Roxburgh House Care Home

We found the following examples of good practice:

• Staff were wearing the required personal protective equipment (PPE). They were aware of the correct process for the taking on and off of PPE, and its safe disposal in accordance with the relevant national guidance.

• A testing programme was in place to frequently test staff and people living at the home.

• The environment was clean and hygienic. Cleaning schedules were in place and cleaning was carried out frequently throughout the day, including touch point cleaning.

• Comprehensive policies, assessments and processes were in place to minimise risk during the pandemic to people living at the home and the staff team.

• The home had built a log cabin in the grounds to support families and friends to visit their loved ones. The cabin was large enough to support social distancing and included a mobile unit for hand washing and sanitising.

• There was an established and consistent staff team which meant the home had not needed to source temporary staff externally.

Roxburgh House Care Home is a residential ‘care home’ in the Bootle area of Liverpool. Roxburgh House provides accommodation and personal care for up to 38 older people, including people living with dementia. The single storey building is separated into two areas: a 23 bed residential unit; and a 15 bed unit for people living with dementia. During the inspection, there were 37 people living in the home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there was a registered manager in post. A 'registered manager' is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in September 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Roxburgh House was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection we found that the registered provider was in breach of regulation in relation to ‘Safe care and treatment’. This was because people were exposed to unnecessary environmental risks and the delivery of care and support was not always safely managed. We identified a number of concerns in relation to the temperatures of radiators, fire doors, internal lighting and health and safety compliance. During this inspection we found that improvements had been made.

At the last inspection we found that local audit and governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the quality assurance systems, audits and checks which were in place and found that improvements had been made.

People’s level of risk was assessed from the outset. Care plans outlined the support people required and risk assessments identified the different support measures that needed to be implemented. Risk assessments were regularly reviewed and records contained up to date and relevant information.

Medication management systems and processes were safely in place. People only received support with their medications by staff who had completed the appropriate medication administration training and regularly had their competency assessed. Medication was stored appropriately and medication audits were routinely taking place.

We checked that there were sufficient numbers of staff supporting people who were living at Roxburgh House. Staff were visible throughout the inspection and were responsive to people’s needs in a timely and supportive manner. We received positive feedback from people, relatives and staff about the staffing levels at the home.

Recruitment was safely managed. The registered provider ensured that the necessary recruitment checks were carried out and people only received support by staff who were suitable to work in a health and social care environment. We found suitable Disclosure and Barring System checks (DBS) in place and appropriate references had been sought prior to employment commencing.

People and relatives told us that the service was safe. Staff were knowledgeable around the area of safeguarding and whistleblowing procedures; they knew how to report any concerns and who to report their concerns to. Staff received the necessary safeguarding training and the registered manager ensured that any safeguarding incidents were appropriately investigated.

Accident and incident processes were in place. We found that all accidents/incidents were recorded; trends were analysed on a monthly basis in order to mitigate further risk and to establish if lessons could be learnt.

Health and safety processes were in place. People lived in an environment that was safe, well-maintained and clean. The registered provider ensured routine health and safety checks were conducted and staff complied with the different health and safety procedures that needed to be followed. Staff were provided with personal protective equipment (PPE) and were observed wearing gloves and aprons during the inspection.

The registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. Consent to care and treatment was gained in line with the MCA. People living in the home were appropriately assessed, assessments were decision specific and 'best interest' processes were clear.

Staff expressed that they felt supported on a daily basis. Staff received regular supervision and were provided with training, learning and developmental opportunities. Staff received a variety of different training opportunities that enabled them to develop their skills and competencies.

People’s nutrition and hydration support needs were effectively managed. We found that appropriate referrals were made to external healthcare professionals and the guidance which was provided was incorporated within care plans.

We received positive comments about the quality and standard of food people received. There was a ‘rolling’ menu in place which meant that people could enjoy different meals on a weekly basis. The registered manager also ensured that people had the opportunity to share their likes, dislikes and preferences.

At the time of the inspection, renovations were taking place to the improve the quality and standards of the environment. Interior improvements had taken place in some parts of the home such as new flooring, carpets and décor and there was a ‘live’ action plan which indicated other renovations that were due to take place.

Staff were observed providing kind, caring and friendly support. Interactions between staff and people living in the home were warm, sincere and familiar. We received positive feedback about the care people received and how staff provided dignified and respectful care.

People were supported to remain as independent as possible. We observed staff supporting, assisting and prompting people with their day to day care needs in a dignified and person-centred manner.

‘Dignity Champions’ were in place at Roxburgh House. Dignity champions ensured that the level of dignified and respectful care was consistently promoted. Champions supported staff with their understanding, awareness and importance of providing dignified care.

Equality and diversity support needs were accommodated from the outset. People were treated equally and received care and support that was tailored around their needs, wishes and desires.

Confidential information was securely stored and in line with General Data Protection Regulation (GDPR). People’s personal information was appropriately protected and sensitive information was not unnecessarily shared with others.

