Archived: Roxburgh House (Liverpool)

Roxburgh House is a residential care home which offers accommodation and support for up to 38 older people. The single storey building is separated into two areas; a residential care home providing support for up to 23 people and a unit to support up to 15 people with dementia. On the day of inspection there were 37 people using this 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 we spoke with told us they felt safe living in Roxburgh House and we found that there were adequate numbers of staff on duty to meet people’s needs. Staff we spoke with were able to explain different types of abuse, potential signs of abuse and how they would report any concerns. Records showed that staff had completed safeguarding training which helped to support them in maintaining people’s safety and wellbeing. We found that staff were recruited in adherence with safe recruitment practices to ensure staff were suitable to work with vulnerable people.

Medicines were kept secure and systems were in place to ensure effective ordering and disposal. Staff had completed medicine training and a medicine policy was available to help guide staff. Medicine administration charts showed that not all medicines were signed for when administered.

We looked at accident and incident reporting within the home and found that incidents were reported and recorded appropriately. Arrangements were in place for checking the environment to ensure it was safe. On the first day of inspection, we looked at the environment and found that there were some repairs required and the manager ensured that these repairs were completed by the second day of inspection to ensure the environment remained safe.

We found the home to be clean and one person told us, “It’s very clean, they clean everyday.”

Staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards. We observed staff seeking people’s consent before providing them with support. When people were unable to consent, an assessment of their mental capacity was completed in line with the principles of the MCA and care provided in their best interest.

Staff were supported through induction, training, supervisions and appraisals. People living in the home and their relatives told us they felt staff were well trained.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing, such as the GP.

Catering staff we spoke with were able to tell us about most people’s dietary needs, however no written information was available in the kitchen to ensure that all people providing meals was aware of each persons dietary needs and preferences. The manager agreed to review this and on the second day of inspection diet notification charts had been created and were available within the kitchen.

We observed the environment of the home and found that the manager had taken steps within the unit for people living with dementia to ensure the environment included orientation signs and aids and which enabled people to be more independent.

People living at the home told us staff were kind and caring and treated them with respect. Relatives we spoke with agreed and staff told us they enjoyed caring for the people living in the home and that it was like an extended family.

We observed relatives visiting throughout both days of the inspection. People we spoke with told us they could have visitors at any time and visitors we spoke with agreed. One visitor told us, “At least one family member comes nearly every day and at different times, we are always made welcome.”

Most care files showed that people had been involved in the development of their care plan. Care plans were specific to the individual person and most were detailed and informative. We found however, that not all care plans contained sufficient detail regarding people’s needs and some contained inconsistent information. The manager was made aware of these findings and on the second day of inspection, the manager had updated the care plans to include the relevant information.

Not all risk assessments we viewed had been completed accurately. If accurate levels of risk are not identified, people may not receive appropriate care to meet their needs. On the second day of inspection, the risk assessment had been reviewed and accurately reflected the person’s level of risk.

Staff we spoke with demonstrated a good knowledge of people’s individual care, their needs, choices and preferences.

People told us they enjoyed activities available within the home, such as bingo, music, singing and trips out in the minibus. did exercises, listened to music, sang, went in the garden in the summer and went out in the minibus.

People had access to a complaints procedure and this was displayed on notice boards within the home and was also available within the residents guide which everybody had a copy of in their rooms.

The home had a registered manager in post. People living in the home told us it was run well and relatives told us they felt able to go to the manager with any concerns and were confident they would be listened to and have their concerns addressed.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had. There were processes in place to gather feedback from people and listen to their views.

There were procedures in place to monitor and improve the quality and safety of the service, such as regular audits completed by the manager and operational director.

The manager had notified the Care Quality Commission(CQC ) of events and incidents that occurred in the home in accordance with our statutory notifications.

The inspection was carried out by an inspector. We set out to answer our five questions; 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. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted.

The service was safe, clean and hygienic and therefore not putting people at unnecessary risk of infection.

When the registered manager set the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them, they were involved in writing their plans of care and care was delivered as it had been planned. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented 'staff couldn't do any better'. We read in the relative's survey, 'there is nothing I would change about my mums care. The staff are lovely and nothing is too much trouble for them'.

Relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. One of the relatives told us they had raised concerns that the carpet in their relative's room smelled and that the acting manager had ensured this was addressed and the flooring was replaced.

We looked at the complaints book and it was completed appropriately with details of the complainant, the complaint, action taken and outcome. People could therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

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, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding that the priority of the home was to provide good quality care and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

You can see our judgements on the front page of this report.

We found improvements had been made since our last inspection in October 2012 where we had concerns relating to: staff supervision and training; quality assurance systems; and the security of records.

We found a range of activities and social events were taking place at the home. An activities coordinator had been appointed and a mini bus had been purchased so that more trips out could take place. Links had been made with the Everton Football Club Community Team, who had been arranging monthly tea dances. Parties had been held for Burn's night, Mothers day and Easter. We saw activities and trips out were planned for the coming months.

The majority of people said they were always treated with dignity and respect. However one person said, 'Not always. Some people [staff] are better than others.' People told us they enjoyed the food and there was usually a choice available.

We spoke with four people who were visiting friends or relatives who live in the home. All were pleased with the care and support being provided. One person said 'The staff have been very supportive and are very responsive if you raise anything.' Another visitor told us they and their family are always made to feel very welcome and that the home has a lovely atmosphere.