About the service:

Roxburgh House (West Midlands) is a residential home that is registered to provide care and accommodation for a maximum of 44 people who do not require nursing care. People using the service are older people and younger adults, some with Dementia. 40 People were using the service at the time of the inspection.

People’s experience of using this service:

People were supported by staff to remain safe. There were enough staff available to people and people’s needs were attended to in a timely manner. Risk assessments were in place to minimise any potential risk to people’s wellbeing. Staff were recruited in a safe way. People received their medicines as expected.

People felt that staff assisting them knew their needs. Staff received regular supervision and training and had been provided with an induction. Meals were nutritious and people were kept hydrated. People were supported to maintain their health.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. Complaints were dealt with appropriately in line with the complaints procedure. People participated in activities that were tailored to their needs. End of life plans were in place and acknowledged by staff.

Quality monitoring systems included audits, checks on staff practice and checks on people’s satisfaction with the service they received, using questionnaires. The provider had systems in place to ensure they kept up to date with developments in the sector and changes in the law. People knew the registered manager and felt they were visible around the home and were approachable.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires Improvement’ with our last report published on 30 December 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. At the last inspection the key questions around Safe, Effective and Well led were rated ‘requires improvement’. This was due to concerns around medicines not always given as prescribed. Lack of staff knowledge around Mental Capacity and Deprivation of Liberty Safeguards (DoLS) and fire procedures and some audits not identifying issues. At this inspection we found that these issues had been resolved.

Enforcement:

No enforcement action was required.

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.

This inspection took place on 26 October 2017 and was an unannounced inspection. The last inspection of Roxburgh House took place in May 2016 and was rated Good across all five key questions.

Roxburgh House provides accommodation for up to 44 older people who require personal care. At the time of our inspection, there were 38 people living at the home. The home was divided into two units; Residential and Lenches. The Residential unit was for people who required residential care, and Lenches was specifically for people who had a diagnosis of Dementia.

There was a manager registered with us. 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.

People were supported by staff who knew how to report concerns of abuse and were able to manage risks to keep people safe. There were sufficient numbers of staff available for people and staff had been recruited safely. Staff gave people their medication in a safe way but we could not evidence that all medication had been given as required due to shortfalls in recording.

People felt staff were well trained and staff reported that they received appropriate training and supervision to support people effectively. Mealtimes were a pleasant experience for people and access to healthcare services was available if required. Staff understanding of DoLS was variable. Staff established consent from people before providing care.

People were supported by staff who were kind, caring and treated them with dignity. People were supported to maintain their independence and relationships with people closest to them. Advocacy services were available to people if required.

People and their relatives were involved in the assessment and review of their care. Staff knew people’s needs well and had regards for their preferences. Activities were available for people and where complaints had been made, these were investigated and responded too.

People spoke positively about the leadership at the home. People, relatives and staff had opportunity to provide feedback on the service to the registered manager and action had been taken in response to this. Audits were completed to monitor the quality of the service and where areas for improvement were identified, these were acted upon.

Roxburgh House is registered to provide accommodation and personal care for up to 44 people, who were older people who may experience dementia. At the time of our inspection 39 people were using the service. Our inspection was unannounced and took place on 12 May 2016. The service was last inspected on the 05 November 2013 where we found that the provider was meeting all of the standards.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given appropriately and the recording of their distribution was clear and concise. They were kept and disposed of as they should be. People’s long term health needs were addressed and people saw medical professionals when they needed to. People received adequate food and drink.

There were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe. People were able to raise any concerns they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and their consent was sought before any care was carried out. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place. Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective. Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

On the day of our inspection there were thirty eight people living at Roxburgh House. Most of the people were up sitting chatting, watching TV or participating in an exercise session facilitated by the activity organiser. Some people were getting ready for the mini bus to take them out to a coffee morning.

We spoke to five of the people who told us “I like my meals”, “they look after us so well”, “it is lovely here”, “I am quite happy”. The people we spoke to were all very positive about the care and support they received at Roxburgh House.

There were many cards and letters of appreciation to the staff from relatives of the people who lived at the home displayed in the reception area.

We were shown around the building by the registered manager. We saw that the home was very clean and hygienic. All the rooms were furnished and decorated to a high standard. The bedrooms were all well-furnished to meet the needs of the individual. The bathroom and toilet facilities were well equipped and modern. The two main lounge areas were light and spacious. We noted people had comfortable chairs which met their individual needs. The registered manager told us the provider organisation had carried out a refurbishment programme which was on going.

We observed staff supported people in a friendly and polite manner. The staff showed the people respect and ensured their dignity was maintained. We observed the lunch being served and the staff spent time supporting people who needed assistance.

We spoke to three members of staff during our visit. One member of staff we spoke with said “we spend time with people to build up relationships”. Another said “We ensure their dignity is maintained, we want them to be involved in their own care and remain the people they were before they came into care”. Staff said they liked to lift people’s spirits and make them laugh. Another told us everyone in the team were important from the domestic team to the manager.

All the staff we spoke to said the provider organisation believed in putting the needs of the people first and they felt this was true.

We spoke with the registered manager and four members of staff. We saw evidence that people were cared for by staff who were supported to deliver care safely and to an appropriate standard.

We carried out this review of compliance in response to concerns about residents with pressure sores that we received from Sandwell Social Services. The concerns had initially been raised by the provider’s Quality Assurance Manager. Following this the provider stated they implemented additional support.

We spoke with three people who lived at Roxburgh House. We spoke with four relatives of people that used the service as the residents we also spoke to could not express their views clearly. We also spoke to three members of staff.

People told us that the “staff look after me” and that “everything” was nice at the home.

People who we spoke with told us that they were happy with the care they received and had no concerns.

People told us that the meals were “nice” and that “everything was tasty”.

One relative told us that they had not been involved in the care as another family member was already involved but their relative received “very good care”.

Relatives told us that staff were “brilliant” and “very good, very polite”. Relatives also told us that their relatives were receiving the right care and felt that “staff know what to do”.

One relative told us that if their relative “needs help, just ask for it and staff are right there. Their privacy is handled very well”.

Another relative told us that their relative’s bedroom was “delightful” and that the home was “beautiful, never had any doubts” (about placing relative in Roxburgh House).

Relatives told us that they were made to feel welcome and were offered refreshments upon arrival. One relative told us that they were offered lunch due to the distance they had travelled.

One relative told us that sometimes had a meal and was “very satisfied” with the quality of the food. Relatives told us that people “have choice” and that the meals were good.

Relatives told us that they had no concerns about the care being received by their relatives but knew how to raise these if they had any.