Archived: Rothbury House Hotel

Rothbury House Hotel is partly registered as a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to nine people and at the time of the inspection, five people were receiving support.

This inspection took place on 28 September 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

We completed a full comprehensive inspection in December 2015 and rated the service ‘good’ overall with a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities), regarding the need for consent. We completed a focussed inspection in March 2017 where we followed up on the breach. At the focussed inspection we considered the provider had made some progress and had met the breach but we did not change the rating of the effective domain as we wanted to be sure that the changes made were sustained.

At this inspection we found the service remained ‘good’ and met all the fundamental standards we inspected against. We also found the effective domain of the report had improved to ‘good’.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. Full detailed finding can be found in the last inspection report.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 at the service ensured people were at the heart of their care and support. People received a high standard of person centred care by the staff and management team who were reported to be exceptionally kind, caring and extremely considerate.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Accidents and incidents were thoroughly recorded, risk assessments were in place and appropriate health and safety checks were carried out.

Appropriate arrangements were in place for the safe administration and storage of medicines, including secure arrangements for people who looked after their own medicines.

There were enough staff on duty to meet the needs of people who used the service. The provider had an effective recruitment procedure in place and carried out suitable employment checks on the staff they employed. Staff were trained to meet people’s needs and received regular supervisions and appraisals.

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

People were complimentary about meals prepared. Kitchen staff ensured people had their dietary needs met.

Discussions with people and staff confirmed that external health care professionals were involved with people’s care during their short staff at the service should this be required.

Staff treated people with extreme dignity and utmost respect and helped to maintain people’s independence during their stay.

People’s needs were assessed before they came to stay at the service and care plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care provided and that their individual wishes, needs and choices are taken into account.

Although there were no people staying at the service who required end of life care, staff told us they would work with healthcare providers if people wished to stay at this stage of their lives.

People were protected from social isolation during their stay with daily camaraderie, events and outings; and the service had good links with the local community. The service had their own transport to support trips out.

The service sought feedback on a regular basis and had received numerous positive comments and compliments. People told us they knew how to make a complaint if they needed to and a clear process was in place that was discussed with people on arrival at the service.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team.

The home had a registered manager in place and our records showed he had been formally registered with the Care Quality Commission (CQC) since September 2013. A registered manager is a person who has registered with the CQC 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 registered manager was on leave at the time of this inspection. We were supported throughout the inspection by the deputy manager for the home.

At our previous inspection in December 2015 we rated the service as Good overall but found one breach of regulations. This related to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Need for consent. The breach concerned the service’s application of the Mental Capacity Act (2005) (MCA). In particular, the need to ensure proper reviews of people’s capacity were undertaken prior to them coming to stay at the home, that the provider’s policy fully reflected the issues around the MCA and that staff had training with regard to the MCA and reviewing capacity. The provider subsequently sent us a plan detailing what action they would take to meet the breach in regulations.

This report only covers our findings in relation to the Effective domain and the details around the previous breach of regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Rothbury House Hotel’ on our website at www.cqc.org.uk

At this inspection we found the provider had updated their policy to include the principles of the MCA when considering people’s capacity to make decisions, although more detail about the practical aspects of this would have been beneficial. Senior staff at the home had completed specific training with regard to applying the MCA to their work and assessing people’s capacity. There was some indication in people’s care records that consideration had been given to whether they had the capacity to make decisions for themselves and whether the home could suitably meet their needs. The deputy manager said they now asked questions about this area when dealing with enquiries, but did not always record these discussions. Care staff told us they had received on overview of the MCA as part of their induction training.

We considered the provider had made some progress in meeting this breach of regulations and staff had an understanding of the requirements of the MCA. We have not changed the rating of this domain as we want to be sure that the changes made are sustained and become further embedded in the operation of the home.

We carried out an inspection in April 2014 and found they were not meeting the regulation relating to medicines management. We undertook a follow up inspection in August 2014 and found that improvements had been made and the service was meeting this regulation.

