Roborough House

Roborough House is a residential care home providing personal and nursing care to up to 44 people. At the time of the inspection 40 people were living at the service. Roborough House supports people with a range of complex needs including their mental and physical health. The service is in a large detached building split into three units with their own communal areas over two floors, and with a lift for people who may have mobility needs. The service is set in its own grounds on the outskirts of Plymouth close to the moors and has an indoor activities space.

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

Many people were not able to tell us verbally about their experience of living at Roborough House. Therefore, we spent some time observing people. The interactions between people and the staff supporting them showed people were happy and relaxed. People told us; “I am happy” and another said; “The staff were kind.”

We last inspected the service in May 2022. At that time, we placed the service into special measures and found breaches of regulation. At this inspection the service had taken action to meet the breaches of regulation.

The manager in post is the third manager in the last 3 years. This manager had been employed as an interim manager to support and improve the service. They will stay for a short time to support the next new manager due to start in the New Year. They had been in post for 4 months. They received regular support from the new nominated individual who visited the service, and also worked with the manager on checking new systems and processes in place were working well.

The last 2 inspections dated November 2021 and May 2022, and the 3 inspections carried out in 2016 all rated the service requires improvement. All these inspections found breaches of regulations and the home has not achieved a good rating since 2018.

The service was placed under whole home safeguarding with the local authority. The healthcare professionals in attendance at a follow up meeting after this inspection all informed us, they had seen recent improvements in the service provided.

The interim manager had clear oversight of the service and had introduced new systems for auditing and updated other systems and processes which had been completed. However, these systems and processes had not yet been embedded into the operation of the service. Another more permanent manager, who would, we were informed, register with the commission, was due to start in 2023. Professionals all agreed that the service had made many improvements and was therefore removed from the whole home safeguarding by the local authority.

At the last inspection, May 2022, and the inspection in November 2021 we had concerns regarding medicine’s management, and that systems and processes in place were not robust enough to identify some areas for improvement. At this inspection we found there had been improvements since our previous inspection. People’s medicines were now managed safely, and they received them in the way prescribed.

At the last inspection we found the service did not have suitable safeguarding systems in place to protect people from abuse. Safeguarding incidents had not been followed up with the local authority’s safeguarding team. Notifications were not sent to CQC when required to report accidents, incidents and safeguarding concerns. We found at this inspection that all safeguarding incidents had been forwarded to the local authority and notifications had been received by CQC.

Infection control procedures were now being followed in line with current government guidance.

Staff now received appropriate training and support to enable them to carry out their role safely, including fire safety and mental health training. Staff employed as carers and auxiliary staff were recruited safely in sufficient numbers to ensure people’s needs were met. However, we found that the nursing posts remained filled by mostly agency nurses. There was time for people to have social interaction and go out into the community. Staff knew how to keep people safe from harm.

Food and fluid charts had been updated and were completed with all necessary information being recorded consistently.

The environment was safe and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed 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

This service has been in Special Measures since 25 May 2022. 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

Follow up

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

Roborough House is a nursing care home that provides personal care for up to 44 people. At the time of the inspection 40 people were living at the service. Roborough House supports people with a range of complex needs including their mental and physical health. The service is in a large detached building split into three units with their own communal areas over two floors, with a lift for people who may have mobility needs. The service is set in its own grounds on the outskirts of Plymouth close to the moors, and has an indoor activities space.

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

Many people were not able to tell us verbally about their experience of living at Roborough House. Therefore, we observed the interactions between people and the staff supporting them. We received mixed reviews from professionals, staff and some people living in the home on how the home was run. Professionals told us the management did not always engage with them and some families also said they’d tried to contact the management without success.

We last inspected the service in November 2020. At that time, we had concerns regarding the medicine’s management, and that systems and processes in place were not robust enough to identify some areas for improvement.

At this inspection we found the issues with both medicines and the audit systems and processes remained the same. Medicines records showed that people did not always receive their medicines in the way prescribed and when they did, records did not always show that this was the case.

The service did not have suitable safeguarding systems in place to protect people from abuse. Safeguarding incidents had not been followed up with the local authority’s safeguarding team. Notifications were not sent to CQC when required to report accidents, incidents and safeguarding concerns.

Infection control procedures were not always being followed in line with current government guidance. Government guidance about COVID-19 testing for visitors was not being followed.

During the inspection we could not be sure all staff had received updated training as no training record was made available. We received the training record after a second request. However, no names of staff or dates of training completed was recorded. Staff did not always receive regular support or induction training. There was a high use of agency staff. One relative said; “Staffing has gone down a lot, you see different faces all the time.”

