Archived: Roxburgh House

Roxburgh House is a residential care home providing personal care to 15 people with a variety of needs. People's needs include, physical disabilities, dementia, learning disability or long-term mental health conditions. The service can support up to 22 people in one adapted building.

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

The quality of service people received had improved since our last inspection. People told us they felt safe, and they received the care and support that they needed.

The provider and manager had a vision of how the service needed to develop and was striving to develop and improve the service offered to people. A governance framework was in place which covered all aspects of the service and the care delivered. Numerous quality assurance audits had been completed. When shortfalls had been identified, plans were in place to continue with the improvements. However, some shortfalls concerning window restrictors had not been identified in the audits. The manager took immediate action to address this. We will check that improvements have continued and sustained at the next inspection. People and staff spoke highly of the support of the management team.

Improvements had been made in the staff recruitment processes. Staff were recruited safely, and safety checks had been completed before they started working at the service. There were enough staff on duty to make sure people received the personal care and support they needed when they needed it. Staff had the appropriate training to enable them to carry out their roles effectively.

The manager and staff promoted and encouraged person centred care to ensure people were treated as individuals. Staff knew how people preferred to receive their care and support. Staff knew how to communicate with people in the way they preferred and suited them best.

People were involved in planning what happened at the service. They had been asked for their views, and these were acted on. People were supported and encouraged to develop and maintain their independence with support from staff. There was a range of activities and pastimes for people to be involved in. People told us they enjoyed all the activities. They said they had fun.

Care plans were up to date, risk assessments were in place and regularly reviewed. The manager carried out regular checks and analysis of accidents and incidents to ensure learning from events was undertaken. This meant risks to people's health and safety were reduced.

People received their medicines on time and when they needed them. Staff had positive links with healthcare professionals which promoted people's wellbeing.

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.

End of life care wishes were explored and recorded. People and relatives knew who to contact with any complaints. People received responsive care. People were supported by kind and caring staff. Staff developed positive relationships with people through meaningful conversations, activities and spending time with them to find out their diverse needs.

The service was clean and improvements to the environment continued.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 2 December 2021). There were two breaches of the regulations. 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 and the provider was no longer in breach of regulations.

At this inspection we also looked at the breach of regulation 9 which had been identified at the inspection in 2019 (published 28 January 2020). The provider had failed to ensure people's needs were assessed and recorded using recognised tools. People had not been supported to plan their end of life care. Information was not available to everyone in ways that meet their needs and preferences. Some people had not been supported to remain active and occupied. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 9.

At our last inspection we recommended the provider consider current guidance in relation to investigating safeguarding vulnerable adult concerns and supporting people to safely manage their own finances. We also recommended the provider consider current guidance in relation to gathering the views of everyone involved with the service and taking meaningful action in response to these views. At this inspection we found the provider had acted on the recommendations and had made improvements. People were managing their own finances if they wanted to and people were asked their views on the service they received, and action was taken.

Why we inspected

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspections for all key questions were looked at on this occasion. The overall rating for the service has changed from Requires Improvement to Good. 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 Roxburgh House on our website at www.cqc.org.uk.

Follow up

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

Roxburgh House is a residential care home providing personal care to 11 people with a variety of needs. People's needs include, physical disabilities, dementia, learning disability or long-term mental health conditions. The service can support up to 22 people in one adapted building.

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

The service people received had improved since our last inspection, however further improvements were required to address two continued breaches of regulation and bring the quality of the service people received up to a good standard.

Staff were not always recruited safely and robust checks has not been completed on their conduct in previous roles. Records of the care people received had improved, however, there remained gaps in records and some information about people was contradictory.

People were not fully involved in planning what happened at the service. They had been asked for their views, but these were not always acted on. People were not supported and encouraged to develop and maintain their independence and staff completed day to day tasks for people rather than with people.

Some relatives reported communication with the provider and manager had improved. Others had not been made aware there was a new manager and felt communication about changes in their relatives needs and the service could be more effective.

Risks relating to people’s care had been assessed and care had been planned to mitigate these. However, further work is needed to involve people in planning how to take and manage risks.

There were enough staff on duty, and they had completed training in key areas such as safeguarding and medicines management. Staff knew how to identify signs of abuse and raise any concerns they had. Medicines were now managed safely.

The building was clean and work had been completed to improve the access and decoration of the building.

We have made recommendations about safeguarding investigations, gathering and acting on people’s views and to maximising people’s choice, control and independence.

