Updated
11 March 2021
This inspection took place on 8 October 2018 and was unannounced.
Roxburgh House Care Home is a residential ‘care home’ in the Bootle area of Liverpool. Roxburgh House provides accommodation and personal care for up to 38 older people, including people living with dementia. The single storey building is separated into two areas: a 23 bed residential unit; and a 15 bed unit for people living with dementia. During the inspection, there were 37 people living in the home.
People in care homes receive accommodation and nursing or personal care as a single package 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.
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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.
At the last inspection which took place in September 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Roxburgh House was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.
At the last inspection we found that the registered provider was in breach of regulation in relation to ‘Safe care and treatment’. This was because people were exposed to unnecessary environmental risks and the delivery of care and support was not always safely managed. We identified a number of concerns in relation to the temperatures of radiators, fire doors, internal lighting and health and safety compliance. During this inspection we found that improvements had been made.
At the last inspection we found that local audit and governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the quality assurance systems, audits and checks which were in place and found that improvements had been made.
People’s level of risk was assessed from the outset. Care plans outlined the support people required and risk assessments identified the different support measures that needed to be implemented. Risk assessments were regularly reviewed and records contained up to date and relevant information.
Medication management systems and processes were safely in place. People only received support with their medications by staff who had completed the appropriate medication administration training and regularly had their competency assessed. Medication was stored appropriately and medication audits were routinely taking place.
We checked that there were sufficient numbers of staff supporting people who were living at Roxburgh House. Staff were visible throughout the inspection and were responsive to people’s needs in a timely and supportive manner. We received positive feedback from people, relatives and staff about the staffing levels at the home.
Recruitment was safely managed. The registered provider ensured that the necessary recruitment checks were carried out and people only received support by staff who were suitable to work in a health and social care environment. We found suitable Disclosure and Barring System checks (DBS) in place and appropriate references had been sought prior to employment commencing.
People and relatives told us that the service was safe. Staff were knowledgeable around the area of safeguarding and whistleblowing procedures; they knew how to report any concerns and who to report their concerns to. Staff received the necessary safeguarding training and the registered manager ensured that any safeguarding incidents were appropriately investigated.
Accident and incident processes were in place. We found that all accidents/incidents were recorded; trends were analysed on a monthly basis in order to mitigate further risk and to establish if lessons could be learnt.
Health and safety processes were in place. People lived in an environment that was safe, well-maintained and clean. The registered provider ensured routine health and safety checks were conducted and staff complied with the different health and safety procedures that needed to be followed. Staff were provided with personal protective equipment (PPE) and were observed wearing gloves and aprons during the inspection.
The registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. Consent to care and treatment was gained in line with the MCA. People living in the home were appropriately assessed, assessments were decision specific and 'best interest' processes were clear.
Staff expressed that they felt supported on a daily basis. Staff received regular supervision and were provided with training, learning and developmental opportunities. Staff received a variety of different training opportunities that enabled them to develop their skills and competencies.
People’s nutrition and hydration support needs were effectively managed. We found that appropriate referrals were made to external healthcare professionals and the guidance which was provided was incorporated within care plans.
We received positive comments about the quality and standard of food people received. There was a ‘rolling’ menu in place which meant that people could enjoy different meals on a weekly basis. The registered manager also ensured that people had the opportunity to share their likes, dislikes and preferences.
At the time of the inspection, renovations were taking place to the improve the quality and standards of the environment. Interior improvements had taken place in some parts of the home such as new flooring, carpets and décor and there was a ‘live’ action plan which indicated other renovations that were due to take place.
Staff were observed providing kind, caring and friendly support. Interactions between staff and people living in the home were warm, sincere and familiar. We received positive feedback about the care people received and how staff provided dignified and respectful care.
People were supported to remain as independent as possible. We observed staff supporting, assisting and prompting people with their day to day care needs in a dignified and person-centred manner.
‘Dignity Champions’ were in place at Roxburgh House. Dignity champions ensured that the level of dignified and respectful care was consistently promoted. Champions supported staff with their understanding, awareness and importance of providing dignified care.
Equality and diversity support needs were accommodated from the outset. People were treated equally and received care and support that was tailored around their needs, wishes and desires.
Confidential information was securely stored and in line with General Data Protection Regulation (GDPR). People’s personal information was appropriately protected and sensitive information was not unnecessarily shared with others.
People and relatives received a ‘service use’ guide from the outset. The guide provided essential information in relation to the level of care and support that could be expected.
A person-centred approach to care was evident; It was clear that staff were familiar with the people they supported and positive relationships had developed between people and staff who provided the support.
The registered provider ensured there was a complaints policy and procedure in place. People and relatives told us that they knew how to raise any concerns if they ever needed to. At the time of the inspection, no complaints were being responded to.
People were supported to participate in a range of different activities that were stimulating and engaging. We received positive feedback about the activities that were provided and informed that people were encouraged to participate in different activities on a daily basis.
People were supported with ‘End of Life Care’. The registered manager and deputy manager had completed End of Life training and staff were familiar with the dignified and sensitive manner end of life care needed to be provided.
Systems were in place to gather feedback regarding the provision of care people received. People, staff and relatives were encouraged to share their views, opinions and thoughts around the quality and safety of care people received.
We received positive feedback about the management and leadership at Roxburgh House. People felt safe in an environment that was regarded as ‘home’ and felt that their quality of care and support was a priority.
The registered manager had notified CQC of all events and incidents that occurred in the home in accordance with our statutory requirements. Ratings from the last inspection were displayed within the home as required.