The registered manager and provider did not always have clear oversight of the service. Audits, systems and processes were not always completed.

Food and fluid charts did not have all information recorded consistently.

The environment was safe and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service. A relative informed us they had not received a response to concerns they’d raised.

Staff were observed as attentive, kind and caring. A relative said; “I think the home is absolutely amazing in terms of caring. The staff are so loving and caring.”

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 requires improvement (report published 6 January 2021) and there were breaches of regulation. At this inspection we found that not enough improvement had been made and the provider was still in breach of these regulations. We also found other breaches of regulation.

Why we inspected

We carried out an unannounced inspection of this service on 24 and 30 November 2020. Breaches of legal requirements were found.

We received concerns in relation to safeguarding people, medicines, lack of suitable equipment on site to meet people’s needs safely, charts not being completed, and paperwork not always being made available when requested, including care plans. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this report.

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.

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.

At this inspection we have identified continued breaches in relation to governance, risk and monitoring systems. We have identified breaches in relation to safeguarding, medicines, infection control and good governance 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 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.

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

Roborough House is a nursing home providing personal and nursing care for 38 people at the time of the inspection. The service can support up to 44 people. Roborough House supports people with a range of complex needs around their mental and physical health. The service is in a large detached building split into three units with their own communal areas, over two floors with a lift for people who may have mobility needs. The service is set in its own grounds, on the outskirts of Plymouth close to the moors, and has an indoor activities space.

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

Medicines were not always managed safely. Improvements had been made recently but there were still errors in administration, recording and some decision making was not documented. Risks that people faced were not always assessed and clear guidance on how to mitigate risks was not always available for agency or new staff. The service had several areas that needed improving and the management team had a plan to address these. However, they were not aware of some of the concerns identified during the inspection and quality and audit processes needed strengthening and embedding in to the day to day running of the service.

Some improvements were needed to the environment as it was showing lots of signs of wear and tear. Improvements had been planned as part of a programme of refurbishments. People were having their care needs met but staff felt rushed and struggled to sometimes support people with their care.

Recruitment processes were robust, and several checks were made to ensure staff were safe to work with people who might be vulnerable. Staff knew people and their needs well and we saw positive interactions and people smiling and happy to see staff. People told us they felt safe and liked living in Roborough House. Relatives gave positive feedback about the service and how safe it was. Safeguarding concerns were reported and acted upon promptly.

Staff reported the culture in the service was changing for the better, they felt supported and the new management team were approachable and listened to them. Relationships with health professionals had improved and communication was good regarding the needs of people.

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.

We have made a recommendation about staffing levels and monitoring of the environment. We identified breaches of regulations regarding safe care and treatment and good governance.

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 14 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about areas of concern such as medicines, staffing and incidents. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection the review the key questions of safe and well led only.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this focused report. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. 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 Roborough House on our website at www.cqc.org.uk.

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.

Roborough House is registered to provide accommodation for 51 people who require nursing and personal care. The service currently has a capacity of 44 whilst accommodation is being re-furbished. At the time of the inspection, 40 people were living at Roborough House.

The service is a specialist unit and provides nursing and personal care for people with complex needs such as mental health disorders including Schizophrenia, progressive diseases such as Huntington’s and Motor Neurone, acquired brain injury and Korsakoff’s disease (brain injury due to alcohol) and learning disability. The registered manager also told us how links had been made with a local stroke specialist unit and a new rehabilitation partnership was planned, to offer further placements for people affected by strokes who required more long term rehabilitation outside a hospital environment. The premises is a large, spacious building with accommodation and communal spaces over three floors. There are three units, Maristow 17 people, Bickham 10 people and Lopez 13 people, accessed using electronic key pads, which those people, who are able, have access to. The registered manager, who was newly employed at the time of the last inspection in December 2016, said they were pleased to have the opportunity to turn the home around since the last inspection and they enjoyed the challenge. They welcomed our inspection to show us what improvements had been made.

During the last inspection in December 2016 we found the areas of safe, effective and well led required improvement with a breach of Regulation 11, Need for consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that time people's capacity was not always assessed and best interest processes were not always followed in line with the principles of the Mental Capacity Act. In December 2016, aspects of the service were not always safe. Infection control practices were not always safe and some areas of the service were visibly dirty. People were not always kept safe within the environment, due to potentially hazardous items not being securely stored. Some areas of people's healthcare needs were not always effectively monitored. At that time, audits were carried out, but the actions taken were not always documented and views on staff morale were mixed.

