Archived: Roden Court

Roden Court provides care and support to people living in specialist 'extra care' housing. At Roden Court there are 40 ‘extra care’ flats available for rent. On the day of the inspection there were 39 people receiving personal care in their own flats.

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

People and relatives told us staff did not always treat them with respect. The provider had introduced dignity and respect training for staff but this had not ensured all people felt treated in a friendly manner.

The provider had not ensured staff were always deployed safely to people’s needs were met. People and relatives told us staff were not always on time to provide their care. The provider did not have a system to routinely be alerted to a missed or late call to rectify staffing issues.

Medicines were not always managed safely. Medicines were not always managed as prescribed. Protocols for administering medicines on an as required basis did not contain enough detail for staff to know how to do so safely.

The provider had begun to make improvements in the culture at the service and there was increased oversight from senior management at the service to increase the standards of care provided. However, there was mixed feedback from staff about the registered manager’s leadership. The provider had increased monitoring of the service but this had not highlighted all the concerns found during the inspection in order for the provider to improve the safety of care in these areas.

The provider had improved the infection prevention and control measures at the service. Staff had been given relevant training and wore personal protective equipment safely to minimise the risk of infections spreading.

The provider had improved their management of the risks people faced. People’s risks had been identified, such as the risk of falls, stroke and diabetes. There were plans in place to minimise the risk of harm.

Staff were recruited safely and they understood how to keep people safe from abuse and the provider had put extra measures in place to minimise the risk of financial abuse.

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 inadequate (published 7 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however there remained areas where further improvement was necessary and the provider was still in breach of regulations.

This service has been in Special Measures since June 2021. During this inspection the provider demonstrated that improvements have begun to be 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 carried out an unannounced focused inspection of this service on 21 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their practices to safeguarding adults from abuse, to promote people’s dignity and respect, and to improve safe care and treatment and good governance.

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 and Well-Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate 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 Roden Court on our website at www.cqc.org.uk.

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 have identified breaches in relation to dignity and respect, staffing, medicine management, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Roden Court provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is owned or rented and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service. There are 40 flats available for rent. On the day of the inspection there were 37 people receiving personal care.

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

People and relatives told us people receiving care from the service and their possessions were not always kept safe. Some people told us they were shouted at and that their belongings had gone missing. Staff were not always aware of what actions to take if they had concerns about people’s safety and did not always know how to blow the whistle on poor practice at the service.

People and their relatives were not always comfortable speaking with management about their concerns. Staff were not always confident about speaking out about their experiences. Staff morale was low and team work was poor and an allegation of bullying was made to us.

The provider did not have a robust system to monitor the quality of service delivery as the concerns we found had not been identified and addressed by the provider to drive forward improvements in care. People and their relatives told us the service was ineffective and disorganised and communication with management was poor.

We were not assured by the provider’s infection prevention and control measures to minimise the risk of the spread of coronavirus and other infections. The registered manager and staff did not always wear personal protective equipment, such as masks, safely. People’s risk assessments had not been updated to reflect the impact of the COVID-19 pandemic on people’s needs.

The care records at the service were unclear and disorganised and the provider had not provided enough written information to staff to ensure they knew how to keep people safe from the risks they faced.

The provider’s approach to medicine management would benefit from further improvement to ensure they were following best practice. Relative’s told us medicines were sometimes missed. Staff who administered medicines were trained and had their competency assessed.

Staff told us there were normally enough staff working to meet people’s needs and the rota reflected this. The provider had a system in place to check staff backgrounds before they started working alone at the service.

We found four breaches of the regulations in relation to dignity and respect, safe care and treatment, safeguarding people from abuse 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 4 July 2018).

Why we inspected

We received concerns in relation to people’s safety and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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.

Special Measures

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

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Roden Court provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. There are 40 flats available for rent. On the day of the inspection there were 23 people receiving personal care.

People told us they liked the staff and felt safe with them.

Staff knew how to recognise and report abuse and understood their responsibilities in keeping people safe. Staff understood that people were at risk of discrimination and knew people must be treated with respect. Staff understood there were laws to protect people from discrimination.

Where risks to people’s safety had been identified ways to mitigate these risks had been discussed with the person and recorded so staff knew how to support the person safely.

The service was following appropriate recruitment procedures to make sure only suitable staff were employed.

Staff had completed training in the management of medicines and understood what they should and should not do when supporting people or prompting people with their medicines.

Staff were provided with the training they required in order to support people safely and effectively.

Staff offered choices to people as they were supporting them and people were involved in making decisions about their care. People confirmed they were involved as much as they wanted to be in the planning of their care and support.

Care plans included the views of people using the service. 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.

The management and staff responded quickly and appropriately to any changes in people’s needs and care plans reflected people’s needs and preferences.

People told us they had no complaints about the service but said they felt able to raise any concerns without worry.

People who used the service and the staff said they felt the service was well run but also felt that communication from the management team could be improved.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach described above.

We undertook a focused inspection on the 5 October 2016 to check the provider had followed their action plan and to confirm they now met legal requirements. This inspection was unannounced.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roden Court on our website at www.cqc.org.uk.

