Archived: Robleaze House

Robleaze care home is a care home providing accommodation for up to 10 people with learning difficulties, including people living with dementia. At the time of the inspection there were 10 people living at the home.

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

We received information raising concerns about whether people using the service were being kept safe.

We inspected the home on 6 June 2021 to see how care was being provided.

We found evidence during this inspection that people’s communication needs were not always being met. Specifically, while we observed some positive engagement this was not consistent from all staff towards all of the people we met.

People were dressed in ways that were individualised. People looked comfortable. We saw as well how people got up at times of their choosing.

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.

Due to the type of inspection we carried out we did not fully inspect to find out if this service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

While staff conveyed a supportive attitude, communication with people was not always person-centred, positive and engaging. However we also found people’s independence was being promoted. People told us they were going out with staff, and another staff member was cooking with another person.

We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10 around making sure that people using the service are treated with respect and dignity at all times while they are receiving care and treatment.

Rating at last inspection

The last rating for this service was Requires Improvement (September 2019). A further inspection has been carried out on 22 April 2021. This was a Responsive Follow up inspection. It was not finalised on the day of our inspection.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to an allegation of concern. A decision was made for us to inspect and check if people were safe. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Please see the caring section of this full report.

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

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.

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

The service was operating before the principles and values that underpin Registering the Right Support had been developed. However, the service would be expected to develop in line with these principles and other best practice guidance. Registering the Right Support 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. It was registered to support up to 10 people. Ten people were using the service. 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. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, improvements were needed to show how people were supported to make decisions when this was done in their best interest. Mental Capacity assessments had not been completed for people where a deprivation of liberty safeguard had been submitted. The provider had failed to notify us of these authorisations and two safeguarding incidents that had happened during August 2019. They have a legal responsibility to report these to the Care Quality Commission and the local authority’s safeguarding team.

Some areas of the home required updating to ensure people were safe. Not all areas of the home were clean and free from odour.

Risks relating to people were not always appropriately assessed and recorded. They did not always take into consideration people's personal circumstances to make sure measures were in place to protect them, staff and other people living at the service from harm. Improvements were needed to ensure people received their medicines safely.

Since the last inspection, improvements had been made to ensure suitable staff were employed and appropriate recruitment checks had been completed. Sufficient staff were supporting people. This had recently been increased in August 2019. Staff said the senior management team were available in the event of an emergency including at night when there was only one member of staff.

Staff knew people well however; the depth of knowledge was not always transferred to the person’s care plan. People’s health care appointments were not always recorded once they had attended an appointment. This put people at risk.

Staff said they were supported in their roles. Formal supervisions, annual appraisals and team meetings had not been carried out in line with the provider’s expectations. There was no formal process to record staff inductions or show competence in respect of the medicine administration once they had completed their induction.

People told us about the activities they completed with staff both in the home and the local community. Some people attended a day centre. People were supported to keep in touch with family and friends.

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.

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 11 June 2018).

Why we inspected

The inspection was prompted due to concerns received from visiting health professionals and commissioners of the service. This was because there were concerns about how the service responded and acted upon their advice and recommendations to meet people’s needs. There had also been a safeguarding incident that had been investigated by the police. This was not substantiated but we needed to be assured people were safe. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements.

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.

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 Robleaze House on our website at www.cqc.org.uk.

At the last comprehensive inspection on 8 March 2017 the service was rated Requires Improvement. We found breaches in the regulations relating to staff recruitment, premises maintenance, quality assurance systems and notifications to CQC. Following this inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a focused inspection on 22 June 2017, in response to specific safeguarding concerns relating to the health, safety and welfare of a person who had lived in the home. The concerns were unsubstantiated. At that inspection, we checked people were safe living in the home, treated with dignity and respect and that staff understood their roles with regard to safeguarding people from avoidable harm and abuse. We had no concerns relating to those aspects of the service at that time.

We carried out a comprehensive inspection on 26 April 2018. At this inspection, we found improvements had been made and the legal requirements with regard to staff recruitment, quality assurance systems, notifications to CQC and shortfalls with premises maintenance identified at that time had been met.

The service has improved to Good.

The registered provider was the person registered with the Care Quality Commission to manage the service. 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 were encouraged and supported to lead active lifestyles in the home and in the community. People were encouraged to be independent in their daily living. This included involvement in menu planning, shopping and cooking meals, and participating in daily ‘household’ tasks and laundry.

Individual risk assessments and risk management plans were completed. Actions were taken to minimise risks of harm, whilst promoting people’s independence.

Medicines were safely managed. Records provided details of the medicines people were prescribed. The provider had systems in place to recognise and take actions when errors were identified.

Staff had received training and were aware of their responsibilities for safeguarding people from avoidable harm and abuse.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff had the opportunity to provide feedback and attend staff meetings on a regular basis.