During this inspection we found that all regulations had been met. We found Roborough House to be providing a good service, especially in meeting people’s very individual and complex needs, often on a one to one basis. A visiting psychiatric nurse told us they had no concerns about the complex support provided to people they visited at Roborough House. They told us, “I think the staff do a good job, we work together as a team. They are accommodating to suggestions and have their finger on the pulse, nothing is too much trouble.” The premises required extensive re-furbishment to promote a more homely, less institutional feel to the large spaces but this was confirmed by the operations and registered manager as having been approved by the provider and scheduled for March 2018 in phases. The premises were therefore slightly shabby, however areas were clean and hygienic. We discussed the décor with the registered manager who assured us they were in the process of promoting a more homely feel, removing institutionalised notices, improving signage and creating individual door plaques for people’s rooms as on-going work rather than waiting for the completion of the re-furbishment. Recruitment was an on-going issue due to the specialist, complex nature of the work and the rural location. However, consistent, regular agency staff were used to ensure there were sufficient staff to meet people’s needs and there was a clear, information sharing process in place. The recruitment effort was on-going and was reviewed regularly, for example incentives had been introduced.

There was a registered manager and deputy manager employed at the home who were clearly passionate about providing a high quality, individualised service. 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.

People were supported by kind, caring and compassionate staff who, along with the management and administration team knew people very well. This was important as people often displayed complex behavioural needs which relied on personalised care and understanding to minimise the risk of distress or behaviour which could be challenging for staff. This understanding of people’s needs enhanced people's quality of life and wellbeing and we saw examples of how people’s quality of life had benefitted since living at Roborough House.

Staff as a whole, supported by the four activities co-ordinators, were passionate about providing people with support that was based on their individual needs, goals and aspirations. They were pro-active in ensuring care was based on people's preferences and interests, seeking out activities in the wider community and helping people live a fulfilled life, individually and less often, in groups. As people often required one to one input and support due to their individual needs or funding arrangements, to go out or engage in activities, the registered manager was carrying out an audit of activities provided to ensure that each individual had regular opportunities. By the second day of the inspection, two additional activity co-ordinator posts and increased hours had been approved by the provider to enable this and an audit commenced. Some people were able to go out independently and staff supported people to do this safely whilst respecting their choices.

Staff were happy working in the home and felt supported in their role. The service employed a mix of registered general nurses as well as registered mental health nurses. They told us they both learnt from each other and worked well as a team. They were clear about their individual roles and responsibilities and felt valued by the registered manager, deputy manager and the wider provider, senior management team. The registered manager said, “Staff came with me when I started, we hit the ground running and just got stuck in.” There was a pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. Staff mentioned difficulties with maintaining a stable staff team due to slow recruitment but felt management made efforts to ensure staffing levels were maintained, for example to cover absences with agency staff. We noted in one area there was a number of people who required assistance with eating and drinking. The meal times were fluid and enabled people to stagger meal times but if each person wished to eat at the same time this could be an issue (we did not see people waiting for support during our inspection), which care workers raised. We fed this back to the registered manager and by the second day of the inspection an additional care worker post had been approved by the provider to act as a ‘floater’ across the units. We saw people receiving timely care in a person centred way depending on people’s daily routines.

People were safe living at Roborough House. There were enough staff to meet people's care needs safely and also to provide individualised support in and out of the service. Some people received funded one to one care due to their individual needs to keep them and other people safe. Risks were identified and assessed, showing staff how to manage them effectively. Where there were risks to others, the registered manager had referred to relevant health professionals and safety measures were put in place.

There was a culture within the home of treating people with respect. Staff were busy but visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. For example, the administrator and chef had both won awards within the company for ‘excellence’ and we saw they also showed they had good rapport with people living at Roborough House. Staff spent time with people to get to know them and their needs. This ensured that behaviours that could be challenging for staff and distressing for people were minimised. People and the staff knew each other well and these relationships were valued. We spoke to the registered manager about the accessible information standard. This ensures people’s communication needs are identified and met. Care plans provided good information and the registered manager discussed plans to more formally include the standard in their assessments, hospital passports and information sharing within the wider staff team.

People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. For example, some people liked to live with strict routines to help them remain well and staff knew and respected those. Information included people’s previous history, including any cultural, religious and spiritual needs.

Staff had received appr

Roborough House is a care home that also provides nursing care. Roborough House can accommodate a maximum of 51 people with dementia, learning disabilities, mental or physical health needs, sensory impairment and substance misuse needs. At the time of the inspection there were 40 people living at the service.

