Roebuck Nursing Home

Roebuck Nursing Home is a care home providing nursing care and accommodation for up to 63 older people, including people living with dementia. At the time of the inspection there were 34 people living at the home.

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

People felt they were safe and well supported by the service. Individual risks were assessed in some cases, and staff were aware of these. However more detail was needed to ensure staff could work safely. Some practices in the home placed people at risk of harm from choking or moving and handling practice. Action was taken by the new manager at the time of our visit.

There were monitoring processes in place to help promote a good standard of service and the quality assurance systems identified some areas that needed further development. However, these systems had not identified all areas that needed to be addressed. This included risks, staffing deployments and preventing the risk of social isolation.

The manager was new to the service as had only started the day before our inspection visit, the home had recently been managed by the provider after undergoing significant changes to the management team. The provider had needed to carry out many roles to support the home until such time as the new manager started. People, relatives and staff were positive about the recent management changes and how the provider had managed to keep the service running.

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 in most cases. The policies and systems in the service did not always support this practice as mental capacity and best interest records needed to be more personalised.

People and relatives told us staff were kind, caring and praised the home for the attention they received. Staff enjoyed working for the service and told us the culture was to ensure care was person centred. Staff told us they would be happy to have a relative of theirs living at the service. Care plans included information to help support people safely in most cases. However, some of these plans needed more work to ensure they were reflective of all aspects of the person’s needs. Further checks were needed to monitor the dining experience, to ensure people did not become socially isolated and to ensure people’s dignity was promoted consistently.

Reviews of events and accidents were carried out and any actions needed were completed. Medicines were managed well, and staff knew how to report any concerns about a person’s safety or welfare. People told us staff were kind and helpful, but often busy.

Staff received training for their role and people and their relatives felt they had good knowledge and skills. Staff felt supported by the provider and management team. People told us they felt their needs were met. Relatives also felt care was to a good standard.

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 28 April 2021) This was a focused inspection only reviewing safe and well led.

Why we inspected

The inspection was prompted in part due to concerns received about people’s welfare due to the changes of management and staff in the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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.

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.

Roebuck Nursing Home is a care home providing accommodation for up to 63 older people, some of whom are living with dementia. At the time of the inspection there were 38 people living at the home.

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

People felt safe and told us the staff looked after them well. We noted staff worked safely and in accordance with people’s care plans and risk assessments. Relatives told us the registered manager and the staff team were very good. People’s safety and welfare was monitored. There was an overview of accidents and events and these were reviewed to help ensure there was not a reoccurrence. Medicines were managed safely.

People were given choices and staff knew people well. Care plans were detailed giving staff the appropriate information to meet people’s needs. People were encouraged to eat and drink well to help promote their wellbeing.

Staffing levels were appropriate to meet people’s needs and staff received training and supervision. They felt supported in their role and enjoyed working at the service. Training relating to infection control and COVID-19 had been delivered. Staff knew how to reduce the risk of transmission of COVID-19. People and relatives praised the team for the management during a difficult time.

Effective governance systems had been embedded in the home. Any events or feedback was used to improve the quality of care. There was an action plan in place to drive improvement throughout service. Feedback from people, their relatives and staff was positive about the leadership in the home and they stated it was a good place to live or work.

Rating at last inspection

The last rating for this service was Good (published 19 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the care people received. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roebuck Nursing Home on our website at www.cqc.org.uk.

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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, effective, responsive and well led to at least good. At this inspection we found that they had made the required improvements and were meeting all the standards. However, there were some areas that needed further development. This was in relation to person centred activity planning, some quality systems and obtaining people’s views.

Roebuck Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 accommodates up to 61 people in one adapted building. At the time of the inspection there were 37 people living there as one of the three floors was not in use.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People, relatives and staff were positive about the running of the home. There were systems in place to monitor the quality of the home, listen to people and value staff. However, further development was needed to involve people in the running of the home and obtain their views. There was a complaints process which people knew how to use and were confident they would be acted upon.

People were supported in a safe and appropriate way and staff knew how to recognise and report any risks to people’s safety. There were sufficient staff who were recruited safely and were well trained and supported. Medicines were administered in accordance with the prescriber’s instructions. However, records needed to be consistently maintained.

People were encouraged and supported to make choices and staff worked in accordance with the principles of the Mental Capacity Act 2005. People were treated with dignity, respect and kindness and were supported in accordance with their preferences and wishes. We found that confidentiality was promoted.

People received person centred care in relation to support needs. Further development was needed to help ensure activities always reflected people’s hobbies and interests. People and their relatives were involved in planning their care. People enjoyed a variety of food and were supported to live a healthy and balanced life.

Roebuck Nursing Home provides accommodation and nursing care for up to 63 people, including people living with dementia. At the time of the inspection there were 42 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

There had been improvements to the way people’s medicines were managed and the management had identified where there were shortfalls, however, there were still some issues ongoing. People felt safe and their individual risks were assessed and managed. Accidents and incidents were acted upon to reduce a reoccurrence. People were supported by enough staff who were recruited robustly.

People’s consent was sought but the MCA principles needed to be consistently supplied in relation to best interest decisions.

