This inspection took place on 30 November and 06 December 2017. The first day was unannounced.

The last inspection of the service was carried out in March 2017 and during that inspection we found breaches of regulations in respect of infection prevention and control, management of medication, records and assessing and monitoring the quality and safety of the service. 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, caring, responsive and well-led, to at least good.

Roby Lodge 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. Roby Lodge accommodates up to 42 people in one adapted building over two floors. There were 32 people accommodated at Roby Lodge at the time of this inspection.

The service has a registered manager. 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.

Improvements had been made to minimise the risk of the spread of infection. The environment was clean and hygienic and smelt pleasant throughout. Staff followed safe practices when handling and disposing of clinical waste.

Improvements had been made to the management of medication. There was clear guidance in place for staff to follow on the use of PRN medication. PRN medication is prescribed for use when it is needed, for example for pain relief. Protocols in place for the use of PRN medication included important information such as the signs staff needed to look out for which indicated that a person needed their medication.

Improvements had been made to systems for checking on the quality and safety of the service and for making improvements. The service was assessed and monitored in line with the registered provider’s quality assurance framework. Where risks to people’s health, safety and welfare were identified action plans for improvements were developed and followed through promptly so that risks to people and others were mitigated.

Improvements had been made so that people received effective care. Care records reflected people’s needs and the care they received. Charts were in place to monitor aspects of people’s care such as fluid intake, skin integrity and weight. The charts recorded what the expected outcome was for the person, for example the amount of fluid people needed to consume in a 24 hour period and required settings for air flow mattresses.

Improvements had been made so that people’s personal belongings were treated with dignity and respect. A system had been put in place to ensure that items of unmarked clothing were promptly returned to people.

Improvements had been made to how complaints and concerns were dealt with. Complaints received were listened to and acted upon in line with the registered provider's policy and procedure. A clear record of complaints received was maintained which showed that they were acknowledged and actioned to achieve a satisfactory resolution.

We have made a recommendation about the environment. Although improvements had been made to the environment to make it more dementia friendly, further improvements were required. There was a lack of stimulus for people living with dementia, particularly for those who enjoyed keeping themselves busy around the environment.

Allegations of abuse were acted upon to ensure people were safe from abuse or the risk of abuse. People were protected by staff who knew about the different types of abuse and how to recognise indications of abuse. Allegations of abus

We visited the service on 25 and 27 January 2017 and 01 February 2017. The first day of the inspection was unannounced and the following days were announced.

Roby Lodge Care Centre is registered to provide accommodation and personal care for up to 40 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 38 people using the service at the time of this inspection.

The service had a registered manager. 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 registered manager was on a period of absence from work at the time of this inspection; however an interim management team was overseeing the day to day management of the service.

The last inspection of the service was carried out on 18 November 2014 and we found that the service was meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations. We did however ask the registered provider to make improvements to the meal time experiences for people and this action had been completed.

We found during this inspection that the registered provider was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations in relation to infection control, managing complaints and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of action taken to mitigate risks to people and make improvements to the service people received. Quality monitoring checks on aspects of the service had not always been carried out at the required intervals and when they had risks to people’s health, safety and welfare had not always been identified.

Infection control practices carried out by staff put people’s safety at risk. Soiled laundry and clinical waste was not always handled in line with good infection prevention and control procedures. Dirty laundry was left on floors and used continence aids were not disposed of correctly.

There was a lack of information contained in some people’s care records about their needs and how they should be met. In addition charts which were in place to monitor aspects of people’s care such as fluid intake and weight had not been completed when required. Not having this information meant people were at risk of receiving ineffective care and support.

The overall management of medication and associated records was safe. However some people’s protocols for medication which was prescribed to take when required (PRN) lacked information about the signs staff needed to look out for which indicated that the person needed their medication. This was actioned after we raised it with the management team.

People’s personal belongings were not always treated with dignity and respect. Items of unmarked clothing were left in the laundry for long periods of time and there was no system in place to ensure the clothing was returned to people. A system was put in place at the time of our inspection to address this.

Complaints and concerns were not dealt with in line with the registered provider's policy and procedure. Complaints raised by family members had not been acknowledged and no action had been taken to resolve them. Action was taken at the time of our inspection to address complaints made by family members.

We have made a recommendation about the environment. People were provided with opportunities to take part in activities which they found enjoyable. However the environment lacked stimulus and aids to orientate people living with dementia. Facilities were available for people to relax and spend time away from the usual day to day environment, however people got little use our of th

This was an unannounced inspection, carried out on 18 November 2014.

Roby Lodge is a purpose built care home over two floors, which provides accommodation for up to 40 people. All bedrooms have en-suite facilities. Access to the upper floor is via a passenger lift or stairs. Local shops and other amenities are a short distance away from the home and there are good public transport links close by.

The service has a registered manager. 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.

At the time of our inspection there were 38 people living at the home.

The last inspection of Roby Lodge was carried out in September 2013 and we found that the service was meeting the regulations.