At the comprehensive inspection on 13 and 14 January 2016, people were not always protected from risks associated with their care, and documentation related to people's risks was not always reflective of their needs. The management of medicines was not always safe and it was not always clear whether people had received their medicines as prescribed and at the right time, we asked the provider to take action to make improvements to medicines management. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation of the breaches. We undertook a focussed inspection on 9 June 2016. This was to check the provider had followed their plan and to confirm they now met the legal requirements. We found that whilst many aspects of medicine management had improved, people’s medicines were not always managed safely. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a manager in post who was in the process of registering with the care Quality Commission. 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 were not always kept safe within the environment at Roborough House. We found some concerns relating to cleanliness and infection control. In addition, we found some potentially dangerous items which could have been used to self-harm or to injure others, which were not securely stored. There were some concerns about areas being cluttered, and an emergency exit which was blocked, which may have been problematic in the event of an evacuation of the building.

Although people’s medicines were administered, stored and disposed of safely, we found some concerns relating to the administration of medicines by agency staff. We found that there was a high staff turnover at the service, a high use of agency staff and a shortage of nursing staff. This could have led to a higher incidence of medicines errors. Morale amongst staff was mixed.

People who lacked capacity to make certain decisions for themselves may not have always been sufficiently protected as mental capacity assessments were not being undertaken. It was therefore not possible to know whether decisions made were in their best interest or the least restrictive available.

People’s health care needs were not always recorded appropriately. Screening tools were used inconsistently and these were not always used to inform the person’s care plan. It was therefore not always possible to know if the person received appropriate care and treatment in response to health concerns. We have made a recommendation about record keeping.

Staff had undergone training in order to carry out their role. New staff received an induction and all staff were supported by an on-going programme of supervision, competency checks and an annual appraisal. There were staff meetings which provided a forum for open and honest communication and for sharing ideas and best practice.

People told us they felt cared for and interactions between people and staff were positive, warm and compassionate. Positive relationships had formed between people and staff. People’s dignity was respected and they were enabled to have their voices heard and to exercise choice and control. People understood how to make a complaint and felt any issues raised would be taken seriously.

People were supported to maintain relationships with people who mattered to them and relatives felt they were welcomed at the service when they visited loved ones. People had access to a range of personalised activities inside the home and in the wider community.

Feedback on the service was sought through a variety of forums and used to make improvements. There were systems in place to ensure the building and equipment were safe.

We found 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.

We undertook this focussed inspection on 9 June 2016. This was to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roborough House on our website at www.cqc.org.uk.

Roborough House provides nursing care and accommodation for up to 51 people. On the day of the inspection 38 people were using the service. Roborough house provides nursing, rehabilitation and residential care for people with mental and physical health needs including acquired brain injury and degenerative conditions.

There had been no registered manager at Roborough House April 2015. 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.

The new manager at Roborough House had been in post since October 2015 and was currently going through the Care Quality Commission registration process to become the registered manager of the service.

Many aspects of medicine management had improved. A medicine policy had been developed and staff were aware of the policy and procedures in place. Further medicine training for staff had occurred, and competency checks were ongoing. Stock control had improved and there were audits in place which were identifying some issues and improving the management of medicines. People were given their medicines safely by staff and people’s care plans had guidance in them which reflected their medicine needs. This helped staff meet people’s individual needs.

However, people’s medicines were not always managed safely. We found storage temperatures were not always within the recommended range which could affect the medicine; the directions available for staff to guide them with administering skin creams was not always in place or consistent across the service. This meant people might not have their skin creams as prescribed. Medicine records had been signed for by staff but we found in some cases, medicines had not always been given to people. This meant people may not have had their medicines prescribed by their doctor. Some people’s medicine records had been changed altering the amount they were receiving but it was not always clear who had authorised these prescription changes. The manager had identified this on one person’s case and was investigating and taking action following inspection feedback.

People’s risks were well known and managed. People’s risk assessments had been updated and were being regularly reviewed. Risk assessment summaries were now in place and comprehensive.

We found a breach 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 report.

Roborough House provides care and accommodation for up to 51people. On the day of the inspection 42 people were using the service. Roborough House provides nursing, rehabilitation and residential care to people with mental and physical health needs including acquired brain injury and degenerative conditions.

The service had a new manager in post that started at Roborough House in October 2015. The new manager was going through the Care Quality Commission registration process to become the registered manager.

