Archived: Roby House Care Centre

Roby House Care Home provides accommodation, personal and nursing care for up to 55 people in one adapted building over two floors with lift access to the upper floor. At the time of our inspection 53 people were living at the service.

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

Risk to people’s safety was not always assessed and managed. Some people did not have access to a nurse call bell and others did not have the ability to operate one, however measures were not taken to identify and mitigate risk.

We were not fully assured that Infection prevention and control measures were followed to minimise the risk of the spread of infection. Equipment used to support people and some carpets and furnishing were dirty and unhygienic. Cleaning schedules for equipment had not been followed and daily checks failed to identify and mitigate the risk of the spread of infection.

We have made a recommendation about staffing. People were kept safe by the right amount of staff; however, the deployment of staff was not always effective to fully meet people’s needs.

Medicines were managed safely. Staff with responsibilities for managing medicines were suitably trained and competent.

The recruitment of staff was safe. A range of pre- employment checks were carried out to assess applicants fitness and suitability for the role.

Managers and staff understood their responsibilities for protecting people from the risk of harm and abuse. Allegations of abuse were well managed. People told us they felt safe and staff treated them well.

Checks on the quality and safety of the service were not always effective in identifying and mitigating risk. Some required checks had not taken place and others failed to pick up on areas for improvement.

Care was planned in a way that promoted person-centred care, however the delivery of care was not always person-centred which impacted on the quality of care people received.

People, their representatives and staff were involved and engaged and there was good partnership working with others. Information about events and changes to the service was shared with relevant others in a timely way.

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 good (published 19 October 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roby House Care Centre on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people’s safety. 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.

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 improvement. Please see the safe and well-led sections of this full report.

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

People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People told us they felt safe living at the service and family members were confident that their relative was kept safe. Medication was managed safely and people received all their prescribed medication on time. Risks people faced were identified and measures put in place to minimise the risk of harm occurring. People were protected from the risk of the spread of infection because staff followed good infection control practices. The premises and equipment were well maintained, they were kept clean and underwent regular safety checks. People’s needs were met by the right amount of staff who were suitably skilled and experienced.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent at what they did. People received the right care and support to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy and dignity particularly when providing intimate personal care. Staff used techniques to help relax people with positive outcomes. Staff had formed positive relationships with people and their family members. Family members and other visitors to the service were made to feel welcome and offered refreshments.

People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the registered manager as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service. Effective systems were followed to check on the quality and safety of the service which lead to improvements being made.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published 15 July 2017)

About the service:

Roby House is a residential care home that provides personal and nursing care for up to 55 people, some of whom are living with dementia. At the time of the inspection 52 people lived in the service.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and that the service has improved to good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Roby House Centre is registered to provide nursing care for 55 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 47 people using the service at the time of this inspection.

There was no registered manager in post at the time of this inspection visit. 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. A new manager had been appointed since the last inspection and was in the process of applying to CQC to become the registered manager.

At the last inspection on 29 September and 04 October 2016 we asked the registered provider to take action to make improvements to the safety and hygiene of the premises and equipment, management of medicines, safeguarding people, planning people’s care, dignity and respect, leadership of the service and monitoring the quality and safety of the service. We received an action plan which showed all actions would be completed by 31 January 2017. At this inspection we found that the actions had been completed.

Improvements had been made regarding the safety of the premises and equipment. Dedicated rooms had been identified and were in use to store equipment when it was not in use. This included equipment which people needed to help with their mobility such as hoists, stand aids and wheelchairs. There was a system in place for the prompt removal of equipment from the premises which was no longer needed such as beds and mattresses. Fire exits and corridors were kept free from obstructions and easily accessible to people. Storage rooms containing cleaning equipment and substances were kept locked when not in use to protect people from the hazards associated with them. The right amount of staff assisted people with transfers by use of appropriate equipment which was used safely.

Improvements had been made to the cleanliness of the environment and infection prevention and control procedures. Cleaning schedules had been developed and were being followed across the service. Staff followed safe infection prevention and control procedures to minimise the spread of infection. They used personal protective equipment (PPE) appropriately such as disposable gloves and aprons and disposed of clinical and non-clinical waste in appropriate bins provided.

