The inspection was carried out on 4 and 5 September 2018 and was unannounced.

Roper House 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.

Roper House provides accommodation with personal care for up to 27 adults with hearing loss, whose communication needs included British Sign Language (BSL). As well as hearing loss, some people had additional needs including old age, learning disability, physical disability, mental health, autism, visual impairment and dementia. There were 27 people living at the service, although two of these people were in hospital at the time of the inspection. Accommodation is over two floors and bedrooms can be accessed by a passenger lift. Facilities included a communal lounge, lounge/activity area, dining room, kitchenette where people could make drinks and a large enclosed garden with seating. There were also two self-contained flats, which included their own kitchen, lounge and garden area for people who were more independent. There was one person living in each flat.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with CQC 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.

We last inspected Roper House on 28 and 29 June 2017 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice relating to care and treatment plans not reflecting people’s changing needs. We also made a recommendation to develop a plan to ensure the environment was adequately maintained.

At this inspection, although improvements had been made and the previous breach met, we found there were three breaches of Regulation and another area identified that needed improvement. The breaches of Regulations related to hot water temperatures that presented a risk of scalding, ineffective quality assurance processes that did not assure people’s safety and a failure to make notification to the Commission (CQC) of a statutory event. We have also asked the provider to review the potential access of all staff to medicines. This is the second consecutive time the service has been rated as Requires Improvement overall.

Water checks and management were not effective, this was because the temperature of the water at some hot water taps was too high. Potentially, people had access to these taps and were at risk of being scalded. Auditing systems had not identified the risk of high water temperatures and consequently no action was taken to address this.

Services that provide health and social care to people are legally required to inform CQC of important events that happen in the service. This is so we can check that appropriate action had been taken. The registered manager was aware they needed to inform CQC of important events in a timely manner, however, they had not always done so.

Medicines practice was safe, there were appropriate processes in place for the ordering, administration, storage and return of unused medicines. However, the door key system in place meant that all staff, including untrained staff, had access to all medicines as well as those with special storage requirements. This presents a risk of unauthorised access to medicines and is an area identified as requiring improvement.

The registered manager had a quality audit in place. However, this was not comprehensive enough to enable the registered manager to assess, monitor and improve the quality and safety of the service. The registered manager was not aware of some of the concerns we found during this i

The inspection took place on 28 and 29 June 2017. The inspection was unannounced.

Roper House provides accommodation with personal care for up to 27 adults with a hearing loss whose communication needs included British Sign Language (BSL) People have a range of additional needs including old age, learning disability, physical disability, mental health, autism, visual impairment and dementia. There were 24 people living at the service at the time of the inspection. The accommodation is over two floors and bedrooms can be accessed by a passenger lift. There is a communal lounge, lounge/activity area, dining room, kitchenette where people could make drinks and a large secure garden with seating. There was also a flat on the ground floor for people who were more independent. There were two people living there who had their own kitchen, lounge and garden area.

There had not been a registered manager at the service for over a year. The new manager of the service had been in post for 5 weeks at the time of the inspection. Their application to be registered as manager was successfully completed after the inspection on 10 August 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous inspection on 29 and 30 June 2016, we identified breaches of Regulation 11, 17 and 18of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to people being unlawfully deprived of their liberty, the management of records and staff supervision. We asked the provider to take action to meet these regulations. The provider sent us an action plan in September 2016 which stated that had complied with these breaches in Regulation.

At this inspection, we found the provider had taken action to meet Regulation 11, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to the deprivation of people’s liberty, staff supervision and record keeping. However, an additional breach of Regulation 9 was identified in relation to shortfalls in care planning.

Care plans and associated guidance did not always reflect people’s care needs which meant there was a risk of people receiving inappropriate care and treatment.

We have made a recommendation in relation to there not being adequate systems in place to ensure the continued maintenance and decoration of the premises.

Assessments of individual risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Accidents and incidents were recorded and guidance and assessments updated to minimise their reoccurrence.

The service had reviewed the management of medicines and was working through a plan to ensure the safe storage, and administration of medicines.

Staff knew how to identify and report any safeguarding concerns in order to help people keep safe. Checks were carried out on all staff before they supported people, to ensure that they were fit and suitable for their role.

There were robust processes in place to ensure only staff that had been checked and assessed as suitable, commenced employment at the service. People said there were enough staff available to meet their needs and support was available when it was requested during the inspection.

There was a rolling programme of essential and specialist training to ensure staff had the skills and knowledge to care for people effectively. This included how to communicate using BSL, support people living with dementia, diabetes and with behaviours that may challenge themselves or others. Staff were effectively supported through supervision. .

