What life is like for people using this service:

People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People told us they felt safe living at the service and family members were confident that their relative was kept safe. Medication was managed safely and people received all their prescribed medication on time. Risks people faced were identified and measures put in place to minimise the risk of harm occurring. People were protected from the risk of the spread of infection because staff followed good infection control practices. The premises and equipment were well maintained, they were kept clean and underwent regular safety checks. People’s needs were met by the right amount of staff who were suitably skilled and experienced.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received all the right care and support from staff who were well trained and competent at what they did. People received the right care and support to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy and dignity particularly when providing intimate personal care. Staff used techniques to help relax people with positive outcomes. Staff had formed positive relationships with people and their family members. Family members and other visitors to the service were made to feel welcome and offered refreshments.

People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the registered manager as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service. Effective systems were followed to check on the quality and safety of the service which lead to improvements being made.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published 15 July 2017)

About the service:

Roby House is a residential care home that provides personal and nursing care for up to 55 people, some of whom are living with dementia. At the time of the inspection 52 people lived in the service.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and that the service has improved to good.

Follow up:

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

This inspection took place on 31 May and 05 and 08 June 2017. The first day of the inspection was unannounced.

Roby House Centre is registered to provide nursing care for 55 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 47 people using the service at the time of this inspection.

There was no registered manager in post at the time of this inspection visit. 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. A new manager had been appointed since the last inspection and was in the process of applying to CQC to become the registered manager.

At the last inspection on 29 September and 04 October 2016 we asked the registered provider to take action to make improvements to the safety and hygiene of the premises and equipment, management of medicines, safeguarding people, planning people’s care, dignity and respect, leadership of the service and monitoring the quality and safety of the service. We received an action plan which showed all actions would be completed by 31 January 2017. At this inspection we found that the actions had been completed.

Improvements had been made regarding the safety of the premises and equipment. Dedicated rooms had been identified and were in use to store equipment when it was not in use. This included equipment which people needed to help with their mobility such as hoists, stand aids and wheelchairs. There was a system in place for the prompt removal of equipment from the premises which was no longer needed such as beds and mattresses. Fire exits and corridors were kept free from obstructions and easily accessible to people. Storage rooms containing cleaning equipment and substances were kept locked when not in use to protect people from the hazards associated with them. The right amount of staff assisted people with transfers by use of appropriate equipment which was used safely.

Improvements had been made to the cleanliness of the environment and infection prevention and control procedures. Cleaning schedules had been developed and were being followed across the service. Staff followed safe infection prevention and control procedures to minimise the spread of infection. They used personal protective equipment (PPE) appropriately such as disposable gloves and aprons and disposed of clinical and non-clinical waste in appropriate bins provided.

Improvements had been made to safeguard people from abuse and any allegation of abuse. Safeguarding procedures set out by the registered provider and the relevant local authorities for responding to allegations of abuse were in place and correctly followed. Allegations of abuse brought to the attention of the manager had been raised with the relevant agency for investigation. Discussion with the manager and records showed that prompt action was taken to safeguard people from any further allegations of abuse. The manager worked positively with other agencies to make sure people were safeguarded from abuse.

Improvements had been made to staffing. The deployment of staff aimed to ensure that people were safe at all times. There were staff present at all times in communal areas which people occupied. People who were being nursed in bed and those who chose to spend time in their bedrooms received regular visits from staff to check on their safety and wellbeing.

Improvements had been made to meeting people’s needs. Care plans had instructions and guidance for staff about how best to meet people’s needs, including how and when to monitor aspects of people’s care. Care records showed that people had received the care and support they needed at the right time. Supplementary records in use to monitor aspects o

We carried out an unannounced comprehensive inspection of this service on 29 September and 04 October 2016. After that inspection we received concerns in relation to people’s safety and the leadership of the service. 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 Roby House Care Centre on our website at www.cqc.org.uk

At the time of the inspection, there was no registered manager in place. 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.

Since the last inspection in September and October 2016 the previous registered manager resigned from their post and a new manager had recently been appointed and is expected to take up their position early in January 2017. In the interim the service was being managed by a team of experienced managers within the organisation.

People told us that they felt safe and that their bedrooms were comfortable and kept clean. They told us that they had always received their medication on time and that staff made sure that they took them. The environment smelt fresh and was clean and tidy and free from hazards.

Checks on the environment and the quality of the care people received were carried out each day. Any findings which posed a risk to people's health and safety were actioned in a timely way to ensure people's safety. Concerns which were raised about people's safety and the quality of the care they received were listened to and promptly actioned.

We visited the service on 29 September and 04 October 2016. Both days of this inspection were unannounced.

Roby House Centre is registered to provide nursing care for 55 people. The service is located in the Huyton area of Liverpool, close to local shops and road links. There were 47 people using the service at the time of this inspection.

A registered manager was in post at the time of this inspection visit. 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.

We carried out an unannounced comprehensive inspection of this service on 21 March 2016 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements, which included planning people’s care, dignity and respect for people, infection control practices, management of medicines and quality monitoring systems. We received an action plan which showed all actions would be completed by 31 April 2016. However, at this inspection we found that the registered provider had not met the legal requirements and we found further breaches of the Health and Social Care Act 2008.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the inspection in March 2016 we received concerns from members of the public, Healthwatch and Commissioners in relation to staffing, care and welfare and the leadership of the service. We looked into those concerns as part of this inspection.