People’s medicines were not always managed safely. People had not always received their medicines as prescribed and there were gaps in people’s medicines administration records. People’s regular medicines were not always in stock; this meant some people did not have their medicines when they required them as prescribed.

People’s care records including their risk assessments were not reviewed frequently or as their needs changed. Records were not well organised, information was held in different places, gave conflicting instructions about people’s care and staff found it difficult to find information when they needed it. Staff told us they did not have time to update people’s care records.

There were quality assurance systems in place but these had not been effective over the past year in maintaining the quality of the service. The service had an open and transparent culture. Staff felt listened to and able to contribute ideas to the development of the service to drive improvement.

Staff received a comprehensive induction programme which included shadowing more experienced staff. There were sufficient staff to meet people’s needs; however there was a reliance on agency staff at the time of the inspection. There was a physiotherapist and occupational therapist to complement the staff team. Some staff had not completed training deemed as essential by the provider which meant there was a risk of them not providing care based upon best practice. We observed staff used the correct techniques to transfer people and staff demonstrated good communication skills and most staff had a good knowledge of the people they cared for.

People were relaxed throughout our inspection. There was a busy but pleasant atmosphere. People were seen laughing, engaging in activities and we saw kind, patient interactions between people and staff. People and relatives told us the care was good at the home and people enjoyed living in the home. Some people had lived at the home for many years and they were happy.

People were promoted to live full and active lives where possible and were supported to be as independent as they could be. Activities were meaningful, individualised and reflected people’s interests, the seasons and their hobbies.

People consented to their care and treatment and the correct legal processes were followed if people were unable to consent to their care.

People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers and mental health nurses.

People and their relatives told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff confirmed they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People and those who mattered to them knew how to raise concerns and make complaints. People told us they had no concerns. The manager informed us any complaints would be thoroughly investigated and recorded in line with the complaints policy.

Staff, relatives and external professionals described the management as supportive and approachable. Staff talked positively about their jobs and the new manager.

Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service. Staff and team meetings were used to reflect on incidents and consider preventative measures to reduce the likelihood of similar situations occurring again.

We found 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.

We found that there were sufficient numbers of staff on duty during our visit to meet the health, safety and welfare of people living at Roborough House. Staff were knowledgeable about the people they were working with and had access to on-going training and development.

At our last inspection we found there was not a system of regular supervision and appraisal for staff. We found that a supervision structure was now in place to support staff and the majority of staff had received supervision over the past three months.

We saw that staff spoke to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that care planning was person centred, respected people's dignity, maintained self-esteem, took account of published guidance and considered all aspects of a person's individual circumstances.

We found that all records were held securely, remained confidential and were monitored and reviewed to ensure they remained fit for purpose.

We found people living at Roborough House were involved in the running of the home. People living at Roborough House were involved in the running of the resident meetings, recruitment and in some of the refurbishment which had occurred since our last visit. People were involved in planning their care and treatment and able to express their views about the service. People told us that they felt involved in service improvements and felt listened to and their views and wishes were respected by staff.

We found progress had been made to people's care planning. Staff were knowledgeable about the people who lived at the home, understood their needs, were aware of their potential risks and carried out their work alongside people respectfully. Health and social care professionals were involved with people's care and reviews to ensure their care needs were met.

We found the home had made significant improvements to the cleanliness of the environment meaning the risk of infection at the home was reduced. Staff had received recent training in infection control procedures, checklists to monitor the cleanliness of the home had been developed and new cleaning staff had been appointed to maintain the cleanliness of the home.

Although some improvements had been made and people were more involved in the running of Roborough House through the residents meetings, people were unsure what was in the care plan and had not been involved in their care plans. We found new team meetings had started which reviewed people's care needs and treatment plans. The staff we met knew people well and therefore knew what care and support people needed, most people's care plans and the information available about people was confusing, difficult to find and not regularly reviewed.

We found that there were not good systems in place to ensure the cleanliness and hygiene in the home, this posed a risk to staff and people living at Roborough House. We found staff who were employed went through a recruitment process but that there were gaps in essential training within the current staff team although there were plans in progress which were addressing these areas. We also found there were not regular supervision and appraisals in place for staff.

We found that there were systems being established to improve the quality monitoring which occurred at the home.

We did not talk to all the people using the service on this occasion; however we did observed some staff interaction with people as they were unable to communicate with us. We talked with staff and checked the provider's records. We spoke to the registered manager, who was due to leave the next day, the interim manager and the company's national operations manager who was available on the day of our visit.

We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse.

We spoke to staff about the change of management of the home. Staff made positive comments including, 'I think things are improving for the better'.