Archived: Roxburgh House

Updated 10 February 2023

The inspection

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. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Roxburgh House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Roxburgh House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. The service had a manager in post, and they had applied for registration, however at the time of the inspection they were not registered with the CQC. This meant the provider is 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 the 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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with five people who lived in the service and two relatives about their experience of the care provided. We observed interactions between people and staff throughout the day. We spoke with seven members of staff including the manager, deputy manager, care staff, activities co-ordinator, cook, maintenance man and trainer. We reviewed a range of records including four peoples’ care records and multiple medication records. We looked at three staff recruitment files. A variety of records relating to the management of the service were reviewed including policies, health and safety checks, meeting notes, training records and audits. 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.

Updated 10 February 2023

About the service

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.