Improvements had been made to safeguard people from abuse and any allegation of abuse. Safeguarding procedures set out by the registered provider and the relevant local authorities for responding to allegations of abuse were in place and correctly followed. Allegations of abuse brought to the attention of the manager had been raised with the relevant agency for investigation. Discussion with the manager and records showed that prompt action was taken to safeguard people from any further allegations of abuse. The manager worked positively with other agencies to make sure people were safeguarded from abuse.

Improvements had been made to staffing. The deployment of staff aimed to ensure that people were safe at all times. There were staff present at all times in communal areas which people occupied. People who were being nursed in bed and those who chose to spend time in their bedrooms received regular visits from staff to check on their safety and wellbeing.

Improvements had been made to meeting people’s needs. Care plans had instructions and guidance for staff about how best to meet people’s needs, including how and when to monitor aspects of people’s care. Care records showed that people had received the care and support they needed at the right time. Supplementary records in use to monitor aspects of people’s care were completed with all the relevant information and at the correct intervals. This included records about fluid intake, positional changes and pressure mattresses settings.

Improvements had been made to the way people were treated. Staff made eye contact when speaking with people and they listened carefully to what people had to say. Staff took time to explain things to people and they spoke respectfully with and about people. People’s meal time experience had improved. People were given a choice of food and drink and mealtimes were unrushed. However people were not given an apology or an explanation about a long delay with the lunch time meal on the first day of the inspection.

Improvements had been made to how complaints and concerns were dealt with. People and family members felt more confident about raising a complaint and being listened to. A record was maintained of all complaints made since the last inspection. These showed that complaints were acknowledged, investigated and responded to in a timely way. The records also showed that lessons were learned following complaints made.

Improvements had been made to activities for people. Since the last inspection a member of staff had been employed to support people with activities. People and family members told us that there were a lot more opportunities to get involved in activities both at the service and in the local community. People felt more stimulated and engaged in things they enjoyed.

Improvements had been made to the way the service was managed. A new manager had been appointed at the service since the last inspection. People, family members and staff told us they had more confidence in the leadership of the service. They said they had seen lots of improvements, and used terms such as approachable, supportive, fair and engaging when describing the new manager.

Improvements had been made to mitigate risks to people and make improvements to the service people received. Quality monitoring and safety checks on aspects of the service were carried out as required, and any risks to people’s health, safety and welfare were identified and acted upon.

We have made a recommendation about the environment. There was a lack of signage and items of stimulus around the service to aid the orientation and provide stimulation for people living with dementia. Some people’s names were not displayed on their bedroom doors and memory boxes were not used to help people identify their rooms.

The registered provider had a safe procedure for recruiting new staff. Staff had completed an application form detailing their qualifications, skills and experience and they underwent a series of pre-employment checks to assess their suitability for the job.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the time of the inspection, there was no registered manager in place. 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.

Since the last inspection in September and October 2016 the previous registered manager resigned from their post and a new manager had recently been appointed and is expected to take up their position early in January 2017. In the interim the service was being managed by a team of experienced managers within the organisation.

People told us that they felt safe and that their bedrooms were comfortable and kept clean. They told us that they had always received their medication on time and that staff made sure that they took them. The environment smelt fresh and was clean and tidy and free from hazards.

Checks on the environment and the quality of the care people received were carried out each day. Any findings which posed a risk to people's health and safety were actioned in a timely way to ensure people's safety. Concerns which were raised about people's safety and the quality of the care they received were listened to and promptly actioned.

Roby House Centre is registered to provide nursing care for 55 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 47 people using the service at the time of this inspection.

A registered manager was in post at the time of this inspection visit. 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.

We carried out an unannounced comprehensive inspection of this service on 21 March 2016 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements, which included planning people’s care, dignity and respect for people, infection control practices, management of medicines and quality monitoring systems. We received an action plan which showed all actions would be completed by 31 April 2016. However, at this inspection we found that the registered provider had not met the legal requirements and we found further breaches of the Health and Social Care Act 2008.

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.