Roden Court is an "extra care" housing provision operated by One Housing Group Ltd. in Haringey, North London. There are 40 flats available for rental by older people. The Care Quality Commission regulates the personal care service provided to residents by One Housing Group Ltd. On the day of our inspection there were 36 people receiving a person care service.

The service has a registered manager who had been in post since the service opened in 2013. 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 our focused inspection we found the provider had followed their action plan. People were receiving their medicines as they had been prescribed. The provider had also ensured there were systems that were being effectively operated to monitor and assess the quality of service that people received. Furthermore, temperatures were being monitored for medicines that required storage in the fridge, in accordance with legal requirements.

Roden Court is an "extra care" housing provision operated by One Housing Group Ltd. in Haringey, North London. There are 40 flats available for rental by older people. The Care Quality Commission regulates the personal care service provided to residents by One Housing Group Ltd. On the day of our inspection there were 37 people receiving a person care service.

The service had a registered manager who had been in post since the service opened in 2013. 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’s needs were assessed and care plans were developed to identify what care and support people required. People said they were involved in their care planning and were happy to express their views or raise concerns. When people’s needs changed, this was quickly identified and prompt, appropriate action was taken to ensure people’s well-being was protected. People had a copy of their care plan in their home.

People felt safe. Staff understood how to recognise the signs and symptoms of potential abuse and told us they would report any concerns they may have to their manager. Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. This included environmental risks and any risks due to people’s health and support needs. The risk assessments we viewed included information about action to be taken to minimise these risks.

However we found errors in medication recording for some people using the service. We have asked the provider to take urgent action to address this.

Staff were highly motivated and proud to work for the service; as a result staff turnover was kept to a minimum ensuring that continuity of care was in place for most people who used the service.

Staff were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care, asking people how they would like things done and making enquiries as to their well-being to ensure people were comfortable.

Care staff received regular supervision and appraisal from their manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required. Care workers we spoke with placed a high value on their supervision.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people living at the service.

We saw that regular visits had been made by the office staff to people using the service and their relatives in order to obtain feedback about the staff and the care provided.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We found that the service was working within the principles of the MCA, and there were no authorisations to deprive people of their liberty.

The management team provided good leadership and people using the service, relatives and staff told us they were approachable, visible and supportive. We saw that regular audits were carried out by the provider’s head office to monitor the quality of care

People were supported to eat and drink. Staff supported people to take their medicines when required and attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The service had a complaints policy. People who used the service told us they knew how to make a complaint if needed.

There was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 You can see what action we have told the told the provider to take at the back of the full version of this report.

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, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Training records showed that most staff had completed safeguarding adults training within the last six months.

There were effective recruitment and selection processes in place, and staff had been through induction and shadowing before starting work. This ensured that the staff were of good character and were competent enough to meet the care and welfare needs of people.

Is the service effective?

People’s health and care needs were assessed specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people. One person told us, “nothing is too much trouble for them.’’

People using the service, and their relatives, were contacted regularly to check if they were satisfied with their care. 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’s needs had been assessed before they moved into the scheme. People had access to activities that were important to them.

People knew how to make a complaint if they were unhappy. The provider had a robust complaints procedure that was accessible to people who use the service.

Is the service well-led?

Staff told us that the management team was’’ always routing’’ for people who used the service and ‘’responded very quickly.’’

Staff told us they were very happy with the manager, “the manager is very good, we all help each other.” Another person told us “the manager is very open; we can speak to her anytime.”

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the agency, quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People expressed their satisfaction with the service and the care they were receiving. They said staff were helpful and looked after them well. One person said, “staff are very kind”. " I never have to wait for my medicines".

Systems were in place for the management of medicines. These had improved since the previous inspection when compliance action had been taken because of shortfalls.

Action had been taken to employ more permanent staff, deliver further training and carry out more frequent medication audits.

We observed that there was a new medicines policy which referred to the new pharmacist supplier and the services they offered.

The auditing systems were much more comprehensive and frequent and were identifying problems. We saw that sometimes the action taken was not recorded in detail so that problems could be reduced further.

“I like it. They give you help if you need it. You get a cup of tea.”

“It’s all right here.”

“It is good.”

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People experienced care, treatment and support that met their needs and protected their rights.

The provider did not have the appropriate arrangements in place to ensure that people were protected against the risks associated with the unsafe management of medicines. We judged this had a moderate impact on people using the service.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The care and support needs of people living at Roden Court are assessed by the local authority. The service is provided by care workers employed by One Housing Group, separately from the terms of the people's tenancies. The range of support people received varied and included assistance with personal care and medication, preparing meals, help with shopping, assistance with managing their finances and cleaning the flats.

We inspected the service on the 10th December 2012. We looked at care records of a number of people using the service, staff files and other records relating to the care and support provided. We spoke with the extra care project manager, eight people using the service and five care workers. We observed care and support being provided in communal areas of the block.

None of the people we spoke with mentioned any concerns they had with the service. One person told us 'it's lovely here.' Another said 'I've got all I really need.'

We had concerns over the provider's management of medication. We noted that the provider had been working actively with the local authority commissioners to address the issues, but we have set a compliance action under the relevant outcome.