About the service: Roxholm Hall Care Centre is a residential care home that. It provides personal care and support for up to 39 older people, people living with a mental health disorder or with a dementia. At the time of the inspection there were 30 people living in the service.

People’s experience of using this service:

Staff were aware of how to identify signs of abuse, reporting mechanisms and the importance of recording incidents. People had their risk of harm assessed and regularly reviewed. Care plans reflected their needs. The staffing levels were appropriate for the number of people currently living in the service.

Medicines were ordered, stored, recorded, administered and disposed of safely. The service was clean. Lessons were learnt when things went wrong.

Care needs were assessed and care plans reflected individual needs, preferences and choice. Staff had the knowledge and skills to carry out their roles effectively. People were provided with a varied, nutritious and well-balanced diet that met their needs and preferences. Special dietary needs were catered for.

There were good working practices and relationships with other professional groups and external bodies. The layout of the service met the needs of the people who lived there. Signage was suitable to individual need in word and picture format.

Staff were aware of the Mental Capacity Act. The service is compliant with deprivation of liberty safeguard legislation.

People were cared for by kind, caring and compassionate staff. People were involved in making decisions about their care. Where unable, decisions were made in their best interest. People were treated with dignity and respect.

Staff have the knowledge and skills to provide people with personalised care. Staff were aware of their individual needs. Information on making a complaint was available to people and their visitors. We saw that complaints are fully investigated and responded to in a timely manner.

People are supported to share their end of life care needs and preferences and all wishes are recorded

The registered manager was a visible leader. People, their relatives and staff reported significant improvements since the current registered manager has been appointed. People had a voice and their opinion was sought on the running of the home. Staff feel that they are listened to and suggestions on improvements to the service are acknowledged and actioned.

The service learnt from the outcomes of audits. The registered manager and their team were committed to sustaining improvements made and further developing the service.

The quality monitoring processes had improved since our last inspection. The provider was no longer in breach of regulation 17 of the health and social care act.

The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2017. More information about this is in the full report.

Rating at last inspection: Roxholm Hall Care Centre was last inspected on 04 December 2017 (report published16 February 2018) and was rated as requires improvement overall.

Why we inspected:

We asked the provider to complete an action plan at our last inspection. We wanted to see if the provider had made progress with their action plan and that the service was safe and well-led.

Follow up:

We will continue to monitor intelligence we receive about Roxholm Hall Care Centre

until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected the service on 4 December 2017. The inspection was unannounced. Roxholm Hall Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Roxholm Hall Care Centre is registered to provide accommodation and personal care for 39 people. The service can provide care for older people and for people who live with dementia and/or who have physical adaptive needs. There were 26 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 13 December 2016 the service was rated, ‘Requires Improvement’. Although there were no breaches of the regulations we found that improvements were needed to ensure that people reliably benefited from receiving safe care. This was because there were not always enough care staff on duty, medicines were not stored correctly and people had not been fully protected for having avoidable accidents. In addition, we found that people could not always access money that had been left with the service for safekeeping. Furthermore, background checks had not always been completed before new care staff were appointed.

We also found that improvements were needed to ensure that people received an effective service. This was because robust arrangements had not always been made to support people to give their consent to the care and treatment they received. In addition, we found that people who lived with dementia did not always receive responsive care if they became distressed and needed reassurance. We noted that all of our concerns had occurred because the service was not well led. In particular, the registered persons’ quality checks had not been rigorous and had not quickly addressed problems in the running of the service.

At the present inspection we found the individual concerns we had previously raised in relation to the service providing safe, effective and responsive care had been addressed. However, we also identified some further concerns that reduced the registered persons’ ability to consistently deliver safe care. We also found that there was a breach of regulations in that the registered persons could not suitably assure us that the service was well led. This was because they had not made suitable provision to involve people who lived in the service and relatives in shaping any improvements that were made. In addition, quality checks were still not being completed in the right way so that problems in the running of the service could quickly be addressed. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. Sufficient steps had not always been taken to prevent and control infection. In addition, some medicines had not been administered in the right way. Furthermore, the arrangements used to learn lessons when thing had gone wrong were not robust. However, in practice risks to people’s safety had been managed so they were supported to stay safe while their freedom was respected. In addition, people had received the support they needed if they had become distressed and were placing themselves and others at risk of harm. Also, there were suitable systems, processes and practices to safeguard people

This was an unannounced inspection carried out on 13 December 2016.