Since the inspection in March 2016 we received concerns from members of the public, Healthwatch and Commissioners in relation to staffing, care and welfare and the leadership of the service. We looked into those concerns as part of this inspection.

The storage of equipment put people at risk of trips and falls. Mobility equipment such as hoists and wheelchairs were left in lounges near to where people were sat, on corridors and in communal bathrooms. Other equipment such as mobile weighing scales, dismantled beds and mattresses were also stored on corridors. The door to a store room on a corridor near to people’s bedrooms was left open despite it being packed with dismantled beds and mattresses and other unused equipment and boxes.

Allegations of abuse were not acted upon to ensure people were safe from abuse or the risk of abuse. The procedures set out by the registered provider and the local authorities for responding to allegations of abuse were not followed. Allegations of abuse brought to the attention of the registered manager were not raised with the relevant agency for investigation. These concerns were raised immediately with a senior manager who took prompt action to ensure people’s safety.

There were sufficient numbers of staff to keep people safe however how staff were deployed did not ensure people’s safety. Staff left the building in groups of up to four at a time to have a cigarette break, leaving people unattended to. Staff also carried out tasks which were not relevant to their role and during this time people were left unsupervised in other parts of the service.

People did not always receive the care and support to meet their needs. One person did not receive personal care as set out in their care plan. There was a lack of information about people needs contained in supplementary care records such as fluid intake and positional change charts, which put people at risk of not receiving the right care and support. Pressure mattresses which people had in place to reduce the risk of developing pressure ulcers were incorrectly set. In addition the amount of fluid people were required to consume in a 24 hour period to maintain appropriate hydration levels was not recorded on their fluid intake charts.

People were not always treated with dignity and respect. Terms used by staff when talking about people were not respectful, for example staff used terms such as she, feeds and double ups. People were left sat for over an hour in damp and stained tabards after being assisted with their meal. Mealtimes were not a positive experience for people and they were disruptive. Staff plated up meals with their backs to people and they carried out tasks such as washing dishes whilst people were eating. Staff served meals to people without checking that the choice of meal was suitable.

Complaints and concerns were not dealt with in line with the registered provider policy and procedure. Prior to and during our inspection we were made aware of a number of complaints which were raised with the registered manager, however there were no records detailing the complaints and the complainants told us that they had not received acknowledgement or an outcome of their complaint. Family members told us they had given up complaining because of the lack of response and that they felt it was a waste of time complaining because nothing was done.

People were not provided with opportunities to take part in activities and there was a lack of stimulation for people. An activities coordinator was employed at the service, however they were given other responsibilities which included assisting people at meal times and cleaning and preparing dining rooms. They said they had little time to organise and facilitate activities for people due to the other tasks required of them.

Throughout both days of our inspection people occupying lounges were either asleep or watching TV. Staff presence in communal areas was minimal and we noted little meaningful contact between staff and people who used the service. Whilst attending to people staff made little or no conversation with them about what they were doing or to give reassurance. On the first day of our inspection a group of people were left sat unattended for a long period of time in a darkened lounge watching a blank television screen after a film which staff had put on had finished.

Family members told us they lacked confidence in the leadership of the service and they described the registered manager as unapproachable and unsupportive. There was a lack of action taken to mitigate risks to people and make improvements to the service people received. Despite us receiving an action plan which detailed improvements made following the last inspection in March 2016 we found ongoing and new concerns. Quality monitoring checks on aspects of the service had not been carried out as required or they had failed to identify risks to people’s health, safety and welfare. This included a lack of robust checks on the safety of the environment, staff practice and the maintenance and security of records in relation to people’s care.

The registered provider had a safe procedure for recruiting new staff. Staff had completed an application form detailing their qualifications, skills and experience and they underwent a series of pre-employment checks to assess their suitability for the job.

Prompt action was taken by the registered provider to safeguard people and mitigate risks to them in response to the concerns which we fedback following both days of our inspection. Since the inspection we have also received details of arrangements which had been put in place to strengthen the overall management and leadership of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Roby House Nursing Centre is registered to provide nursing care for up to 60 people. The service is located in the Huyton area of Liverpool, close to local shops and road links.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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.