People were supported to eat and drink sufficient amounts however fluid charts were not always reviewed and the mealtime experience needed development, particularly for those living with dementia.

People were supported by staff who were trained and supervised and there was regular access to health and social care professionals.

People were treated with dignity and respect. We saw staff speak appropriately to people and treat people with kindness. People and their relatives told us that they were involved in planning their care.

Confidentiality was promoted. However, when we arrived at the service the nurse’s station was left open and records would have been accessible to those who were not authorised to have access. .

People’s care needs were met and their care plans were clear with the appropriate information to enable staff to support people and these were kept up to date. Activities needed further development to ensure more frequency and availability.

The quality assurance systems required further development to ensure they were effective. There was a new deputy manager in post who was working with the provider and registered manager to develop quality assurance systems. The ethos of the home and information about lessons learned were not always shared effectively with staff. People knew the registered manager and told us they were approachable. Staff told us that the management team were supportive.

Roebuck Nursing Home provides accommodation, care and nursing for up to 63 people, some of whom live with Dementia. At this inspection 50 people were living at the service.

The service has a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

We found that people received a good standard of care and the feedback about the staff and registered manager was positive. However, we found that the systems and processes in place were ineffective and inconsistent. This related to audits, checks and other governance systems.

People told us that staff were kind and caring. People also told us that they felt involved with the planning of their care. We found that care plans about people’s needs were incomplete in some areas, however, staff knew people’s needs well.

People and their relatives gave mixed views on staffing levels at the home. However, we saw that staffing had been raised as an issue at the last inspection and via an independent survey. We found this remained an issue, in particular on the top floor where people were living with dementia. Staffing numbers impacted on people’s mealtime experiences and the provision of activities.

People told us they felt safe and staff were aware of how to keep people safe. However, noted that medicines were not always managed safely and the system for reviewing accidents and incidents needed improvement.

Recruitment files needed reviewing to ensure that all appropriate pre-employment checks were carried out prior to staff members starting work. We saw that staff received sufficient training for their role.

People did not always have their mental capacity assessed or have best interest meetings about their needs. Although the registered manager had applied for DoLS to help ensure people were not unlawfully restrained, we saw that staff used a form of restraint to keep people safe and there was no guidance available about the least restrictive options to be used.

People felt the registered manager was approachable and would address concerns and complaints they raised. Staff were clear of their role and respected the registered manager for their firm approach to help ensure people received good care.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our inspection on 14 November 2013 we found that necessary improvements had been made.

We checked the care records relating to seven people who lived at the home. They all contained detailed and accurate information about people's care, treatment and support needs. We saw that risk assessments had been reviewed regularly and the records used to monitor the care and treatment provided were up to date and had been completed properly.

A senior member of care staff told us, 'Management have taken the records issue very seriously. We have all worked really hard to make the improvements needed and new audit systems are now used to make checks on a daily basis. Our care records have improved significantly since the last inspection.'

Care plans we looked at showed that people's needs and preferences had been assessed and documented. A relative told us, 'The care here is very personalised. They treat everyone with respect and dignity.'

The premises were safe, suitable and fit for purpose. Adequate emergency procedures had been put in place and the safety equipment we saw had been regularly checked and well maintained. People told us they liked living at the home because it was clean, in good decorative order and they had their own shower and toilet facilities.

Records showed that the provider had put effective recruitment procedures in place to ensure that staff were fit, able and properly trained to meet the needs of people who used the service. This included carrying out appropriate checks before staff began work.

A complaints policy and procedure had been put in place and we saw evidence that people's comments, feedback and suggestions had been regularly sought.

However, some of the care records we looked at had not been reviewed in line with the providers own policy and contained information that was both incomplete and out of date.

During our visit people spoke positively about the home. Ten of the 12 people living there and all five of the relatives we spoke with said they felt they had contributed to the care planning process. People spoke well of the service. One person said, "I am of the belief I have chosen the right place.' A visitor told us, 'My family and I are very happy with the care my [relative] is receiving."

We also saw that care was delivered according to people's needs that arose from their cultural or ethnic backgrounds. For instance, two people told us that staff had managed their specific skin care requirements very well.

Care was delivered in a way that ensured people were safe. Risk assessments and corresponding management plans were in place to help the staff at the home deal effectively with issues affecting their wellbeing, such as wounds or pressure sores.

The staff at the home followed a clear infection control policy and cared for people in a clean and safe environment. Hand-washing was the primary means of providing a barrier against infection at the home. Some of the disinfectant gel dispensers were found to be empty.

People's care plans and other records were generally accurate and fit for purpose. However, charts used to record when people changed position had some gaps that could not be accounted for.

We found that people's care was planned and delivered in accordance with their needs. One visitor told us, 'Nursing and care is very good ' they provide me with information about anything that happens and keep me up to date.'

People felt safe at this home. One person said, "Oh yes I feel very safe." One visitor told us that they had never worried about safety of their relative because the staff were very professional.

We saw that people were cared for a by a staff team that had received proper training for their role and that were supported by an effective supervision and appraisal regime.

The provider had an effective approach to monitoring the quality of the service they deliver and people who live there and their relatives contributed to this. One visitor we spoke with said, 'My relative takes part in resident's meetings. In my experience they do want feedback and they do listen'.