Roden Hall Nursing Home

We found the following examples of good practice.

• The proposed extension to the designated unit was clean, hygienic and uncluttered. Daily cleaning schedules were in place and checked by the registered manager to ensure compliance.

• A visiting policy was in place. Visitors were required to complete a COVID-19 screening questionnaire, temperature checks were undertaken prior to entry and they were required to wear Personal Protective Equipment (PPE) in line with current guidance. Individual risk assessments were completed for those who were permitted visitors due to exceptional circumstances.

• Arrows were used on the floor of wide corridors to promote a one way system and encourage social distancing in line with current guidance.

• People were supported by staff who were trained in infection prevention and control (IPC) and wore PPE in line with current guidance. The provider had produced a video to support staff with donning and doffing PPE which they had updated to ensure it was in line with current guidance.

• The provider had developed information cards which provided staff with concise information to ensure support was provided in line with current COVID-19 guidance.

• Staff risk assessments were undertaken and where staff were identified as being at higher risk of infection, measures were put in place to mitigate the risks.

We were not assured that the additional beds proposed met good infection prevention and control guidelines specifically as a designated care setting. This was due to the unit not being ready to accept people who had tested positive for COVID-19 in a way that ensured they would be zoned separately to people already residing in the home who had not tested positive for COVID-19.

We found the following examples of good practice.

• People residing on the unit identified for the designated care setting were supported in a self-contained area of the home that was accessed via a separate entry. People had their own en-suite facilities and were supported by a staff cohort who worked solely on the unit to reduce the risk of transmission of Covid-19.

• People were supported by staff who were trained in infection prevention and control (IPC) and wore Personal Protective Equipment (PPE) in line with current guidance. The provider had produced a video to support staff with donning and doffing PPE which they had updated to ensure it was in line with current guidance.

• The designated care setting appeared clean and hygienic. Cleaning schedules were in place and daily checks were undertaken to monitor cleanliness and staff compliance with the provider’s infection control policy.

• People were supported to communicate with their relatives via telephone and video calls. Window visits were planned to enable relatives to visit people residing on the designated unit safely whilst communicating with them via a telephone or tablet.

• The provider had developed information cards which provided staff with concise information regarding providing care to people during the Covid-19 pandemic to ensure support was provided in line with current guidance.

• Staff risk assessments were undertaken and where staff were identified as being at higher risk of Covid-19, measures were put in place to mitigate the risk.

• IPC audits were in place and where actions were identified, these were addressed in a timely manner.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Roden Hall Nursing Home is a residential care home registered to provide personal and nursing care for up to 68 people. At the time of our inspection the service was supporting 38 people across three separate areas, each of which had separate adapted facilities.

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

Since our previous inspection the home had moved into a purpose-built building and improvements had been made to the home.

We found the recruitment process had improved to ensure the suitability of staff working in the home. People were supported by enough staff who were trained to recognise and report abuse. There were effective procedures to assess and manage risks. Improvements had been made to ensure medicines were managed in line with policies and procedures. The new purpose-built building mitigated previous infection control risks and when concerns were identified, they were addressed.

People’s needs were assessed, and their care was delivered in line with their preferences. People were supported by staff who were trained and had the skills to meet their needs. People were supported to eat and drink to maintain a healthy diet. People had access to healthcare services and were supported by a range of healthcare professionals to meet their needs. The home was adapted to meet people’s needs and offered a range of onsite facilities.

Care was delivered in accordance with the Mental Capacity Act 2005 (MCA) principles. 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 well treated and respected and had their views and input into their care. People’s privacy and dignity was respected, and they were promoted to maintain their independence.

People’s care was personalised and included their choice, preference and control. We found the home met people’s communication needs and followed the Accessible Information Standard (AIS). People were supported to maintain and develop relationships and quality of care was improved in response to complaints or concerns.

Improvements had been made to the governance systems to ensure the safety of the environment. The home promoted a positive person-centred culture and staff were supported to be open and honest when things went wrong. Managers and staff were clear about their roles and legal responsibilities. Management considered the views of staff, people living in the home and their relatives and worked together with health and social care professionals.

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 4 June 2019) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The home had moved into a purpose-built building therefore we carried out a comprehensive inspection.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Focused inspection

We undertook an unannounced focused inspection of Roden Hall Nursing Home on 23 April 2019.

People’s experience of using this service:

•Since our last inspection in July 2018, the provider had not taken sufficient action to comply with the breach of regulation 17, Good governance.

•The provider’s governance remained ineffective to address the shortfalls identified at our previous inspection.

•The provider had not taken appropriate action since the last inspection to ensure the safety of equipment to reduce the potential risk it could pose to people.

•People could not be assured they would be protected from the risk of cross infection.

•The provider was unable to demonstrate that all staff were subject to the appropriate safety checks before and whilst working in the home.

•People’s prescribed medicines were not always stored in accordance to the pharmaceutical instructions on the box.

•Accidents were recorded but action was not always taken to avoid them happening again.

•People were supported by trained staff to take their prescribed medicines.

•People were cared for by sufficient numbers of staff.

•People could be confident that staff were aware of their responsibility of safeguarding them from the risk of potential abuse.

Why we inspected: This inspection was carried out because we had received concerns about the suitability of staff working in the home.