People had their health and nutritional

The inspection took place on 29 and 30 June 2016 and was unannounced. At the previous inspection on 5 September 2014 we found there was a breach of regulation as detailed information about individual people had inappropriately been completed in general records so that people’s privacy was not maintained. At a follow up inspection on 10 March 2015, the service had recorded people’s information in way that maintained their privacy and dignity.

Roper House provides accommodation with personal care for up to 27 adults with a hearing loss. People have a range of additional needs including old age, learning disability, physical disability, mental health, autism, visual impairment and dementia. There were 21 people living at the service at the time of the inspection. The accommodation is over two floors and bedrooms can be accessed by a passenger lift. There is a communal lounge, lounge/activity area, dining room, kitchenette where people could make drinks and a large secure garden with seating. There was also a flat on the ground floor for people who were more independent. There were two people living there who had their own kitchen, lounge and garden area.

There had not been a registered manager at the service for five months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The service had not consulted the local authority with regards to making DoLS applications, to ensure that people were only deprived of their liberty when it had been assessed as lawful to do so.

The service had not followed its policy in providing staff with regular supervision which offers staff support and learning to help with their development and to improve care for people.

People’s records could not always be easily accessed and they did not always provide the information and guidance that staff needed to support people effectively.

Some aspects of the service did not promote people’s independence nor value their contributions. A communal bathroom was locked but staff did not know why people did not have access; people in an independent flat had their medicines stored at the main house so they were not readily available; and mealtimes were not always effectively managed resulting in people queuing for their lunch in their own home. We have made a recommendation for the service to review its practices to ensure people are empowered in their everyday lives.

Assessments of individual risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Accidents and incidents were recorded and guidance and assessments updated to minimise their reoccurrence.

Staff knew how to identify and report any safeguarding concerns in order to help people keep safe. Checks were carried out on all staff before they supported people, to ensure that they were fit and suitable for their role.

There were a number of staff vacancies and agency staff were used to ensure there were enough staff available to meet people's needs. Staffing levels were re-assessed and adjusted when the number of people who lived at the service changed.

A schedule of cleaning was in place to ensure the home was clean and practices were in place to minimise the spread of any infection. The service had a number of spaces for people to use and equipment and assistive technology was used to aid people to mobilise and remain safe in their home.

Safe systems were in place for the storage, recording, administration and disposal of medicines.

There was a rolling programme of essential training to ensure staff had the skills and knowledge to car

During the inspection we met six people who lived at the home, looked at seven people’s support plans and spoke with two of the staff members. The manager was unavailable at the time of the inspection.

The focus of the inspection was to answer if the service had taken action to comply with the outcomes around record keeping which were made following our visit on 5 September 2014.

Action to improve the way that personal information was recorded had taken place. . This meant that records were kept in a way that was confidential to the person. However, on 15 February 2015, an internal memo had been sent to staff instructing them of the information they could record on communal records which resulted in people’s private and sensitive information being recorded on a single, communal document. The person in charge took immediate action to remove the instructional memo, and set up the recording system so that people’s personal information remained confidential and to ensure that this error could not be repeated.

People had one-to-one meetings with their main staff (key worker) each month. This is where people can plan for their next month and make changes to their care and support. The exception to this was for two people who had not had a meeting for five or six months. The provider sent written notice and a copy of the systems that were immediately put in place to maintain compliance around safe and effective record keeping. We are therefore confident that the service is now compliant.

The inspection was carried out by an Inspector and an interpreter, as people who lived in the home had a hearing loss and communicated by British Sign Language (BSL). The interpreter spent the morning at the home. Their role was to interpret the conversation between the inspector and people who lived in the home, and not to make any judgments or comments about the quality of service. The inspection was in response to concerns raised to the Care Quality Commission from an anonymous source. During the visit we talked with people living in the home, talked with staff and observed staff carrying out care duties. The manager was available throughout the day. We did not find any evidence to substantiate the anonymous concerns that had been brought to our attention.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us that they were treated with dignity and respect by the staff. One person told us, “Staff are good. I am not frightened. I feel safe living here”. Staff communicated with people in a respectful manner and responded when people asked them questions.

Staff had skills and experience needed to support the people living in the home. They received a comprehensive induction, attended mandatory training courses to keep them up to date with current practice. All staff attended training in British Sign Language, if they did not already have this skill. This meant that people who lived in the home were able to effectively communicate their needs and concerns.

The Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

When people attended important meetings concerning their care and welfare, the home ensured that an independent interpreter was available. This meant that when required people could access additional support.

Most people were happy with the care that was delivered and said that their needs were met. One person told us, “I like living here because the staff are very good and they help me. They speak and sign to me”.

People were involved in health and social care needs assessments and writing their plan of care. Some plans had been developed using pictures, so that people found them easier to understand.

Staff had a good understanding of people’s care and support needs and knew them well. They were able to describe people’s care needs and what support people required so that their needs were met.

People were given a choice of what to eat and offered a varied diet. One person told us, “Yes, I have a choice if I don’t like something. The food is alright”. People’s nutritional requirements were contained in their plans of care and the chef demonstrated that he was aware of them.

Is the service caring?

People were supported by attentive staff. They stopped to talk to people. When staff started a conversation with people they got their attention in a respectful manner if the person was not looking in their direction.

At lunchtime we saw that people were able to do things at their own pace and were not rushed.

People’s preferences, interests, aspirations and diverse needs were recorded, and care and support were provided in accordance with their wishes.

When speaking with staff it was clear that they were genuinely interested in what people had to say.

Is the service responsive?

People’s needs had been assessed before they moved into the home, so that staff knew how to support people appropriately.

People met with their key workers to set goals that were important to them. However, some people had not met with their key workers for a considerable period of time.

The home had an activities coordinator who ensured that people had access to activities that were important to them, in and outside the home. This included arts and crafts, swimming, shopping, and reminiscence and day trips. One person told us about a holiday that they were planning to Spain, with staff.

Is the service well led?

Staff had a good understanding of the ethos of the home and their roles and responsibilities.

People said that if they had any worries or concerns that they could talk to any member of staff. Although the manager could not converse in BSL, people felt confident that if they informed a member of staff of any concerns, these would be brought to her attention and acted upon.

People regularly completed a customer satisfaction survey. The last time this was done, 98% of people were happy with the care and support they were receiving from Action on Hearing Loss.

People told us that they could make their needs know at the regular residents’ meetings which took place. One person told us, “Residents meeting are very good as I can talk about things”.

A quality assurance system was in place to audit various aspects of the home such as health and safety, medicines and equipment. Shortfalls were identified so that action could be taken to address them.

However, risk assessments had not always been regularly reviewed. Also people did not have a separate and confidential daily record to ensure consistency of care.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to maintaining accurate and personal care records.

We did not have an independent translator of British Sign Language with us on this occasion, so all translations were carried out by the home manager or staff member. The home had a very welcoming and relaxed atmosphere. All those living at the home spoken with (via translation) told us they were very happy. One person told me about his work in the garden. Staff showed they understood the people they were supporting on each accession they interacted. Staff showed compassion and care during some interesting and difficult dissuasions observed.

Staff spoken with showed a good understanding of their role, and that of the home. One person using the service came to talk about the fact he had not enjoyed their lunch, the staff member immediately suggested a meeting with the home's cook to chat about what he likes and dislike and to ensure he would be happy in the future. Another was very supportive when a person came to the office clearly in pain.

Staff were seen to be supporting people using the service attending appointments out of the home. We also saw others going out independently. The home has a newly appointed activity person, and was already showing to be very popular.

We used an independent interpreter of British Sign Language (BSL) to communicate with the people who used the service. They signed that they liked living in the home and that they liked most of the staff. One person signed " yes, I like it here. I am friends with the staff, they treat me well." Another signed " sometimes I have to tap the staff on the arm to get their attention, but I feel looked after."

Not all of the people using the service could use BSL but others were able to indicate that they were happy living in the home and they enjoyed many activities that were available. One person we communicated with told us " I love gardening, I work alot in the garden, not at the moment as its too cold, but in the spring and summer I spend most of my time outside."

The people who used the service that we communicated with told us that they felt safe and could talk to the staff if they were concerned about anything. One person signed "I am safe here, I can talk to the staff or the manager if I feel upset, or if there is a problem and they sort it out for me quickly."

We used an independent interpreter of British Sign Language (BSL) to communicate with the people who used the service. They signed that they liked living in the home and that they liked the staff. One person signed, “I love it here - everyone is lovely. I have plenty to do. I’m happy, very happy”. Another signed, “ G (one of the staff) always makes me laugh”

Not everyone in the home was able to use BSL but others were able to indicate that they were very happy living in the home and that they enjoyed the various activities that were available.

One person signed, 'I like gardening. I work a lot in the garden. Come and see how nice it is”.