Archived: Roby Lodge

The last inspection of the service was carried out in March 2017 and during that inspection we found breaches of regulations in respect of infection prevention and control, management of medication, records and assessing and monitoring the quality and safety of the service. 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, caring, responsive and well-led, to at least good.

Roby Lodge 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. Roby Lodge accommodates up to 42 people in one adapted building over two floors. There were 32 people accommodated at Roby Lodge at the time of this inspection.

The service has a registered 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.

Improvements had been made to minimise the risk of the spread of infection. The environment was clean and hygienic and smelt pleasant throughout. Staff followed safe practices when handling and disposing of clinical waste.

Improvements had been made to the management of medication. There was clear guidance in place for staff to follow on the use of PRN medication. PRN medication is prescribed for use when it is needed, for example for pain relief. Protocols in place for the use of PRN medication included important information such as the signs staff needed to look out for which indicated that a person needed their medication.

Improvements had been made to systems for checking on the quality and safety of the service and for making improvements. The service was assessed and monitored in line with the registered provider’s quality assurance framework. Where risks to people’s health, safety and welfare were identified action plans for improvements were developed and followed through promptly so that risks to people and others were mitigated.

Improvements had been made so that people received effective care. Care records reflected people’s needs and the care they received. Charts were in place to monitor aspects of people’s care such as fluid intake, skin integrity and weight. The charts recorded what the expected outcome was for the person, for example the amount of fluid people needed to consume in a 24 hour period and required settings for air flow mattresses.

Improvements had been made so that people’s personal belongings were treated with dignity and respect. A system had been put in place to ensure that items of unmarked clothing were promptly returned to people.

Improvements had been made to how complaints and concerns were dealt with. Complaints received were listened to and acted upon in line with the registered provider's policy and procedure. A clear record of complaints received was maintained which showed that they were acknowledged and actioned to achieve a satisfactory resolution.

We have made a recommendation about the environment. Although improvements had been made to the environment to make it more dementia friendly, further improvements were required. There was a lack of stimulus for people living with dementia, particularly for those who enjoyed keeping themselves busy around the environment.

Allegations of abuse were acted upon to ensure people were safe from abuse or the risk of abuse. People were protected by staff who knew about the different types of abuse and how to recognise indications of abuse. Allegations of abuse had been reported to the relevant agencies in a timely way.

Safe procedures were followed for recruiting new staff. Staff had provided details of their qualifications, skills and experience and they underwent a series of pre-employment checks to assess their suitability for the job. Staff entered onto an induction programme when they started work at the service and relevant training was provided to all staff on an ongoing basis.

People were treated with kindness and compassion and their privacy, dignity and independence was respected and promoted. Staff provided people with comfort and reassurance when they were anxious or upset and people responded positively to this. People received intimate care in private and they were encouraged to be as independent as possible.

Roby Lodge Care Centre is registered to provide accommodation and personal care for up to 40 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 38 people using the service at the time of this inspection.

The service had a registered 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. The registered manager was on a period of absence from work at the time of this inspection; however an interim management team was overseeing the day to day management of the service.

The last inspection of the service was carried out on 18 November 2014 and we found that the service was meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations. We did however ask the registered provider to make improvements to the meal time experiences for people and this action had been completed.

We found during this inspection that the registered provider was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations in relation to infection control, managing complaints and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of action taken to mitigate risks to people and make improvements to the service people received. Quality monitoring checks on aspects of the service had not always been carried out at the required intervals and when they had risks to people’s health, safety and welfare had not always been identified.

Infection control practices carried out by staff put people’s safety at risk. Soiled laundry and clinical waste was not always handled in line with good infection prevention and control procedures. Dirty laundry was left on floors and used continence aids were not disposed of correctly.

There was a lack of information contained in some people’s care records about their needs and how they should be met. In addition charts which were in place to monitor aspects of people’s care such as fluid intake and weight had not been completed when required. Not having this information meant people were at risk of receiving ineffective care and support.

The overall management of medication and associated records was safe. However some people’s protocols for medication which was prescribed to take when required (PRN) lacked information about the signs staff needed to look out for which indicated that the person needed their medication. This was actioned after we raised it with the management team.

People’s personal belongings were not always treated with dignity and respect. Items of unmarked clothing were left in the laundry for long periods of time and there was no system in place to ensure the clothing was returned to people. A system was put in place at the time of our inspection to address this.

Complaints and concerns were not dealt with in line with the registered provider's policy and procedure. Complaints raised by family members had not been acknowledged and no action had been taken to resolve them. Action was taken at the time of our inspection to address complaints made by family members.

We have made a recommendation about the environment. People were provided with opportunities to take part in activities which they found enjoyable. However the environment lacked stimulus and aids to orientate people living with dementia. Facilities were available for people to relax and spend time away from the usual day to day environment, however people got little use our of them.

People who used the service and family member were aware that changes had been made to the management of the service; however they were unsure about the current management arrangements. Meetings took place during our inspection and others had been arranged as a way of communicating the changes to people and family members.

Allegations of abuse were acted upon to ensure people were safe from abuse or the risk of abuse. People were protected by staff who knew about the different types of abuse and how to recognise indications of abuse. Allegations of abuse had been reported to the relevant agencies in a timely way.

The registered provider had a safe procedure for recruiting new staff. Staff had provided details of their qualifications, skills and experience and they underwent a series of pre-employment checks to assess their suitability for the job. Staff entered onto an induction programme when they started work at the service and relevant training was provided to all staff on an ongoing basis.

People told us that they felt safe living at Roby Lodge and we found that staff were aware of how to identify and report potential safeguarding occurrences. During our visit we found that records relating to protecting people were sufficiently robust.

There were sufficient staff working at Roby Lodge to meet the needs of the people living there. Relatives told us they liked the staff team. Some of Their comments included, 'Fantastic,' and 'They do a good job.'

'You can't fault the staff, I couldn't ask for any more'.

'We're well looked after here'.

"They really look after Mum, I don't have to worry".

Each of the people using the service had a care plan. The care plans we looked at were up to date and contained relevant information about the needs of the person. We found that where a need had been identified in a person's care plan then this was reflected in practice. We saw evidence that people had been consulted about their care plan and that they were in agreement with it.

People told us they felt safe living at the service and that they had been very well treated. They also said they felt confident about telling somebody if they had any concerns about the way they were treated.