Roche Abbey Care Home

Roche Abbey is a residential care home providing personal and nursing care for up to 67 people. At the time of our inspection there were 37 people living at the home. Some people using the service were living with dementia.

People’s experience of using this service and what we found

There were quality monitoring systems in place. However, these were not always effective. Some areas for improvement we identified during the site visit were not identified as part of the providers quality monitoring systems. For example, infection control shortfalls and management of risk. We identified risks in relation to people's nutrition and weight loss were not managed effectively.

We have made a recommendation about the management of risks.

We found enough staff on duty on the day of our site visit. The registered manager used a dependency tool to determine staffing levels and we saw this was followed. However, we observed staff could be task orientated with set times for specific support, rather than care being person-centred.

The home generally, was visibly clean. However, we found some areas that were not clean. Mattresses, pressure cushions and chairs were stained and dirty and kitchenettes required a thorough clean. The registered manager confirmed action had been taken following our inspection.

People received medication as prescribed. Staff received training and competency assessments. However, we identified some minor documentation issues that had not been picked up by the audit systems. These were addressed by the registered manager following our site visit.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were aware of what actions to take to safeguard people from the risk of abuse. The manager kept a record of safeguarding concerns and monitored the outcome. Accidents and incidents were analysed and evidence to show what actions had been taken to mitigate future incidents.

People and relatives spoke highly of the registered manager and felt she was approachable and listened to any concerns or issues raised. Most staff told us they worked well as a team and were supported, however, some felt the registered manager could be more visible on the units.

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

Rating at last inspection

The last rating for this service was requires improvement (published February 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections

Why we inspected

This was a planned inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This was a focused inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roche Abbey on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to governance and leadership.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Roche Abbey Care Home is a residential nursing home providing accommodation, personal care and treatment of disease, disorder or injury for 31 people, at the time of the inspection. The service is a three-floor building. Each floor has separate adapted facilities.

Management oversight at the service was not always effective. We found audits were irregular and did not always identify issues at the service which required attention. People living at the service and staff had confidence in the manager, and the service worked well with other professionals to improve people's care.

People's experience of using this service and what we found

Although some improvements had been made since our last inspection, continued improvement is required to the management of people’s medicines and the management of the risks identified to some people. People told us they felt safe living at Roche Abbey. Staff were recruited safely and there were sufficient staff on duty to deliver person-centred care. The home was clean and had safe infection prevention and control practices and procedures in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff working at the service received regular supervision. People we spoke to told us they enjoyed the food at Roche Abbey. People's needs had been assessed before they moved to Roche Abbey and people had access to healthcare professionals when required.

People spoke positively about living at Roche Abbey and liked the staff who supported them. People were treated kindly and had their privacy and dignity protected.

Care plans and other documents detailed people's care needs, and staff used these to provide people with the right care and support. People were able to do the things they enjoyed and were supported to have contact with people who were important to them.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 February 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

Why we inspected

We carried out this inspection following a routine review of information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Roche Abbey is a care home providing personal care and nursing. It can accommodate up to 67 people. Some people using the service were living with dementia. There were 22 people using the service at the time of the inspection.

People’s experience of using this service and what we found

The service had recently had a change in management. There was no registered manager however, the provider had appointed a new manager who was registering with the Care Quality Commission (CQC). We found systems and processes used to ensure the service was running safely had not been followed so were not robust or effective. The information in audits was inconsistent and, in some cases, not completed, therefore they were not able to be effectively reviewed to drive improvements.

People were not always safe. Risks were not managed to ensure people’s needs were met and safety maintained. Medication procedures were not always followed to ensure people received their medicines as prescribed. We identified shortfalls in the way people’s medicines were managed. People were not always protected by the risk and spread of infection. The environment was not clean, we found areas of the home had malodours and were not thoroughly cleaned. We were not assured by the infection control systems in place. However, the manager has actioned this following our inspection.

There were predominantly adequate staff on duty on the day of our inspection and staff said there was mostly enough staff to meet people’s needs. However, there was no effective dependency tool in place to ensure staff were deployed effectively to ensure people’s needs were met. Staff had not consistently received specific training to meet people’s needs.

People were supported to have maximum choice and control of their lives and we observed staff supported them in the least restrictive way possible and in their best interests. However, this was not reflected in people’s care plans. Care plans were not personalised, difficult to follow and did not detail people’s current needs. Peoples preferences were not always recorded, this included people who were receiving end of life care.

The provider had a recruitment process in place which showed staff were recruited safely. However, we found not all checks required were carried out. Safety checks were carried out. However, we found not all checks were carried out in line with the policy.

The staff team worked together with external agencies to deliver effective care and treatment and support people’s access to healthcare services. However, this was not always clearly documented to show actions taken.

Staff felt supported and spoke highly of the clinical lead. However, they were not formally supervised. Staff felt there had been lack of leadership and direction but felt more confident the home was now in a better place to move forward.

There were systems in place to safeguard people from abuse.

Staff supported people appropriately. Their approach was kind, caring and person-centred. Staff respected people’s privacy and dignity. People and relatives, we spoke with, praised the care staff and could not fault the care they provided.

The new manager had identified many of the shortfalls since their appointment and told us improved quality monitoring was being devised to ensure issues were resolved and to drive improvements.

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

Rating at last inspection

This service was registered with us on 11/03/2020 and this is the first inspection.

The last rating for the service under the previous provider was Inadequate, published on 19 July 2018.

Why we inspected

The inspection was prompted due to concerns received from the local authority commissioners. These were regarding, staffing and lack of robust infection prevention and control. There had also been an outbreak of COVID-19 in the home. As a result, we undertook an inspection looking at all five key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service is requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cambron House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and leadership and oversight at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.