Follow up: We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. More information is in Detailed Findings below.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Roden Hall Nursing Home accommodates up to 45 people with bedrooms on several floors, which are accessible by a lift and stairway. However, at this inspection alterations were being made to the building and people were living on the ground and first floors. In addition to the alterations to Roden Hall Nursing Home a new purpose build nursing home was being built in the grounds. As a result, the numbers of those living there had been reduced. At this inspection 22 people were living there.

Since our last inspection a newly appointed registered manager has taken up their position at Roden Hall Nursing Home and was present during this inspection’s site visit. 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.

Following our last inspection in January 2017 we published our report in April 2017. At that inspection we identified areas of improvement that needed to be made. These were in relation to the key questions, Safe, concerns about abuse and ill-treatment were not always passed to appropriate agencies and there were not always enough staff to meet people’s needs in a timely manner. In addition, the fire safety plan was not being followed. Effective, people sometimes had to wait for assistance at meal times. Caring, people were not always treated with respect. Responsive, people did not always have care plans that were up to date. Well-led, quality checks were not always effective to identify improvements needed.

At our last inspection we identified one breach in regulation. This was Regulation 12 HSCA Regulations 2014 - Safe care and treatment. Risks had been identified in relation to managing fire risks safely and an action plan to reduce the risk had been produced but was not being followed. We asked the provider to complete an action plan to show what they would do, and by when, to improve this key question. At this inspection we found improvements had been made and they were no longer in breach of this regulation.

However, at this inspection we identified some improvements were still required regarding the safety of parts of the building. In addition, we found that effective infection prevention and control practices were not fully embedded into staff members practice and that parts of the building did not support effective cleaning procedures. The management team and the provider did not have effective quality checks in place to identify and drive the changes required.

People were safe from the risk of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the registered manager were acted on appropriately. There were enough staff to support people to meet their needs in a timely manner. The provider followed safe recruitment procedures when employing new staff members.

People were safely supported with their medicines by competent staff members. New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff members had access to on-going training to maintain their skills and to keep up to date with changes in adult social care.

People received care that was effective and personalised to their individual needs and preferences. 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’s human rights and protected characteristics, like faith and disability, were supported and promoted by those providing care and support for them. People received information in a way they found accessible.

People received support that was caring and respectful. People were supported by a staff team that was compassionate, thoughtful and kind. People’s privacy and dignity was respected by those providing assistance. People were supported at times of upset and distress.

People, and when needed family or advocates, were involved in developing their own care and support plans. When changes occurred in people’s personal and medical circumstances, these plans were reviewed to reflect these changes. People’s individual preferences were known by staff members who supported them as they wished. People and their relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

The management team at Roden Hall Nursing Home was approachable and supportive. People’s suggestions and comments were valued by the provider. Staff members believed their opinions and ideas were listened to by the provider and, if appropriate, implemented. The provider had systems in place to monitor the quality of service they provided and where necessary made changes to drive improvements. The provider learnt from incidents and accidents and worked with people and families to minimise the risk of reoccurrence if things had gone wrong.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection took place on 23 and 24 January 2017 and was unannounced on the first day..

The service had a registered manager at the time of our inspection. 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.

Risks to people’s health and welfare were not always identified or acted upon to ensure people received safe support. Staff were not always working in ways that reflected risk management plans in order to reduce risks. This placed people at risk of potential harm.

Staff were confident that they could recognise and report poor practice or concerns about people’s safety. However, allegations of abuse had not always been managed appropriately to ensure people were protected from harm.

People were not always supported by sufficient staff to meet their needs safely and effectively and in a timely manner.

Staff were recruited safely meaning that only people suitable to work in the role were appointed. People received their medicines safely and there were safe systems for administering, storing, recording and auditing medicines. The registered manager addressed issues in relation to medicine management during the inspection.

People were supported by staff who had the skills and knowledge to meet their needs effectively. Staff had access to a variety of training opportunities and most staff felt well supported to carry out their duties.

People’s rights were protected under the Mental Capacity Act 2005. The registered manager had a good understanding of the principles and application of the MCA. People were supported by staff to make choices in relation to the care and support they received.

People’s nutritional needs were met and people were satisfied with the quality and choice of the food. People’s Individual dietary preferences and needs were catered for although people’s dining experience varied. Staff worked with healthcare professionals when required to ensure people’s maintained good health and wellbeing. This joint working ensured people’s needs were met consistently and effectively.

People were not always supported by staff who were respectful when entering their private space. Despite this people told us that they felt supported by staff who were kind and caring. People’s independence was promoted wherever possible and people felt listened to. Overall people’s privacy and dignity was respected.

People were not always supported by staff who had up to date information and knowledge about their care and support needs. This meant that they did not always provide a responsive service that met people’s changing needs. Staff did not always have access to written information about people’s changing needs. Activities were limited but were being developed. People had been involved in assessments of their needs and in reviews of their care and support.

People told us they were able to raise concerns and felt these would be acted on by the registered manager. The provider had a complaints procedure that people had been confident to use. However, not all complaints received had been managed appropriately and improvement was required to ensure that complaints were used to improve the service provided. There were systems in place to ensure that people’s views and opinions were heard and their wishes acted upon.

Processes to audit the service were seen in place but did not always identify issues that required action to make the home safer. The registered manager did however, take prompt action to protect people when we raised issues relating to people’s safety.