The last inspection of the service was carried out in October 2013 and we found that the service was meeting all the regulations that were assessed.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s health and safety was put at risk because parts of the environment were unhygienic and unsafe. There was a build-up of dirt, dust and food debris in a kitchenette and dining room on the first floor. Also furniture and carpets in a lounge on the first floor were heavily stained and there was a build-up of dust and dirt around window ledges and skirting boards. A sluice room and the medication room on the first floor were cluttered and unclean with dust and stains from spillages. Items of equipment stored in communal bathrooms posed a trip hazard to people because they obstructed their access to toilets and sinks. Staff removed the equipment after we raised our concerns with them.

Medication was not always managed safely. An unlocked trolley containing people’s medication was left unsupervised on a corridor outside the dining room and medication administration records (MARs) were signed in advance of people receiving their medication. Medication details and instruction for use which had been handwritten onto MAR sheets were not signed by a second member of staff to check the accuracy of the record.

The condition of the environment and mealtime experiences undermined people’s dignity. People were left sitting at dining tables for more than 30 minutes prior to their meal being served and during that time staff did not engage with people to inform them that their meal would be late and the reason why. People’s leftover meals were disposed of in an undignified way and their living environment was not maintained to a satisfactory standard.

There were limited opportunities for people to engage in meaningful activities at the service. The activities coordinator had been absent from work for some time and no interim arrangements had been made to replace them. Care staff felt they had little time to socialise with people because they were too busy with other tasks. People commented that they spent most of their time watching TV because there was little else for them to do.

The registered provider had implemented a quality assurance system with clear guidance about how to use it. However, the checks and audits which were carried out at the service failed to identify and risks to people’s health and safety and improvements which were required to the service people received.

We have made a recommendation about staff supervision. Staff had not received formal supervision in line with the registered provider’s staff supervision policy and procedure. This meant staff lacked the opportunity to take part in one to one discussions with their line manager about their work and training and development needs.

People who used the service were safeguarded from abuse and potential abuse because the registered provider had taken steps to minimise the risk of abuse. Staff had completed safeguarding training and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. They recognised the different types and indicators of abuse and were confident about reporting any concerns they had.

Procedures were in place for responding to emergencies and staff were familiar with them and confident about following them through. A personal evacuation plan (PEEP) which was developed for each person who used the service provided staff with specific information about how to ensure people’s safety during an evacuation of the service.

People were cared for and supported by the right amount of suitably qualified staff. The process for recruiting staff included a range of checks which were carried out to check applicants’ suitability and character prior to them commencing work at the service.

Staff received the training they needed for their job. New staff completed an induction programme and all staff received on going training relevant to their role, responsibilities and the needs of the people they supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

Staff worked together as a team and with other professionals including GPs, McMillan Nurses and other specialist teams to help to provide the highest standard of care possible for people at end of life and their families. People were given the opportunity to express their wishes regarding their care at end of life and an appropriate care plan was put in place for this.

People were well supported to access a range of healthcare professionals as appropriate to their individual needs. People’s health and wellbeing was monitored to ensure they remained healthy and well and staff quickly recognised any health concerns and sought appropriate advice.

We looked at how medication was managed at Roby House Care Home and found appropriate arrangements for the handling and administration of all medicines which ensured the safety of all people using services. We observed records were all up to date and clearly documented which meant it was straightforward to account for all medication used and disposed of. The provider ensured that all staff were properly supported to provide care and support to all people using services. All staff members were enabled to partake in training and development that was relevant and appropriate which ensured they carried out their role effectively. We observed evidence and heard comments that showed the provider considered complaints fully, responded appropriately and resolved, where possible, any comments or complaints received.

This service cares for people with a range of conditions and conversation with some of the residents was limited due to their complex needs. We therefore spent time in the communal areas making observations of how people were being cared for. We observed staff assisting people with personal care. We saw that staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

We spoke with one person about the care and support they received. They said they were happy living at the service and told us that the staff were "always really lovely". Another person we spoke to who had a relative living at the service told us 'I can not fault them here, they are all brilliant. I know my mum is safe here."