Roxholm Hall Care Centre can provide accommodation and personal care for 39 older people. It can also provide care for people who live with dementia and people who need support maintaining their mental health. There were 34 older people and people living with dementia using the service at the time of our inspection.

The service was operated by a company. There was a registered manager who was employed by the company to run the service. However, they had not been involved with the service for several months. In their absence the service was being overseen on a temporary basis by one of the company’s area managers and by an acting 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. In this report when we speak about the company in relation to its running of the service we refer to it as being, ‘the registered person’.

At an inspection on 19 November 2014 we had found that there were eight breaches of legal requirements. This was because people were not always promptly given the care they needed, medicines were not consistently managed in the right way and people were not reliably supported to eat and drink enough. In addition, we found that staff had not been provided with sufficient training and were not wholly confident about how they should safeguard people from situations in which they may experience abuse. Another problem involved people’s dignity not always being promoted. All of these issues resulted from shortfalls in the way quality checks had been completed because they had not identified and quickly addressed problems in the running of the service.

We carried out an unannounced focused inspection of the service on 24 August 2015 to check that the breaches of legal requirements had been met. We found that sufficient improvements had been made to address each of the breaches. However, we also noted that further improvements needed to be introduced. These were needed to ensure that the progress made was sustained so that people who lived in the service could reliably receive safe and consistent care.

We inspected the service again on 19 May 2016. We did this because we had received concerning information that people were not always being cared for in a safe way. We found that some of the improvements we had previously said needed to be introduced had not been sustained. The problems included shortfalls in the management of medicines and delays in the provision of care. We highlighted these issues to the registered person so that they could continue to focus upon making the necessary changes.

At the present inspection we found that medicines were not always being stored in the right way, there were not always enough staff on duty and the arrangements used to recruit new staff were not consistently robust. In addition, we noted that effective action had not consistently been taken to prevent people having avoidable accidents and care was not always provided in a way that ensured people’s legal rights were protected. A further issue involved people not always receiving the reassurance they needed when they became distressed. We also found that quality checks had not always quickly resolved problems in the running of the service and people had not fully benefited from staff acting upon good practice guidance.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse. Staff had received the training and guidance they needed and they knew how to care for people in the right way. People had been assisted to eat and drink enough and had been supported to receive all of the healthcare assistance they needed.

People we

We carried out an unannounced comprehensive inspection of this service on 24 August 2015. After that inspection we received concerns in relation to the care being unsafe and risks not been appropriately identified and managed. In addition concerns were raised that medicines had not been administered as prescribed. We also had concerns that the registered manager was not managing the home well as they had not identified these concerns. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roxholm Hall Care Centre on our website at www.cqc.org.uk.

The home provides residential care for up to 39 people who require care due to old age, living with dementia or mental health needs. It is located in the countryside four miles north of Sleaford in Lincolnshire.

There was a registered manager for the home. 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 provider had trained staff to understand when people were at risk of harm and cooperated with the local safeguarding authority to fully investigate any concerns raised. Risks to people when receiving care had been identified and care pans contained information on how to keep people safe. However, at times the information did not support staff to provide person centred care.

The provider had systems in place to assess the number of staff needed to provide safe care for people. However, at times people were left alone and care was not provided in a prompt manner. Medicines were stored and administered safely. However, care plans did not support staff to provide as required medicines in a person centred way. Staff had completed the medicine administration records but did not always fully complete other records associated with medicines.

The provider had reviewed the management structure for the home following the recent referrals to the local safeguarding authority as the management team had failed to identify concerns about the quality of care being provided. The changes made appeared to be positive, however,given the improvements had recently been made we needed assurance that these could be sustained over a period of time.

The inspection took place on 24 August 2015 and was unannounced.

The home provides residential care for up to 39 people who require care due to old age, living with dementia or mental health needs. It is located in the countryside four miles north of Sleaford in Lincolnshire. On the day of our inspection there were 34 people living at the home.

We carried out an unannounced comprehensive inspection of this service on 19 November 2014. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to safeguarding service users from harm, ensuring people received care which met their needs, providing appropriate numbers of staff with the correct skills and support to meet people’s needs, managing medicines safely, meeting people’s nutritional needs and ensuring that they gathered people’s views on the service and had effective systems to assess the quality of service provision.

There was a registered manager for the service, however, they no longer worked for the provider and a new manager was in post. The new manager had submitted an application to register with the Care Quality Commission and we asked the provider to request the registered manager cancel their registration. 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 our inspection on 24 August 2015 the provider had taken all the actions necessary to meet the legal requirements in the areas where they had breached regulations. However, time was needed to see if the systems would continue to support good quality care over time. In addition, further improvements were needed to provide person centred care which met people’s individual needs.