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 16 June 2021) and there were multiple breaches of regulation. We took urgent action against the provider to stop any new people moving into the service. We also required the provider to tell us how they had mitigated risks to people. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

This service has been in Special Measures since 13 November 2020. 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 carried out an unannounced focused inspection of this service on 17 August 2021. Breaches of legal requirements were found. We undertook this focused inspection to check the provider had taken action 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.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roxburgh House 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 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.

We have identified breaches in relation to staff recruitment and record keeping 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 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.

Roxburgh House is a residential care home providing personal to 14 people with a variety of needs. People’s needs include, physical disabilities, dementia, learning disability or long-term mental health conditions. The service can support up to 22 people in one adapted building.

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

People were not always safe at Roxburgh House. Some people told us they were scared at times. Allegations of abuse and incidents between people had not been shared with the local authority safeguarding team so they could be investigated.

There was a continued lack of effective leadership and oversight by the provider and this had led to failures throughout the service. The provider had failed to make the required improvements following the last inspection in September 2020 and breaches of regulation continued. Checks and audits completed had not identified the shortfalls we found at the service. People were not valued and were not at the centre day to day life at the service. They were not encouraged or supported to maintain and develop their independence. People’s views and opinions were not listened to.

The provider had not developed an open culture and there was a lack of trust and respect between the provider and staff. Most longstanding staff members had left. A blame culture had developed between the provider and staff and staff did not work as a team to support people.

Risks associated with diabetes, epilepsy, choking, catheter care and behaviours which challenge had not been robustly assessed and action had not been taken to reduce risks to keep people safe. People continued not to be protected from the risks in the event of a fire. Accidents and incidents were not reviewed to identify any patterns or trends and reduce the risk of them reoccurring.

Medicines were not managed safely. People did not always receive the medicines they were prescribed by their doctor and one prescribed medicine was shared between four people. There continued to be no guidance available for staff about people’s ‘when required’ medicines.

Improvements made to staff recruitment process had not been maintained. People were not protected from the risks of staff who did not have the skills to fulfil their role or were not of good character. Staffing levels were not consistent to ensure people received the care and support they needed. Staff continued to work long hours.

The cleanliness of the building had improved but people continued to be at risk from the spread of infection. Laundry and rubbish were not managed or stored safely. Government COVID-19 guidance had not always been followed. The new manager had not begun to develop their relationship with other professionals involved with the service

Records at the service were inaccurate or incomplete. Medicines records contained gaps in the administration of medicines and some important records could not be found such as medicines sent for destruction. Staff rotas did not reflect who had worked at the service. Some recruitment records were not easily accessible. Personal information about people was not held securely.

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 14 November 2020) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the leadership and culture of the service, maintenance of the building, the registered manager leaving and staff not being able to meet people’s needs. A decision was made for us to inspect and examine those risks and follow up on action we told the provider to take at the last inspection. 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 remained Inadequate. This is based on the findings at this 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 COVID-19 and other infection outbreaks effectively.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roxburgh House 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 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.

We have identified breaches in relation to people’s safety, medicines management, staff recruitment, staff deployment, responding to allegations of abuse, effective checks and audits, records and seeking and acting of feedback from people, their relatives and staff at this inspection.

We took urgent enforcement action against the provider and applied conditions to their registration.

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.

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

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

There was a lack of leadership at the service and the quality of care people received had not improved. The provider and staff did not share a sense of direction or vision and values. Robust plans had not been put in place to drive change and the lack of progress had not been recognised. Checks and audits were not robust and had not identified shortfalls we found.

People’s views and opinions had not been used to improve the service. Some people had raised concerns but these had not been addressed. Others did not raise concerns as they were not confident, they would be addressed.

People continued to be at risk from the spread of infection, including Covid 19. The vacancy for a cleaner had not been filled and the post had not been covered.

Staff were not deployed to a sufficient level to meet people’s needs. People had to wait assistance at times. Care staff were required to completed domestic duties and this took them away from people. Staff had not completed practical refresher training in key skills such as moving and handling. Medicines were not consistently well managed and recorded.

People told us they were bored at times. There was no programme of activities or occupation and people spent their time doing nothing. People had asked to go out but had not been supported to do this.

Preadmission assessments remained inadequate and care had not been planned with people when they began to use the service. Risks had not been identified for everyone and action had not been planned to mitigate risks.

Staff were recruited safely.

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 25 January 2020) 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to confirm the provider was now met legal requirements because we were not assured they had acted to improve the service. 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 requires improvement to inadequate. 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 Roxburgh House 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 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.