Staff understood what is meant by abuse and they were aware of the different types and indicators of abuse. They knew the process for reporting any concerns they had and for ensuring people were protected from abuse. Family members told us they had no concerns about their relative’s safety. They commented; “I am not a bit worried about mums safety. They all treat her really well and give her all the care she needs and more”. And “It’s knowing that I can walk away and she is safe”.

We found that improvements were required to enhance people’s meal time experience. Some people’s food was not well presented. Staff carried out cleaning tasks around people during mealtimes and took meals ways from people without providing them with any prompting or encouragement to eat. This meant people’s mealtime experience was unsupportive and disruptive.

Staff were caring and we saw that they treated people with kindness and respect during our visit. A family member told us staff were caring towards their relative. Staff told us they would not hesitate to raise concerns and felt that they would be dealt with appropriately. Staff and family members said there was a culture at the home which allowed them to openly discuss any concerns they had.

People’s care and support needs were assessed and planned for and staff had a good level of information about how to meet people’s needs, including any risks and how they need to be managed. Care plans were regularly reviewed with the involvement of the person they were for and other important people such as family members and health and social care professionals involved in their care.

Recruitment processes were followed to ensure staff were suitable to work with vulnerable adults. There were sufficient qualified, skilled and experienced staff on duty to meet people’s needs. Staff were available when people needed them and there was always a member of staff present in the communal areas people occupied.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. People were referred onto to the appropriate service when concerns about their health or wellbeing were noted. Medication was managed safely and people received their medication as prescribed. Staff had information about how to support people with their medicines.

People who were unable to communicate verbally were understood by staff because staff had information and were knowledgeable about people’s preferred ways of communicating.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff had knowledge and an understanding of the Mental Capacity Act 2005 and their roles and responsibilities linked to this. Records we saw and discussions held with the registered manager showed how they ensured decisions were made in people’s best interests.

Staff received a good level of support which enabled them to discuss any matters, such as their work, policies and procedures and training needs. There was an on going programme of training for staff which was relevant to the work they carried out and the needs of people.

The premises were accessible, clean, safe and well maintained and staff were aware of their responsibilities for ensuring people were protected against any environmental hazards. Staff were familiar with the procedures which were in place for responding to emergencies and they were confident about dealing with an emergency situation.

The service was managed well by a person who was approachable and supportive of others. Systems were in place to check on the quality of the service and ensure improvements were made. These included regular audits on aspects of the service and obtaining people’s views and opinions about the quality of the service.

We spoke with visiting relatives of people living within the service; they gave us good feedback about their relatives care and support. People's comments included; "They do a good job." Another person told us “It's a good place."

People told us that they felt safe living at Roby Lodge and we found that staff were aware of how to identify and report potential safeguarding occurrences. During our visit we found that records relating to protecting people were sufficiently robust.

There were sufficient staff working at Roby Lodge to meet the needs of the people living there. Relatives told us they liked the staff team. Some of Their comments included, “Fantastic,” and “They do a good job.”

We used a number of different methods to help us understand the experiences of people living at Roby Lodge. This was because many of the people using the service had complex needs which meant they were not able to tell us their experiences. However during our inspection we were able to speak with two people who used the service and a relative visiting the service, we also spoke with a visiting health professional. People we spoke with told us they were happy with both the care they had received and the overall standard of care at the service. Their comments included:

“You can’t fault the staff, I couldn't ask for any more”.

“We’re well looked after here”.

"They really look after Mum, I don't have to worry".

Each of the people using the service had a care plan. The care plans we looked at were up to date and contained relevant information about the needs of the person. We found that where a need had been identified in a person's care plan then this was reflected in practice. We saw evidence that people had been consulted about their care plan and that they were in agreement with it.

People told us they felt safe living at the service and that they had been very well treated. They also said they felt confident about telling somebody if they had any concerns about the way they were treated.

Many people living at Roby Lodge were unable to directly express their views about medicines handling due to a variety of complex needs.

We found that written guidance had been put in place for care workers about the use of medicines prescribed ‘when required’ to help ensure these are used correctly, when needed.

Some people living at Roby Lodge were less able to discuss their medicines due to a variety of complex needs. But, one person we spoke with told us they were happy for care workers to look after their medicines and that that the care workers were 'very good'.

One relative said they were kept well informed about their parent’s

needs and any changes to their wellbeing. Another person told us they would like to be consulted more about their parent’s care.

One person told us the food was very good. Another said they were happy with the care provided.

One family member told us that anything they asked for was never too much trouble for staff. Another told us they thought staff did a good job and that they were sensitive in their approach. Another person told us that staff were very helpful and welcoming.

One person told us that staff were approachable. Another person told us they felt there was sufficient staff to meet the needs of residents.

A couple of people told us that the home did not have sufficient staff and that they needed more training.

One person told us: 'I take my hat off to staff. They are very capable of doing the job. I can’t speak highly enough of them. They don’t speak to people as though they are silly'.