This inspection took place on 8 October 2018 and was unannounced.

Roxburgh House Care Home is a residential ‘care home’ in the Bootle area of Liverpool. Roxburgh House provides accommodation and personal care for up to 38 older people, including people living with dementia. The single storey building is separated into two areas: a 23 bed residential unit; and a 15 bed unit for people living with dementia. During the inspection, there were 37 people living in the home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there was a registered manager in post. 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in September 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Roxburgh House was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection we found that the registered provider was in breach of regulation in relation to ‘Safe care and treatment’. This was because people were exposed to unnecessary environmental risks and the delivery of care and support was not always safely managed. We identified a number of concerns in relation to the temperatures of radiators, fire doors, internal lighting and health and safety compliance. During this inspection we found that improvements had been made.

At the last inspection we found that local audit and governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the quality assurance systems, audits and checks which were in place and found that improvements had been made.

People’s level of risk was assessed from the outset. Care plans outlined the support people required and risk assessments identified the different support measures that needed to be implemented. Risk assessments were regularly reviewed and records contained up to date and relevant information.

Medication management systems and processes were safely in place. People only received support with their medications by staff who had completed the appropriate medication administration training and regularly had their competency assessed. Medication was stored appropriately and medication audits were routinely taking place.

We checked that there were sufficient numbers of staff supporting people who were living at Roxburgh House. Staff were visible throughout the inspection and were responsive to people’s needs in a timely and supportive manner. We received positive feedback from people, relatives and staff about the staffing levels at the home.

Recruitment was safely managed. The registered provider ensured that the necessary recruitment checks were carried out and people only received support by staff who were suitable to work in a health and social care environment. We found suitable Disclosure and Barring System checks (DBS) in place and appropriate references had been sought prior to employment commencing.

People and relatives told us that the service was safe. Staff w

This inspection took place on 26 September and 2 October 2017 and was unannounced.

Roxburgh House Care Home is a residential care home in the Bootle area of Liverpool. The service offers accommodation and support for up to 38 people. The single storey building is separated into two areas: a 23 bed residential unit; and a 15 bed unit for people living with dementia. During the inspection, there were 38 people living in the home.

We looked at how the registered manager and provider ensured the quality and safety of the service provided. The registered manager told us that the provider visited the service every month. We saw that audits completed did not highlight the concerns that we identified during the inspection. This meant that systems in place to monitor the quality and safety of the service were not effective.

A registered manager was in post. 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. Feedback regarding the management of the service was positive.

We saw that the environment was not always safely maintained. Not all radiator covers were securely attached to the wall, two radiator covers were extremely hot to the touch and people were at risk of sustaining a burn if they were to lean on the covers or fall against them. Not all fire doors were held open safely and a number of doors did not close securely within the frames. This meant that people would not be protected from harm in the event of a fire. We also noted that there was not adequate lighting in one corridor within the home.

Although external contracts were in place to help ensure the safety of the building and its equipment, we saw that they were not all in date. The registered manager was aware and had already taken action to address this.

Personnel files contained evidence of safe recruitment practices.

People told us they felt safe living in Roxburgh House. Staff were knowledgeable regarding safeguarding and how to report concerns. We found that there were sufficient numbers of staff on duty to meet people’s needs in a timely way.

We saw that medicines were managed safely within the home. Staff completed training and had their competency assessed to ensure they were able to administer medicines safely.

Records showed that applications to deprive people of their liberty had been made appropriately.

Staff told us they always asked for people’s consent before providing care and we observed this during the visit. When people were unable to provide consent, mental capacity assessments were completed in line with the principles of the Mental Capacity Act 2005 and decisions were made in people’s best interest.

Staff told us they were well supported and records showed that staff received a comprehensive induction, regular supervision an annual appraisal and regular training to support them in their role.

People living in Roxburgh House were supported by the staff and external health care professionals to maintain their health and wellbeing. Visiting healthcare professionals told us that they received appropriate referrals from the staff and that care they recommended was always carried out.

Feedback regarding the meals available was positive. People told us they had enough to eat and drink and that they enjoyed their meals. Staff knew and met people’s dietary needs and preferences.

People living at the home told us staff were kind and caring and treated them with respect. Interactions between staff and people living in the home were familiar, warm and supportive. It was clear that staff knew people well and interacted with them in a way that best met their needs.

Throughout the inspection we observed people’s dignity and privacy being respected by staff. We