We have identified breaches in relation to low staffing levels and staff training, risk management, medicines, lack of oversight by the provider and registered manager, not acting of feedback, inaccurate records and failure to notify CQC of significant events 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Roxburgh House is a residential care home providing personal care to 18 older people and people living with a physical disability at the time of the inspection. The service can support up to 22 people.

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

People living at the service had a wide range of needs. Most people were happy living at the service but others felt areas of the service could improve. We found the service was not clean and people were not protected from the risk of infection.

The provider and registered manager did not have a good oversight of the service. They had not completed effective checks on the quality of the service and were unaware of shortfalls we found.

Staff were not always recruited safely and there were not always enough staff to meet people’s needs. Staff had not been held accountable for the poor cleanliness at the service. New staff completed an induction.

The management of people’s medicines required improvement. Guidance was not available to staff about some medicines and some records were not complete.

Risks to people had been identified and staff had been trained to provide the care people needed. However, on one occasion we noted staff did not move a person safely.

Assessments of people’s needs were not always accurate, however people did receive the support they needed.

People were not protected from the risk of fire as an exit gate was locked and flammable items were not stored safely. Staff were confident to use evacuation equipment. Action had been taken after accidents and near misses to stop them from happening again.

People had not been offered the opportunity to discuss their end of life preferences. However, people did receive support to have a comfortable and pain free end of life.

People were protected from the risks of harm and abuse. Staff knew how to identify and raise concerns.

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 supported to remain as healthy as possible. They had access to a dentist and guidance was in place about people’s health care needs. Staff promptly contacted healthcare professionals when people’s needs changed.

People were referred to respectfully. They had been asked about their lifestyle and equality needs and choices. People had privacy and were treated with dignity. Staff treated people with caring and compassion and supported them to remain independent.

People knew how to complain about the service and complaints had been resolved.

People were supported to eat and drink enough.

Staff felt supported by the registered manager and worked as a team. People and staff were asked for their views, and these had been used to develop the service. The registered manager understood their legal responsibilities and had informed us about significant events that happened 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)

The last rating for this service was good (published 16 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the cleanliness of the service and infection control processes, staff recruitment and deployment, and checks on the quality of the service. We also identified breaches in relation to needs assessments, mitigating risks, medicines records and end of life planning.

Please see the action we have told the provider to take at the end of this 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Roxburgh House is a residential care home for 22 people with a physical difficulty and older people, some of whom may be living with dementia. The service is a large, converted domestic property. Accommodation is arranged over three floors and there is a stair lift to assist people to get to the upper floors. There were 19 people living at the service at the time of our inspection.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

The registered manager was leading the service and was supported by a senior carer. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. Complaints were investigated and responded to.

People had enough to do during the day, including going out to local shops and cafes. Staff supported people to maintain relationships with their friends and family.

Assessments of people’s needs and any risks had been completed and care had been planned with people and their relatives to meet their needs and preferences and keep them safe.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet and food they liked.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The registered manager had oversight of the service. Staff felt supported and were motivated by them. Staff shared the registered manager’s vision of a good quality service and told us they would be happy for their relatives to live at Roxburgh House. Records in respect of each person were accurate and complete.

People told us and we saw that they could bring their own furniture and possessions for their rooms and we saw that one person had their own phone line so they could contact friends and relatives whenever they wanted to. Other people who used the service told us that they were given their own mobile phone and that staff had spent time with people to show them how to use them.

We saw that care plans had been written based on people's individual assessments of their needs and contained detailed information. For example, care plans recorded people's medical conditions, along with their individual preferences and choices in relation to their care. We found that people's records contained a range of assessments, including appropriate risk assessments and we found that care plans were up to date. We saw evidence of monitoring and regular evaluations of the support that was provided, together with involvement and liaison with relatives and various health professionals, to ensure they were kept informed of changes in people's conditions when necessary.

We saw that the provider had measures in place to help safeguard people from abuse. There were enough staff on duty to enable people to promptly receive the assistance they needed. We saw that there was an effective system for resolving concerns and complaints.

All of the five people with whom we spoke gave us positive feedback about most aspects of the service. One of them said, 'I've lived here a while and it's home. The staff are all so lovely and kind. I do what I want including spending time in my bedroom and it's very relaxed. There are no fixed rules, the staff are always asking how I am and whether I want anything. '

We saw that some parts of the accommodation were not furnished and decorated to make them comfortable spaces. Also, records did not confirm that an important health and safety check had been completed. We observed that the dining room and one bedroom were not heated adequately. One person who was sitting in the dining room waiting for lunch to be served said, 'I feel a bit cool in here at the moment. It was okay before this recent cold weather but the heater can't heat the room enough when it's really cold outside.'