About the service:

Roxton Nursing Home is registered to provide accommodation and personal care for up to a maximum of 45 people some of who may be living with dementia. At the time of our inspection there were 42 people living at the home.

People’s experience of using this service:

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people. Staff members followed effective infection prevention and control procedures although some pieces of equipment were due for replacement owing to wear and tear.

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors should they occur. The provider completed regular checks to ensure that people were receiving the right medicine at the right time and people’s medicines were stored correctly.

The provider had assessed risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the risk of harm to people. The provider had systems in place to respond to any additional risks to people. Staff members were aware of the necessary action they should take in the event of an emergency.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision. Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those living at Roxton Nursing Home.

People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding food and drink. The environment where people lived suited their individual needs and preferences and people freely moved around their home.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to retain their independence.

People participated in a range of activities that met their individual choices and preferences and found interesting and stimulating. People were provided with information in a way that they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

The provider, and management team, had good links with the local community which people benefited from. The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration.

More information in Detailed Findings below.

Rating at last inspection:

Good (report published 15 March 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’ The inspection was also partly prompted by concerns that had been raised with us.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This unannounced inspection took place on 17 February 2017 with a return announced visit on the 20 February. At the last inspection, the service was rated with an overall good although their recreational activities and encouraging peoples’ interests and hobbies required some improvement. At this inspection we found there had been an improvement.

Roxton Nursing Home is a residential care and nursing home providing accommodation for up to 45 people with a range of care and support needs including people living with dementia. At the time of our visit 42 people were living at the home. There are three floors to the home with the first and second floors accommodating people with more complex needs, some of whom are cared for in bed.

There was 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.

At the last inspection improvement was required for some people because they did not have sufficient group or individual social activity to prevent them from being isolated. Although there had been an overall improvement, there remained a mixture of opinions and views from people and relatives around the quality of the activities and interests being offered. We found the provider had employed permanent staff to develop activities, hobbies and interests with people. External agencies visited the home twice a week to develop exercises and musical interests and volunteers from the local community were regular visitors and spent time talking with and reading to people.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. The care plans and risk assessments were reviewed and updated regularly.

We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were safely recruited.

People received appropriate support to take their prescribed medicines and records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

We found mental capacity assessments had been completed for people who lacked the mental capacity to consent to their care and welfare. The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.

People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs changed. People and relatives told us they were involved in developing and reviewing their care

On the day of our visit there were 44 people living in the home. The provider did not know we were coming. We spoke with four relatives, three people living in the home, four staff and the manager /provider. All the people we spoke with were complimentary about their care and the staff. One relative told us, “Excellent home, care really good and staff so approachable“.

Some of the people who lived at the home had dementia and were not always able to tell us about their experiences. We spent 20 minutes in a communal area and observed how people were being care for. We saw that staff respected peoples privacy and dignity and involved them in their care.

People’s care and health care needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely. One relative told us, “Whenever I go there staff are always cheerful, and supporting people with respect”.

We saw that menus were varied and people were given a choice of what they wanted.This meant peoples nutritious needs were met. All the people spoken with told us they enjoyed their meals.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

We found that there was an effective complaints system available and comments and complaints people made were responded to appropriately.

We were not able to speak with some people because their abilities prevented them from being able to tell us what they thought about the service being provided. Those people who were able to speak with us told us that they were generally happy with the service and that the people who worked there were kind and helpful. They were generally happy with the food. Some people told us they sometimes got things they did not like.

We spoke with visitors in the home. They told us they were happy with the care being provided and that they could visit when they wanted.

We spoke with people who worked in the home. They told us that they had the information they needed to care for the people receiving a service. They were provided with training and supervision to ensure they carried out their work safely. They felt that there were always sufficient people on duty to care for the people living in the home.

This was an unannounced inspection which took place on 11 and 12 January 2015. At the last inspection on 23 January 2014 we found that the provider was meeting the requirements of the Regulations we inspected.

Roxton Nursing Home is a residential care and nursing home providing accommodation for up to 45 older people. At the time of our visit 43 people were living there.

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.

Everyone who lived at the home told us they felt safe. Relatives and staff all said they felt people were kept safe. The provider had processes and systems in place to keep people safe and protected them from the risk of harm and ensured people received their medication as prescribed.

Risks to people had been assessed and appropriate equipment was available for staff to use.

We found that there were enough staff to meet people’s identified needs because the provider ensured staff were recruited and trained to meet the care needs of people. Although during the holiday period some staff felt the provider did not have enough staff to cover for illness and placed remaining staff under additional pressure.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their care or treatment they receive. The provider had made the appropriate applications in line with the DoLS legislation.

We saw that people were supported to have choices and received food and drink at regular times throughout the day. Staff supported people to eat their meals when needed.

People were supported to access other health care professionals to ensure that their health care needs were met.

People told us the staff were very caring, friendly and treated them with kindness and respect. We saw staff were caring and helpful.

We found that people’s health care needs were assessed and regularly reviewed. We saw that some people did not have sufficient group or individual social activity to prevent them from being isolated.

People and their relatives told us they were confident that if they had any concerns or complaints, they would be listened to and the matters addressed quickly.

The provider had management systems to assess and monitor the quality of the service provided. This included gathering feedback from people who used the service and their relatives.