We saw the provider had appropriate assessments to identify where people were at risk while receiving care. Care was planned and equipment used to reduce the level of risk and keep people safe. In addition, accident and incidents had been reviewed and changes made to people’s care to prevent similar occurrences in the future. Medicines were stored and administered to people safely. However, records did not contain information needed to provide person centred support to people and medication records did not contain information about the creams people needed applying.

Staff received ongoing training which supported them to have the skills needed to care for people safely. However, staff did not always provide care according to the training they had received. Training in how to keep people safe from harm had been effective and staff knew how to raise concerns to external agencies. The manager had worked collaboratively with the local safeguarding authority to ensure people were safe from harm.

The manager had calculated the number of care workers needed to meet people’s needs and had used this information to develop rotas which included more staff at busy periods of the day. However, at times the home was not fully staffed due to sickness and this impacted on the care people received.

People were supported to have access to hot and cold drinks and appropriate equipment was provided to support them to remain independent with drinking. Staff and the cook were knowledgeable about people’s nutritional needs and ensured appropriate food was available. People had a choice of meals but could also request food not on the menu.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are 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. This is usually to protect

themselves. The registered manager was aware of their responsibilities under the Mental Capacity Act 2005. However, information on DoLS was not always recorded in people’s care files.

There was a warm and caring relationship between staff and people who lived at the home and people were supported to be involved in planning their care. Staff respected people’s privacy. However, at times people had not been supported with their dignity.

Care plans had been regularly reviewed and contained information needed to provide safe care. However, they did not always support staff to provide person centred care. There was some activities provided in the home which some people chose to join in. However, some people told us the activities did not suit their needs or support them to maintain their hobbies. The provider had recognised the need to improve activities and was working with an outside agency to improve they type of activities offered.

The manager was available and approachable and people living at the home, visitors and staff were happy to raise concerns and were confident that they would be resolved. The provider had responded to complaints in an open and transparent manner which showed they were aware of their legal responsibility to be honest with people using the service.

People living at the home, visitors, healthcare professionals and staff had been consulted about their views of the home and the manager had taken account of their views to improve the quality of care provided. There was a series of audits in place to monitor the risks to the service and quality of service provided. The manager had taken action such as informing staff of issues and providing extra training when the audits had identified concerns.

This inspection took place on 19 November 2014. This was an unannounced inspection.

The last inspection took place on 29 July 2014 and the provider was meeting the requirements of the law in the areas we look at.

The home provides residential care for 39 people who require care due to old age, dementia or mental health. It is located in the countryside four miles north of Sleaford in Lincolnshire.

There was a registered manager in place at this home. 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. However, on the day of our visit the registered manager was not available. There was a registered manager from another home the provider owned providing support and advice to people living in the home and staff. We have referred to them as the acting manager throughout the report.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report. People told us they were not happy living at the home. In addition, our own observations and the records we looked at highlighted there were concerns with the quality of service provided.

People’s safety was being compromised in a number of areas and some staff we spoke with were unaware of how to raise a concern with the local safeguarding authority. During the inspection we identified a number of concerns which we raised with external authorities. Medicines were not always administered at the appropriate time and systems for recording the administration of medicines were not completed accurately.

The acting manager was aware of the recent changes in the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and applications had been completed appropriately.

We found that people’s health care needs were assessed and care was planned to meet those needs. However, people’s care was not delivered consistently. In some cases, this either put people at risk or meant they were not having their individual care needs met. People were not always supported to drink enough fluid to meet their hydration needs.

People’s privacy and dignity was not respected and people told us staff were not always kind and caring. People did not have access to appropriate private space where they could spend time with relatives when they visited. When people became agitated and restless they were not appropriately supported and this impacted on other people living at the home.

Care was based around completing tasks and did not take account of people’s preferences. We were concerned that some people living at the home felt isolated as there were not enough meaningful activities for people either as a group or to meet their individual needs.

The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. However, some of the people told us the registered manager had not responded to concerns which had been raised with them.

Training was available for staff, however staff told us they did not have the time or resources to complete the training. Everyone we spoke with raised concerns about low staffing levels.

There was a lack of communication between the staff and the acting manager. This meant the acting manager was not aware of the issues which arose during the day of our inspection. This included a person’s room being left in an unhygienic state, people were not supported to take their medicines at the right times and no hot drinks were available to people downstairs during the morning.

