This inspection was carried out on 14 November 2017 and was unannounced. At their last inspection on 14 March 2017, they were found to not be meeting the standards we inspected. This was in relation to management systems and the lack of activities meet people’s needs.

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.

This inspection was carried out on 14 March 2017 and was unannounced. At their last inspection on 2 August 2016, they were found to not be meeting the standards we inspected. At this inspection we found that they were not meeting all the standards and there were still areas that required improvement. This was in relation to management systems and activities provided for people.

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.

This inspection was carried out on 2 August 2016 and was unannounced. At their last inspection on 18 and 23 April 2015 the service was found to not be meeting all the standards we inspected. This was in relation to infection control practices and security of records. We also found that staffing, restraint processes and management systems required improvement. They sent us an action plan setting out how they would make the necessary improvements. At this inspection we found that they had made sufficient improvements in relation to infection control and the security of records. However in other areas, they were not meeting all the standards. This was in relation to management of medicines, staffing, the Mental Capacity Act and Deprivation of liberty, the consistency of records about people’s needs and management systems.

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.

The inspection took place on 15 and 23 April 2015 and was unannounced. At our last inspection on 14 November 2013, the service was found to be meeting the required standards. Roebuck Nursing Home is a purpose built nursing and residential care home. It provides accommodation and personal care for up to 63 older people, some of whom live with dementia. The home is comprised of residential nursing units and a dementia care unit spread over three floors where staff look after people with varying needs and levels of dependency. At the time of our inspection there were 60 people living at the home.

There is a manager in post who has 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.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that some people had aspects of their freedoms restricted in a way that did not fully comply with the DoLS or relevant requirements of the MCA 20015.

During our inspection we found that most areas of the home were clean, well maintained and smelt fresh. However, although staff had received training in relation to hygiene and infection control, we found that some did not demonstrate a sufficiently good understanding of their roles and responsibilities in practice. People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse. However, not all staff knew how to report concerns externally.

People who lived at the home and their relatives expressed mixed views about staffing levels. We found that the effectiveness of staff deployment lacked consistency across different units at the home. In some units we saw there were sufficient numbers of staff to meet people’s needs promptly in a calm and patient way. However, in others units, particularly where people’s needs and dependency levels were greater, there were often insufficient staff to cope with the demands placed upon them.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies.

We found that people had been supported to take their medicines on time and as prescribed by staff who had been trained. People told us that potential risks to their health and well-being had been identified, discussed with them and their relatives and reduced wherever possible. The environment and equipment used, including mobility aids and safety equipment, were well maintained and kept people safe.

Staff obtained people’s consent before providing the day to day care they required. Where ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions were in place, we found that these had been made with the full involvement and consent of the people concerned or their family members.

People were positive about the skills, experience and abilities of the staff who looked after them. We found that most staff had received training and refresher updates relevant to their roles. The manager and senior staff carried out observations and competency checks in the work place which, together with regular supervision meetings with staff, enabled them to tailor training provision to staff development needs.

People expressed mixed views about the standard and choice of food provided at the home. We saw that the meals served were hot and that people were regularly offered drinks. Fresh fruit was available on dining tables and people were offered alternative menu options such as salad, sandwiches and soup. However, although care staff were familiar with people’s dietary requirements, we found that the chef who developed the menus and prepared meals was not. For example, they were unable to tell us if anyone had specific nutritional needs or were at risk of malnutrition or adverse weight gain.

People told us that their day to day health and support needs were met and they had access to health care professionals when necessary. We saw that GP’s from a local surgery attended the home regularly to review people’s care and ensure they received safe treatment that reflected their changing needs and personal circumstances.

We saw that people were looked after in a kind and compassionate way by staff who knew them and their relatives well. Information about local advocacy services was available for people who wished to obtain independent advice. We found that staff had developed positive and caring relationships with the people they looked after. They provided help and assistance when required in a patient, calm and reassuring way that best suited people’s individual needs.

However, people and their relatives expressed mixed views about the extent of their involvement in the planning, delivery and reviews of the care and support provided. Some people told us they had been involved but others less so. We found that the guidance and information provided to staff about people’s involvement lacked consistency across the different units at the home.

The confidentiality of information held about people’s medical and personal histories was not sufficiently maintained across the home. In every unit personal information was kept in unlocked cupboards located within insecure and frequently unattended offices which were in areas used by people and their visitors.

We found that personal care was provided in a way that promoted people’s dignity and respected their privacy. However, when we started our inspection at 7:30am we found that the majority of people’s bedroom doors were wide open. Many people were still in bed asleep, with bed clothes and night wear positioned and worn in such a way that did not always preserve people’s dignity or respect their privacy.

People told us they received personalised care that met their needs and took account of their preferences. We found that staff had taken time to get to know the people they looked after and were knowledgeable about their likes, dislikes and personal circumstances. However, we found that the guidance and information provided about people’s backgrounds and life histories was both incomplete and inconsistent in many cases.

People expressed mixed views about the opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. We saw that where complaints had been made they were recorded, investigated and the outcomes discussed with the people concerned. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way.

Everybody we spoke with was very positive about the management and leadership arrangements at the home. However, we found that the methods used to reduce risks, monitor the quality of services and drive improvement were not as effective as they could have been in all areas.

At this inspection we found the service to be in breach 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.

Our previous inspection of Roebuck Nursing Home in August 2013 found that certain minimum standards of quality and safety had not been met. People had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not always been maintained. We judged that this had a moderate impact on people who lived at the home at the time.

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.”

During our inspection of Roebuck Nursing Home on 8 August 2013, we saw evidence that staff had made every effort to identify and act on the wishes of people who lived there. One person told us, “I can do what I like and nobody tells me what to do. [It's] free and easy; just like home.”

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.

We inspected the Roebuck Nursing Home on 20 December 2012 in response to concerns we had received about infection control and wound management practices.

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.

When we visited the Roebuck Nursing Home on 28 September we found that the service respected people's individuality and involved them in the community of the home. One person said, "It's just like my home here" whilst another told us, "We are a big happy family."

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”.