People and relatives received a ‘service use’ guide from the outset. The guide provided essential information in relation to the level of care and support that could be expected.

A person-centred approach to care was evident; It was clear that staff were familiar with the people they supported and positive relationships had developed between people and staff who provided the support.

The registered provider ensured there was a complaints policy and procedure in place. People and relatives told us that they knew how to raise any concerns if they ever needed to. At the time of the inspection, no complaints were being responded to.

People were supported to participate in a range of different activities that were stimulating and engaging. We received positive feedback about the activities that were provided and informed that people were encouraged to participate in different activities on a daily basis.

People were supported with ‘End of Life Care’. The registered manager and deputy manager had completed End of Life training and staff were familiar with the dignified and sensitive manner end of life care needed to be provided.

Systems were in place to gather feedback regarding the provision of care people received. People, staff and relatives were encouraged to share their views, opinions and thoughts around the quality and safety of care people received.

We received positive feedback about the management and leadership at Roxburgh House. People felt safe in an environment that was regarded as ‘home’ and felt that their quality of care and support was a priority.

The registered manager had notified CQC of all events and incidents that occurred in the home in accordance with our statutory requirements. Ratings from the last inspection were displayed within the home as required.

Roxburgh House Care Home is a residential care home in the Bootle area of Liverpool. The service offers accommodation and support for up to 38 people. The single storey building is separated into two areas: a 23 bed residential unit; and a 15 bed unit for people living with dementia. During the inspection, there were 38 people living in the home.

We looked at how the registered manager and provider ensured the quality and safety of the service provided. The registered manager told us that the provider visited the service every month. We saw that audits completed did not highlight the concerns that we identified during the inspection. This meant that systems in place to monitor the quality and safety of the service were not effective.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Feedback regarding the management of the service was positive.

We saw that the environment was not always safely maintained. Not all radiator covers were securely attached to the wall, two radiator covers were extremely hot to the touch and people were at risk of sustaining a burn if they were to lean on the covers or fall against them. Not all fire doors were held open safely and a number of doors did not close securely within the frames. This meant that people would not be protected from harm in the event of a fire. We also noted that there was not adequate lighting in one corridor within the home.

Although external contracts were in place to help ensure the safety of the building and its equipment, we saw that they were not all in date. The registered manager was aware and had already taken action to address this.

Personnel files contained evidence of safe recruitment practices.

People told us they felt safe living in Roxburgh House. Staff were knowledgeable regarding safeguarding and how to report concerns. We found that there were sufficient numbers of staff on duty to meet people’s needs in a timely way.

We saw that medicines were managed safely within the home. Staff completed training and had their competency assessed to ensure they were able to administer medicines safely.

Records showed that applications to deprive people of their liberty had been made appropriately.

Staff told us they always asked for people’s consent before providing care and we observed this during the visit. When people were unable to provide consent, mental capacity assessments were completed in line with the principles of the Mental Capacity Act 2005 and decisions were made in people’s best interest.

Staff told us they were well supported and records showed that staff received a comprehensive induction, regular supervision an annual appraisal and regular training to support them in their role.

People living in Roxburgh House were supported by the staff and external health care professionals to maintain their health and wellbeing. Visiting healthcare professionals told us that they received appropriate referrals from the staff and that care they recommended was always carried out.

Feedback regarding the meals available was positive. People told us they had enough to eat and drink and that they enjoyed their meals. Staff knew and met people’s dietary needs and preferences.

People living at the home told us staff were kind and caring and treated them with respect. Interactions between staff and people living in the home were familiar, warm and supportive. It was clear that staff knew people well and interacted with them in a way that best met their needs.

Throughout the inspection we observed people’s dignity and privacy being respected by staff. We also found that care files containing people’s confidential information were stored securely in a locked office in order to maintain people’s privacy.

Care plans were written in a way as to promote people’s independence. We also saw that assistive technology was utilised in order to enable people to retain their independence, whilst also helping to ensure their safety.

We found that people had choice about their care and how they spend their day, such as where they ate their meals or spent time during the day.

We observed relatives visiting the home throughout both days of the inspection and we saw that staff knew them well and made them welcome when they arrived. For people who had no family or friends to represent them, contact details for a local advocacy service were available.

Most people were involved with their care plans and those people that could not recall seeing a care plan told us staff discussed their care with them or their families and that they were happy with the support that they received.

With one exception care plans we viewed were specific to the individual and provided sufficient detail to enable staff to provide care based on their needs and preferences. We also found that planned care was evidenced as provided.

Care plans also reflected people’s preferences in relation to their care and contained information regarding people’s life history. This enabled staff to provide care to people based on their preferences.

We saw activities such as colouring, singing and dancing take place. People we spoke with told us external entertainers visited the home regularly and staff put on a party each month.

Systems were in place to gather feedback regarding the service, including regular meetings and quality assurance surveys. People knew how to make a complaint if they needed to.

There was a range of policies and procedures available to help guide staff in their roles. Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

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