Improvements had been made and there was an on-going programme of maintenance and redecoration. Actions were needed to ensure the premises were safely maintained, specifically with regard to fire safety and legionella risk assessments and management plans. Following our visit, the registered person requested the fire services authority to visit, and a legionella risk assessment was completed.

People were provided with the support they needed with food and fluids. People’s dietary requirements and preferences were recorded and people were supported to make healthy food choices.

People’s legal rights were respected. People were supported to exercise control, consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed. People were supported to express their opinions and views.

Staff were kind and caring. We found people were treated with dignity and respect and people’s privacy was maintained.

The service was well-led. Systems were in place for monitoring quality and safety. People using the service, relatives and staff were encouraged to provide feedback and this was acted upon to make improvements to the service. The provider understood their responsibilities with regard to notifications they were legally required to send to CQC.

We undertook this focused inspection to ensure that people living in the home were safe. We checked that staff understood their roles with regard to safeguarding people from avoidable harm and abuse, and understood actions to take if they had concerns. We also checked that people were treated with dignity and respect.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Robleaze House on our website at www.cqc.org. The current overall rating for the home is ‘Requires Improvement.’ The registered provider sent us an action plan following our last comprehensive inspection undertaken in March 2017. They told us how they would address the breaches of regulations we had identified, and the timescales in which the required improvements would be made. The breaches of regulations at that time related to records, staff recruitment procedures, notifications and maintenance of the premises.

Robleaze House is registered to provide accommodation for up to 10 people with a learning disability. At the time of our visit, eight people were living in the home.

The registered provider was registered with the Care Quality Commission to manage the service. 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.

Staff understood their roles and responsibilities with regard to safeguarding people from harm and abuse. Staff had received training and understood the actions they needed to take if they suspected people were being harmed or abused.

People were treated with dignity and respect. Staff promoted peoples’ independence and people were supported to make choices.

The provider wrote to us in February 2016 and told us how they intended to meet the recruitment regulation. During this inspection, we found that although some improvements had been made in relation to recruitment, further action was still required.

Robleaze House provides accommodation and personal care for up to 10 adults with a learning disability. At the time of our inspection there were nine people using the service who were aged between 40 and 75. Most of the people in the service had lived there for between 20 and 25 years since the service had first opened.

The provider had not ensured that recruitment procedures were robust. Despite improvements in procedures since our last inspection, we found a reference had not ensured the provider had ascertained relevant information before appointing a staff member. Areas of the service had been poorly maintained and required repairs. The current condition of the service could present a risk to people.

Appropriate records had not been maintained by staff for people in relation to their activities and meals. Records had not been made where required when an accident had occurred. This shows that current governance arrangements and systems were not robust in identifying these shortfalls. The provider had failed to send a serious injury notification and a notification to advise the Care Quality Commission that a person living at Robleaze House was being lawfully deprived of their liberty.

People at the service felt safe. Staff received safeguarding training and appropriate policies were in place to help keep people safe. There were sufficient staffing numbers on duty and we made observations that people could be well supported by staff. People’s assessed needs and risks were recorded. Where required, identified risks were highlighted to ensure staff were aware of concerns. People’s independence was promoted through positive risk management. People received their medicines as prescribed.

People received effective care from staff. The provider was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. Staff were aware of how the Mental Capacity Act 2005 was relevant to their role and applied the guiding principles through choice and enablement.

There were systems that ensured staff received induction, supervision and appraisal to support them in their roles. People were supported to eat and drink sufficient amounts and were actively involved in the choosing and cooking of food. People had access to healthcare professionals and services when needed. The GP for the service spoke highly of the care provided.

People commented that staff were caring and we made observations of staff interactions with people to support this. Staff support to people was kind and caring and staff evidently knew people well. Staff were able to tell us about people’s individual current and historical healthcare concerns. People had individualised rooms and there was a positive social atmosphere in the service. People’s care records were personalised and showed information about people’s choices and preferences. People had an allocated keyworker and there were activities for people to be involved in.

It was evident from our observations that people knew the provider well. Staff did not raise any concerns about the leadership at the service and positive feedback had been received from healthcare professionals. There were some effective governance systems in operation and there were systems to communicate with staff. Feedback about the service was sought from people, their relatives and staff through annual surveys.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we saw the provider had taken steps to address some of the concerns raised, but progress had been slow and not to the required standards. People were not being cared for in a clean and hygienic environment. We found the building continued to be in a poor state of repair and lacked robust maintenance plans.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. The provider had not taken steps to provide care in an environment that is suitably designed and adequately maintained.

A senior member of staff showed us around the home and pointed out areas where work had begun in order to meet required standards. Although work had been started in several areas of concern, only one area had been completed. Therefore, not all the expected improvements had been made.

Below is a summary of what we found. The summary describes what we observed and records we looked at.

Is the service safe?