We used a number of different methods to help us reach a judgement on the quality of service provision. These included talking with five people who used the service. We also spoke with the registered manager, three care staff, the cook and the laundry person. We also spoke with two visiting health care professionals.

We looked at records. These included care plans and information about how the service was managed. We conducted a tour of the building and observed the interactions between the care staff and people residing at the home.

Records we looked at showed that people’s needs had been assessed and appropriate support provided to care for their needs.

We found that people were provided with a choice of suitable and nutritious food and drinks in sufficient quantities to meet their individual needs and preferences. One person who lived at the home told us, “The food is alright mate. I like everything but there’s always a choice.”

We saw that the building was well maintained and furnished and in good decorative condition. It was light, airy and spacious and was free of any unpleasant odours.

There were sufficient numbers of suitably qualified and experienced staff that helped to ensure people who lived at Roxholm Hall received good quality, safe care.

The service was well led and managed.

We carried out an inspection of Roxholm Hall Care Centre to follow up on two areas of non-compliance identified in a previous inspection. We reviewed the evidence that demonstrated the provider's compliance in these two areas.

We spoke to the registered manager and conducted a walk around tour of parts of the building. We looked at records.

We saw that the provider had taken the appropriate measures to meet the essential standards of care for people living at Roxholm Hall.

We used a number of different methods to help us understand the experiences of some of the people who used the service. This was because they had complex needs which meant that they were not all able to tell us about their experiences.

We looked at records, including personal care plans. We spoke to the manager and staff who were supporting people, and we observed how they provided that support. We also spoke with two relatives who were visiting the home.

One person living at the home said, “It’s a really nice place to live. The girls (staff) are marvellous.”

One relative told us that, “We always find a warm welcome and we visit regularly. The care provided has been good and we have seen a change since the new manager came. She is really positive and is changing things here.”

We observed that staff provided sensitive support using special equipment when people needed help with moving safely, during meal times and when people were undertaking individual or group activities.

A person told us, “Everything is good. I am treated with respect.” They also told us they felt their privacy and dignity was respected.

Another person said, ”I do think I am treated with respect. I think there is enough respect and courtesy amongst them all.”

People we spoke with told us they were happy with their care. One person said, “I get a bath when I want one. We have got two good cleaners so my room is kept nice.”

We asked one person if they took part in any activities and they told us, “I don’t get asked about activities, they know I prefer to stay here (in my room). They have them down there (in the lounge).” Another person said, “There are activities some join in but not all.”

People said they enjoyed their meals. One person told us, “I get plenty to eat. Most of the meals are on time.”

People said staff supported them with their medication. One person said, “I have a tablet in the morning. They never forget to give me it and don’t run out. The other day I was asked if I had been given my tablet as it hadn’t been ticked off. I said yes.”

We asked people if they felt safe in the home and they told us they did. One person said, “I feel safe. There are fire alarms, safety alarms. They are always checking the fire alarms.” Another person said, “I do feel safe. They take notice and watch.”

One person told us, “I think there are enough staff around. Staff are always popping in and out.”

We asked people whether they felt staff were suitably trained for the work they do. One person told us, “They have got a few fresh ones. They are learning.” Another person said, “Seem to be all right. Seem to know what they are doing.”

One person told us, “Overall I am happy here you can say what you want.”

We did not get peoples’ views directly from them as this was a follow up visit.

People described how they felt involved in deciding the care they received and said they usually felt listened to and respected. One person told us, “They listen to me most of the time, you get the odd one who doesn’t.”

People said they felt their care and health needs were met in the way they wished them to be. They told us they feel safe and had not been put at risk. One person told us hearing the fire alarm being tested helped make them feel safe.

People told us they did not think there were always enough staff on duty but those who were there did have the training they needed. One person said, “I think they are a bit short staffed.”

People did not feel they had opportunities to comment on how the home is run. One person told us, “They used to have them (residents’ meetings) but don’t now.”

There are problems with the heating and hot water supply. At times there is no hot water and at other times the temperature is very warm. One person said, “I like the fan in the lounge, it keeps it cooler.”

The approach road is in a very poor state of repair and this is affecting people coming to visit friends and relatives in the home.

People felt happy with the care they received, but commented that staff work very hard.

People do not always have opportunities to comment on the services they receive. Some completed surveys had gone missing and one person said, “We have not had a residents’ meeting recently, we have in the past but they are rare.”