Rothbury House is run by The Royal Air Force Association (RAFA) to provide short welfare breaks for people who serve or have served with the Royal Air Force (RAF). It provides personal care for up to nine people. Nursing care is not provided. The service also operates as a hotel for other RAF personnel who do not require personal care during their stay.

The service had its own mini bus and was able to collect people or take them home following their stay.

There were two people using the regulated service and seven ‘guests’ staying at Rothbury House Hotel at the time of the inspection.

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 and others with whom we spoke were extremely complimentary about the service and staff. The secretary of the local MS Society said, “The standard of care is fantastic – I have been all over and been in the hotel business and catering for over 30 years and I couldn’t fault anything” and “When people arrived outside the hotel there was a oohh, then when they got in there was a ooohhhh and then after they had stayed there was a wacking great big WOW!” Everyone we spoke with described the care as “outstanding.” They explained how staff went “above and beyond” to meet their needs. This included ensuring they were safe when they returned home. They also said that their privacy and dignity was promoted. Mobile bath hoists were available which fitted in people's en suite baths and meant that people could bathe in the privacy of their own bathroom.

People told us that they felt safe. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they would take if abuse was suspected. We saw that the building was extremely clean and well maintained. Medicines were managed safely and systems were in place for people to deal with their own medicines.

Staff told us and our own observations confirmed that there were enough staff to meet people’s needs Safe recruitment procedures were followed. There was a training programme in place. Staff were trained in safe working practices and to meet the specific needs of people who lived at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.”

There was no evidence that assessments had been undertaken to check whether people’s plan of care would amount to a deprivation of their liberty.

There was a DoLS procedure in place; however, there was no MCA policy or procedures in place to inform staff how they should assess people’s mental capacity, if there were any concerns about their ability to make decisions for themselves. In addition, with the exception of the registered manager, staff had not yet undertaken MCA training.

People were supported to receive a suitable nutritious diet. We looked in the kitchen and food storage areas and observed that there was a wide variety of fresh fruit and vegetables. There was a range of drinks available. This included tea and coffee and apple, orange and tomato juices. At night, wine was served with the meal. There was also a bar, which people told us was appreciated and enjoyed.

Feedback was obtained from people in the form of surveys and complaints were recorded. Accidents and incidents were documented, reported and analysed. We noted that feedback and accident analysis was carried out for all people who stayed at Rothbury House Hotel including those who did not receive any care. This meant it was difficult to separate specific information and analysis which related to the service regulated by CQC. The registered manager told us that the provider was aware of this issue and this would be addressed.

The registered manager carried out a number of audits and checks to monitor all aspects of the service. Staff told us they enjoyed working at Rothbury House Hotel and morale was good.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the need for consent. The action we have told the provider to take can be found at the back of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at the records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely. People told us that they had no concerns about their medicines.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. They were cared for in an environment that was safe, clean and hygienic. They informed us the home was 'spotless' and told us that they felt safe. One said, 'We're as safe as houses here.' We consulted the local authority's safeguarding adults' team who did not raise any concerns about the service.

We found that appropriate arrangements were not in place to manage medicines. A safe system was not fully in place for the receipt, recording, storage and disposal of medications. We considered that people were not protected against the risks associated with medicines. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents and complaints and concerns. This reduced the risk to people and helped the service continually improve.

The manager was knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. He informed us that no one was subject to Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People were extremely happy with the care that was delivered. They told us that their needs were met. One person had written on a recently completed questionnaire, 'I feel blissfully pampered and so well cared for. All I have to say is a great big thank you to everyone here.' It was clear from our observations and through speaking with staff that they had a good understanding of people's care and support needs.

We spoke with a member of the district nursing team, a care manager and a GP. All spoke positively about the service. They informed us that staff contacted them immediately if there were any concerns and any advice they recommended was followed.

