from the risks of harm and abuse. Staff knew how to identify and raise concerns.

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 were supported to remain as healthy as possible. They had access to a dentist and guidance was in place about people’s health care needs. Staff promptly contacted healthcare professionals when people’s needs changed.

People were referred to respectfully. They had been asked about their lifestyle and equality needs and choices. People had privacy and were treated with dignity. Staff treated people with caring and compassion and supported them to remain independent.

People knew how to complain about the service and complaints had been resolved.

People were supported to eat and drink enough.

Staff felt supported by the registered manager and worked as a team. People and staff were asked for their views, and these had been used to develop the service. The registered manager understood their legal responsibilities and had informed us about significant events that happened at 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 good (published 16 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the cleanliness of the service and infection control processes, staff recruitment and deployment, and checks on the quality of the service. We also identified breaches in relation to needs assessments, mitigating risks, medicines records and end of life planning.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they imp

Inspection carried out on 16 May 2017

During a routine inspection

Care service description

Roxburgh House is a residential care home for 22 people with a physical difficulty and older people, some of whom may be living with dementia. The service is a large, converted domestic property. Accommodation is arranged over three floors and there is a stair lift to assist people to get to the upper floors. There were 19 people living at the service at the time of our inspection.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

The registered manager was leading the service and was supported by a senior carer. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. Complaints were investigated and responded to.

People had enough to do during the day, including going out to local shops and cafes. Staff supported people to maintain relationships with their friends and family.

Assessments of people’s needs and any risks had been completed and care had been planned with people and their relatives to meet their needs and preferences and keep them safe.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet and food they liked.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The registered manager had oversight of the service. Staff felt supported and were motivated by them. Staff shared the registered manager’s vision of a good quality service and told us they would be happy for their relatives to live at Roxburgh House. Records in respect of each person were accurate and complete.

Inspection carried out on 28 October 2014

During a routine inspection

Roxburgh House was inspected on 28 October 2014. The inspection was unannounced. The service provides accommodation and personal care for up to 22 older people who may have dementia, Huntington’s disease and/or physical disabilities. There are communal areas including a lounge and dining room and people had access to the garden. At the time of the inspection there were 19 people using the service.

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.

People's care and support needs were assessed and any personal risks were identified before they moved into the service. People confirmed that they had the opportunity to be involved in these assessments and in the planning of their care. People said their needs were regularly reviewed so staff were up to date with their care needs. People were treated with respect and dignity by the staff. Staff spoke with and supported people in a caring, respectful and professional manner. People’s diversity was recognised and encouraged in that individuals representing more than one national origin, colour, religion, and sexual orientation were welcomed and respected by the staff.

People were asked about their dietary requirements and people were regularly consulted about their food preferences. One person told us “The meals are very good its all home cooked”.

Healthcare professionals, including GPs, speech and language therapists and dieticians, had been consulted as required. All appointments with, or visits by, health care professionals were recorded in individual care plans and advice was followed.

There were sufficient numbers of suitably trained, skilled and experienced staff to keep people safe and to meet their needs. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training and supervision records were up-to-date so the manager knew when refresher training was due.

Staff told us that communication at the service was good and included handovers at the beginning of each shift and regular staff meetings. At staff meetings any changes in people’s needs were discussed. Staff confirmed that they felt valued and supported by the manager.

People who used the service, visitors, staff and outside professionals were asked for their opinions about the service. This information was used to improve the service. Systems were in place to audit and monitor the quality of service. Actions had been taken to address any shortfalls, discrepancies or issues highlighted by the audits.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, we found that the manager understood when an application should be made and how to submit one. They were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Inspection carried out on 31 July 2013

During a routine inspection

The people who used the service, who we spoke to, told us that they were happy with the care and support they received. One person told us �The staff are very good; they know what I need and how I like to be helped so I am very happy here�. Another person said, �The food is very good and there is plenty of it. If someone doesn�t like what�s on the menu they are always offered something else.

People told us and we saw that they could bring their own furniture and possessions for their rooms and we saw that one person had their own phone line so they could contact friends and relatives whenever they wanted to. Other people who used the service told us that they were given their own mobile phone and that staff had spent time with people to show them how to use them.

We saw that care plans had been written based on people's individual assessments of their needs and contained detailed information. For example, care plans recorded people�s medical conditions, along with their individual preferences and choices in relation to their care. We found that people�s records contained a range of assessments, including appropriate risk assessments and we found that care plans were up to date. We saw evidence of monitoring and regular evaluations of the support that was provided, together with involvement and liaison with relatives and various health professionals, to ensure they were kept informed of changes in people's conditions when necessary.

Inspection carried out on 22 January 2013

During a routine inspection

People who used the service said that staff consulted with them about how they wanted to be supported. They also said that they received all of the health and personal care they needed.

We saw that the provider had measures in place to help safeguard people from abuse. There were enough staff on duty to enable people to promptly receive the assistance they needed. We saw that there was an effective system for resolving concerns and complaints.

All of the five people with whom we spoke gave us positive feedback about most aspects of the service. One of them said, �I�ve lived here a while and it�s home. The staff are all so lovely and kind. I do what I want including spending time in my bedroom and it�s very relaxed. There are no fixed rules, the staff are always asking how I am and whether I want anything. �

We saw that some parts of the accommodation were not furnished and decorated to make them comfortable spaces. Also, records did not confirm that an important health and safety check had been completed. We observed that the dining room and one bedroom were not heated adequately. One person who was sitting in the dining room waiting for lunch to be served said, �I feel a bit cool in here at the moment. It was okay before this recent cold weather but the heater can�t heat the room enough when it�s really cold outside.�

Inspection carried out on 25 January 2012

During a routine inspection

People who use services said that the staff treated them with respect and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'There's quite a nice feeling to things and the staff are always kind to me and helpful. They're absolutely lovely to me'.

Reports under our old system of regulation (including those from before CQC was created)