About the service: Roden Hall Nursing Home provides residential and nursing care and is registered to accommodate up to 45 people. On the day of the inspection the service was providing personal and nursing care to 23 people.

Focused inspection

We undertook an unannounced focused inspection of Roden Hall Nursing Home on 23 April 2019.

People’s experience of using this service:

•Since our last inspection in July 2018, the provider had not taken sufficient action to comply with the breach of regulation 17, Good governance.

•The provider’s governance remained ineffective to address the shortfalls identified at our previous inspection.

•The provider had not taken appropriate action since the last inspection to ensure the safety of equipment to reduce the potential risk it could pose to people.

•People could not be assured they would be protected from the risk of cross infection.

•The provider was unable to demonstrate that all staff were subject to the appropriate safety checks before and whilst working in the home.

•People’s prescribed medicines were not always stored in accordance to the pharmaceutical instructions on the box.

•Accidents were recorded but action was not always taken to avoid them happening again.

•People were supported by trained staff to take their prescribed medicines.

•People were cared for by sufficient numbers of staff.

•People could be confident that staff were aware of their responsibility of safeguarding them from the risk of potential abuse.

Why we inspected: This inspection was carried out because we had received concerns about the suitability of staff working in the home.

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. More information is in Detailed Findings below.

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

Roden Hall Nursing Home 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.

Roden Hall Nursing Home accommodates up to 45 people with bedrooms on several floors, which are accessible by a lift and stairway. However, at this inspection alterations were being made to the building and people were living on the ground and first floors. In addition to the alterations to Roden Hall Nursing Home a new purpose build nursing home was being built in the grounds. As a result, the numbers of those living there had been reduced. At this inspection 22 people were living there.

Since our last inspection a newly appointed registered manager has taken up their position at Roden Hall Nursing Home and was present during this inspection’s site 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.

Following our last inspection in January 2017 we published our report in April 2017. At that inspection we identified areas of improvement that needed to be made. These were in relation to the key questions, Safe, concerns about abuse and ill-treatment were not always passed to appropriate agencies and there were not always enough staff to meet people’s needs in a timely manner. In addition, the fire safety plan was not being followed. Effective, people sometimes had to wait for assistance at meal times. Caring, people were not always treated with respect. Responsive, people did not always have care plans that were up to date. Well-led, quality checks were not always effective to identify improvements needed.

At our last inspection we identified one breach in regulation. This was Regulation 12 HSCA Regulations 2014 - Safe care and treatment. Risks had been identified in relation to managing fire risks safely and an action plan to reduce the risk had been produced but was not being followed. We asked the provider to complete an action plan to show what they would do, and by when, to improve this key question. At this inspection we found improvements had been made and they were no longer in breach of this regulation.

However, at this inspection we identified some improvements were still required regarding the safety of parts of the building. In addition, we found that effective infection prevention and control practices were not fully embedded into staff members practice and that parts of the building did not support effective cleaning procedures. The management team and the provider did not have effective quality checks in place to identify and drive the changes required.

People were safe from the risk of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the registered manager were acted on appropriately. There were enough staff to support people to meet their needs in a timely manner. The provider followed safe recruitment procedures when employing new staff members.

People were safely supported with their medicines by competent staff members. New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff members had access to on-going training to maintain their skills and to keep up to date with changes in adult social care.

People received care that was effective and personalised to their individual needs and preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s human rights and p

Roden Hall Nursing Home provides nursing care, personal care and accommodation for up to 45 older people. There were 35 people living at the service when we carried out our inspection.

Our inspection took place on 23 and 24 January 2017 and was unannounced on the first day..

The service had a registered manager at the time of our inspection. 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.

Risks to people’s health and welfare were not always identified or acted upon to ensure people received safe support. Staff were not always working in ways that reflected risk management plans in order to reduce risks. This placed people at risk of potential harm.

Staff were confident that they could recognise and report poor practice or concerns about people’s safety. However, allegations of abuse had not always been managed appropriately to ensure people were protected from harm.

People were not always supported by sufficient staff to meet their needs safely and effectively and in a timely manner.

Staff were recruited safely meaning that only people suitable to work in the role were appointed. People received their medicines safely and there were safe systems for administering, storing, recording and auditing medicines. The registered manager addressed issues in relation to medicine management during the inspection.

People were supported by staff who had the skills and knowledge to meet their needs effectively. Staff had access to a variety of training opportunities and most staff felt well supported to carry out their duties.

People’s rights were protected under the Mental Capacity Act 2005. The registered manager had a good understanding of the principles and application of the MCA. People were supported by staff to make choices in relation to the care and support they received.

People’s nutritional needs were met and people were satisfied with the quality and choice of the food. People’s Individual dietary preferences and needs were catered for although people’s dining experience varied. Staff worked with healthcare professionals when required to ensure people’s maintained good health and wellbeing. This joint working ensured people’s needs were met consistently and effectively.

People were not always supported by staff who were respectful when entering their private space. Despite this people told us that they felt supported by staff who were kind and caring. People’s independence was promoted wherever possible and people felt listened to. Overall people’s privacy and dignity was respected.

People were not always supported by staff who had up to date information and knowledge about their care and support needs. This meant that they did not always provide a responsive service that met people’s changing needs. Staff did not always have access to written information about people’s changing needs. Activities were limited but were being developed. People had been involved in assessments of their needs and in reviews of their care and support.

People told us they were able to raise concerns and felt these would be acted on by the registered manager. The provider had a complaints procedure that people had been confident to use. However, not all complaints received had been managed appropriately and improvement was required to ensure that complaints were used to improve the service provided. There were systems in place to ensure that people’s views and opinions were heard and their wishes acted upon.

Processes to audit the service were seen in place but did not always identify issues that required action to make the home safer. The registered manager did however, take prompt action to protect people when we raised issues relating to people’s safe