The premises had been adapted to meet the needs of people with physical impairments. Electronic door entry control buttons were fitted. These opened the door when pushed which made it easier for people to move around in the building.

Is the service caring?

People were supported by 'kind' and 'lovely' staff. We saw that care workers showed patience and gave encouragement when supporting people. One person informed us, 'The staff are lovely, so caring.' Another person said, 'You couldn't ask for nicer staff.' Health and social care professionals informed us that they had no concerns about people's care and welfare. The GP commented that as far as he was aware, they were always called out appropriately. The care manager told us that she was happy with the care that was delivered at Rothbury House.

People completed a satisfaction survey following their stay. One person had written, 'Words cannot express my feelings of the care, friendliness and excellent staff you have and my personal experience of the help that I have been given.'

There was a cheerful atmosphere at Rothbury House. People and staff were singing whilst one person was playing the organ. Many staff had worked there for a considerable period of time. This experience contributed to the efficiency and skill with which staff carried out their duties.

Is the service responsive?

People's needs had been assessed before they visited the service. They were able to undertake a range of activities both within and outside the service. The service had its own minibus, which helped to keep people involved with the local community. One person informed us, 'The trips out are great. We go out and about with [staff member's name].'

Staff were responsive to people's needs. One person became unwell during her stay at Rothbury House. Staff contacted the GP who visited and prescribed antibiotics for a chest infection.

People's complaints were fully investigated and resolved, where possible, to their satisfaction. One complaint had been received in 2014. Records were available of the investigation process and outcome.

Is the service well-led?

A new manager had been in place since August 2013. Staff spoke positively about him and the support he provided.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continually improving. People completed a satisfaction survey following their stay. We read recently completed questionnaires which had been completed in April 2014. One person had written, 'Most impressed with Rothbury House. Never knew such a caring, well run place existed, would recommend it to anyone. Nothing is too much trouble to the wonderful staff. Request an extra blanket and it's there; difficulty with window in bedroom ' solved right away. Trips out with such helpful drivers and food second to none. A treasure here in beautiful Northumberland.'

Staff told us they were clear about their roles and responsibilities. They informed us that regular meetings were held. This was confirmed by minutes of meetings.

The manager carried out a monthly audit which covered all aspects of the service. We noted that this audit also included a check regarding whether any CQC notifications had been made. Notifications are changes, events or incidents that the provider must inform CQC about under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The manager had recorded, 'No incidents recorded during March.'

We noted that the service's statement of purpose had been updated to include details of the new manager. A statement of purpose is a document which includes a standard required set of information about a service.

People were extremely complimentary about the care and treatment. One person told us, "The care is unbelievable' and 'It's fantastic ' it's better than a five star hotel, I would never have believed it.' We concluded that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us that they thought the food and drink at Rothbury House was 'excellent' and 'absolutely delicious.' We found that people were supported to be able to eat and drink sufficient amounts to meet their needs.

We concluded that there was enough equipment to promote the health, independence and comfort of people who use the service.

People told us that they thought that staff were well trained. One person said, 'The training must be fantastic.' We found that staff received appropriate training for their professional development, supervision and appraisal.

We concluded that people's personal records and those records which related to staff and the management of the service were accurate and fit for purpose.

People were extremely complimentary about the care and treatment. One person told us, "The care is second to none. It's the best place to come to for care." We considered that people experienced care, treatment and support that met their needs and protected their rights.

People we spoke with were complimentary about the cleanliness of the service. Two people told us, 'It's spotless.' We looked around and observed that all areas, including bedrooms and communal areas were clean. We considered that people were cared for in a clean, hygienic environment.

Most people told us that there was enough staff to look after them. One person said that more staff would be appreciated. We also spoke with a relative who said, 'I think there's enough staff at the minute, but I wouldn't like them to get rid of anyone.' We concluded there were enough qualified, skilled and experienced staff to meet people's needs.

People told us they felt able to raise any concerns or comments about the service and that they had no complaints to make. We considered that people were made aware of the complaints system.