While we acknowledged the provider had begun to address the areas that required improvement, not all areas identified had been completed. We found evidence of poor practice procedures being carried out which meant standards of infection control were inadequate.

We found areas of the home required improvements to ensure people's safety and well-being. Therefore, we decided to include Outcome 10 Regulation 15 in this inspection. We have asked the provider to tell us what they are going to do to meet the regulations in relation to the safety and suitability of the premises.

Is the service effective?

We found suitable robust and effective maintenance plans were not in place. Due to the state of the building throughout, cleaning schedules may not be able to be effectively implemented. This meant people's safety and well-being was at risk.

At the time of our inspection there were nine people living in the home. We made observations of how staff interacted with people that used the service and examined the care documentation that was in place to support people. We spoke with five people living in the home and we spoke with four members of staff.

Below is a summary of what we found.

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

Is it safe?

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff received safeguarding training and knew who they needed to contact should they have any concerns around people's welfare. People living in the home told us they felt safe living in the home and told us if they had any concerns they would tell the manager or their key worker. One person told us 'yes it's lovely I do feel safe all the day'. People who used the service were cared for by staff who knew how to protect them from the risk of abuse.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The provider confirmed no one currently living in the home was subject to such an application. However staff had been trained to understand when an application may be required. The provider told us staff meetings were used to remind staff of the process and scenario discussions were held. This meant that people will be safeguarded as required.

We saw that incidents/accidents were regularly audited by the provider. This reduces the risks to people and helps the service to continually improve people's safety.

The service was safe, however not all areas of the home were clean and hygienic. Robust infection control guidelines had not been followed as the maintenance and cleaning schedules were not effective. This could put people at risk of harm of cross infection.

Is it caring?

People were supported by sensitive and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal area observing interactions between staff and people that used the service. The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs. Staff sat with people to have lunch which was a relaxed and communicative dining experience. People told us they were consulted before staff undertook their care routines.

People's preferences, interests, likes and dislikes had been recorded and in a format that supported their individual needs.

Is it effective?

We found people's health and care needs were assessed with them and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need. Pictorial documentation was used that ensure people could participate fully.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People had signed their documentation and demonstrated their involvement. People told us their keyworker met with them on a monthly basis.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is it responsive?

People's needs had been assessed before they moved into the service. Multidisciplinary assessments were undertaken that involved the social work teams. The registered manager told us people met with their key workers monthly to discuss their care plans and relatives were involved as people required and agreed by the person.

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people's files held information and advice sought from the community learning disability team (CLDT) that supported people's changing needs.

Is it well-led?

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. The provider told us if any concerns were raised these would be addressed promptly. People were asked what they liked about Robleaze House. Comments included: 'Staff, food and day care'. 'It's very nice'. 'I like listening to music, I like most of the other people and I like my room, it's nice' , 'Watching T.V, the food' , 'Going trampoline and gateway club '. 'The staff".

People we spoke with were able to tell us their experience. They confirmed they felt listened to by staff and knew how to raise a complaint if they needed to.

The owner provider was also the day to day manager. A stable staff team was in place that provided a consistent level of care to all people living in the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to Infection Control. We are awaiting further clarity on this.

People we spoke with were able to verbally tell us about the care they received and if they were happy. People appeared happy and relaxed in the company of the staff and were seen to be engaged in discussions about the day's activities ahead. Staff were observed supporting people in a sensitive and inclusive manner.

We looked at people's personal care files to see if their care assessment documentation met their needs. We spoke with eight people who used the service and three members of staff during our inspection.

We received positive comments from people living in the home. People told us how staff supported them to be as independent as possible. People's comments included; 'I like it here people are nice I go on holiday'. 'I work in a charity shop. It's nice and quiet here'. 'I'm happy here my brother comes to visit'.

Staff we spoke with told us 'we get people involved in their lives. They make the choices and we support them'. Another member of staff told us 'it doesn't really feel like work, it's not rigid we can be creative'.

On the day of our inspection there were nine people living in the home. During our inspection we looked at the care records of people who use the service, and spoke with people living in the home to gain their views and feelings about the service. We also spoke with staff who were on duty that day.

People we spoke with were happy with the service at Robleaze house. Comments included; "I like the staff, I feel great, I'm settled here", " we have lots to do, I go to trampolining with X". Another person told us how they regularly spend time with their key worker, to discuss what they may like to do, and told us 'I like my key worker ".

We spoke with seven people living in the home. People we spoke with were able to discuss their life at the home, and what they enjoyed about living there. People said that they appreciated having their own space, and being able to choose what they wanted to do, one person told us "I really like going out and I do my own washing".

Two people who use the service told us that they were included in decisions about their care. For example, one person told us"I can choose what activities I like to do, and staff help me cook, I'm good at cooking!" Another person told us that they helped to make cakes for people.

All the people we spoke with told us they felt safe living in the home and would tell a member of staff if at any time if they didn't. People also told us, the food was "good".