Archived: Robleaze House

Updated 25 July 2021

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act.

The inspection

This was a targeted inspection to check whether the provider had met the requirements of the specific concern we had about peoples safety .We will assess all of the key question at the next comprehensive inspection of the service.

Inspection team

This inspection was undertaken by two inspectors.

Service and service type

Robleaze is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager who was also the sole provider registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We spoke briefly with three members of staff including the provider. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Our SOFI observed care and support for six people who lived at the home.

After the inspection We continued to seek clarification from the provider to validate evidence found.

Updated 25 July 2021

About the service

Robleaze House provides accommodation with personal care for up to 10 people with a learning disability. At the time of our inspection 10 people were living in the home. Four people had lived there since the home opened 26 years ago.

The service was operating before the principles and values that underpin Right support, right care, right culture had been developed. However, the service would be expected to develop in line with these principles and other best practice guidance. Right support, right care, right culture ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

There were areas found at the last inspection that meant the provider was in continued breach of requirements such as the failure to report incidents they have a legal responsibility to report to the Care Quality Commission.

Some of areas of the home still needed ongoing maintenance to ensure they were in a good state of repair. This was impacting on the cleaning of the home, which was vital in the management of infection control especially during a pandemic.

Not all areas of the home were clean and free from odour, however, this was addressed by day two of the visit. Cleaning schedules had not been signed as being completed.

As seen at the last inspection, the provider did not have effective systems in place to consistently assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.

There had been some improvements noted since the last inspection, in areas such as records relating to people who lacked capacity and how decisions had been on their behalf. Where people lacked capacity, appropriate applications for a deprivation of liberty safeguard had been submitted.

Improvements had been made to ensure systems were in place to ensure people received their medication safely. There had also been improvements to the reporting of allegations of abuse, staff training, appraisals, supervisions and staff meetings.

People and their relatives spoke positively about the care and support provided by the staff and the registered manager. Some people had lived at the home for many years. This was a family run business. Staff knew people well.

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. The provider said that it had been difficult during the pandemic with the restrictions in place and keeping people safe. However, people had been involved in decisions about activities, menu planning and COVID-19 testing and vaccinations.

Some improvements were needed in respect of meeting some of the underpinning principles of Right support, right care, right culture. Care plans focused on what the person could and could not do with little focus on people’s hopes and aspirations.

Care plans were in the process of being reviewed. Triggered in part by this inspection, with information being put in one central file for each person. New assessments were being completed which would inform the new care plan for each person.

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 October 2019). 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 sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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, effective, responsive 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 not changed. This is based on the findings at this inspection.

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 continued breaches in relation to the home environment, which was not properly maintained, and the lack of effective systems were not in place to continually monitor and improve the service. The provider had continued to fail to notify us of incidents which they legally need to report

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.

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 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.