The storage of equipment put people at risk of trips and falls. Mobility equipment such as hoists and wheelchairs were left in lounges near to where people were sat, on corridors and in communal bathrooms. Other equipment such as mobile weighing scales, dismantled beds and mattresses were also stored on corridors. The door to a store room on a corridor near to people’s bedrooms was left open despite it being packed with dismantled beds and mattresses and other unused equipment and boxes.

Allegations of abuse were not acted upon to ensure people were safe from abuse or the risk of abuse. The procedures set out by the registered provider and the local authorities for responding to allegations of abuse were not followed. Allegations of abuse brought to the attention of the registered manager were not raised with the relevant agency for investigation. These concerns were raised immediately with a senior manager who took prompt action to ensure people’s safety.

There were sufficient numbers of staff to keep people safe however how staff were deployed did not ensure people’s safety. Staff left the building in groups of up to four at a time to have a cigarette break, leaving people unattended to. Staff also carried out tasks which were not relevant to their role and during this time people were left unsupervised in other parts of the service.

People did not always receive the care and support to meet their needs. One person did not receive personal care as set out in their care plan. There was a lack of information about people needs contained in supplementary care records such as fluid intake and positional change charts, which put people at risk of not receiving the right care and support. Pressure mattresses which people had in place to reduce the risk of developing pressure ulcers were incorrectly set. In addition the amount of fluid people were required to consume in a 24 hour period to maintain appropriate hydration levels was not recorded on their fluid intake charts.

People were

This was an unannounced inspection, carried out on 21 March 2016.

Roby House Nursing Centre is registered to provide nursing care for up to 60 people. The service is located in the Huyton area of Liverpool, close to local shops and road links.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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 last inspection of the service was carried out in October 2013 and we found that the service was meeting all the regulations that were assessed.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s health and safety was put at risk because parts of the environment were unhygienic and unsafe. There was a build-up of dirt, dust and food debris in a kitchenette and dining room on the first floor. Also furniture and carpets in a lounge on the first floor were heavily stained and there was a build-up of dust and dirt around window ledges and skirting boards. A sluice room and the medication room on the first floor were cluttered and unclean with dust and stains from spillages. Items of equipment stored in communal bathrooms posed a trip hazard to people because they obstructed their access to toilets and sinks. Staff removed the equipment after we raised our concerns with them.

Medication was not always managed safely. An unlocked trolley containing people’s medication was left unsupervised on a corridor outside the dining room and medication administration records (MARs) were signed in advance of people receiving their medication. Medication details and instruction for use which had been handwritten onto MAR sheets were not signed by a second member of staff to check the accuracy of the record.

The condition of the environment and mealtime experiences undermined people’s dignity. People were left sitting at dining tables for more than 30 minutes prior to their meal being served and during that time staff did not engage with people to inform them that their meal would be late and the reason why. People’s leftover meals were disposed of in an undignified way and their living environment was not maintained to a satisfactory standard.

There were limited opportunities for people to engage in meaningful activities at the service. The activities coordinator had been absent from work for some time and no interim arrangements had been made to replace them. Care staff felt they had little time to socialise with people because they were too busy with other tasks. People commented that they spent most of their time watching TV because there was little else for them to do.

The registered provider had implemented a quality assurance system with clear guidance about how to use it. However, the checks and audits which were carried out at the service failed to identify and risks to people’s health and safety and improvements which were required to the service people received.

We have made a recommendation about staff supervision. Staff had not received formal supervision in line with the registered provider’s staff supervision policy and procedure. This meant staff lacked the opportunity to take part in one to one discussions with their line manager about their work and training and development needs.

People who used the service were safeguarded from abuse and potential abuse because the registered provider had taken steps to minimise the risk of abuse. Staff had completed safeguarding training and they had access to information about how to prevent abuse and how to re

During our visit, we observed people using services being asked for their consent before any care or treatment was delivered which showed people`s decisions were important, listened to and respected. Where people did not have capacity to make a decision, we saw and heard evidence that members of the family were contacted and involved in making decisions about the person`s care. One family member who was visiting said, "any problems they always ring us". We observed comprehensive care plans which were regularly reviewed and updated if necessary and were clearly focused on individual needs and choices which reflected a person-centred approach to care and treatment.

We looked at how medication was managed at Roby House Care Home and found appropriate arrangements for the handling and administration of all medicines which ensured the safety of all people using services. We observed records were all up to date and clearly documented which meant it was straightforward to account for all medication used and disposed of. The provider ensured that all staff were properly supported to provide care and support to all people using services. All staff members were enabled to partake in training and development that was relevant and appropriate which ensured they carried out their role effectively. We observed evidence and heard comments that showed the provider considered complaints fully, responded appropriately and resolved, where possible, any comments or complaints received.

We spoke with a range of people about the service during our visit. We did this to gain a balanced overview of what people experienced. The people we spoke to included, the service management, staff members, people who lived at the service, family members of people living at the service and two visiting health professionals.

This service cares for people with a range of conditions and conversation with some of the residents was limited due to their complex needs. We therefore spent time in the communal areas making observations of how people were being cared for. We observed staff assisting people with personal care. We saw that staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

We spoke with one person about the care and support they received. They said they were happy living at the service and told us that the staff were "always really lovely". Another person we spoke to who had a relative living at the service told us “I can not fault them here, they are all brilliant. I know my mum is safe here."

No one was able to express their views during our visit but we were ale to use other ways to assess the safety of medication and these are included in this report.