All inspections: Romney Cottage Residential Care Home

This inspection took place on 30 and 31 August 2016 and was unannounced.

Romney Cottage Residential Care Home provides care and support for up to 22 people. There were 11 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with Korsakoff syndrome, a chronic memory disorder most commonly caused by alcohol misuse, dementia and some behaviours which may challenge others. People were living with a range of care needs, including diabetes and epilepsy. Some people needed full support with all of their personal care, and some mobility needs. Other people were more independent and needed less support from staff.

Accommodation is arranged over two floors with communal lounges and dining areas. People had their own bedroom, shower and bath facilities were shared. Access to the first floor is gained by stairs, making some areas of the service inaccessible to people with limited mobility.

The service did not have a registered manager in post at the time of our inspection; a registered manager had not in post since February 2016. 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 provider had appointed a manager to manage the service who had taken up the position in March 2016. They confirmed their application to manage the service had been made and received by the Care Quality Commission (CQC). The new manager was present throughout our inspection. The service was also supported by the recent appointment of a specialist social care consultancy service.

At the last inspection on 25 and 26 January 2016 the service was placed into special measures by CQC. On 17 May 2016 a further focussed inspection looked at the safety of people at the service; this included administration of medicines, how risks were assessed and managed as well as how incidents and accidents were investigated and mitigated. We found not enough improvement had been made. This inspection again found there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve our continued concerns.

Medicines were not always available in the service when people needed them; obsolete and out of date medicines were stored with current medicines and a recent audit identified concerns about medication record keeping.

Restraint was used to provide personal care; staff were untrained in how to do this; staff and the acting manager had not recognised this as a form of abuse.

Aspects of the service were not well maintained or clean; a fire door did not meet requirements, window restrictors were not always in place or used where needed.

Recruitment processes were incomplete; this did not promote and ensure the safety of people at the service.

Training had substantially lapsed; supervision of staff had not taken place to meet the service’s policy on this; competency checks, other than in medicines, did not ensure staff had the right skills and knowledge to support people.

Some Mental Capacity Act and Deprivation of Liberty Safeguards had not been correctly understood of applied.

Staff lacked training and knowledge to recognise poor practice; this impacted on the care people received.

People felt activities were the same as they had always done and did not necessarily reflect their interests.

Care planning did not always give staff sufficient guidance about how to safely and consistently support people; some needs assessments were completed incorrectly and it was evident some people’s needs were not being met.

Leadership of the service was poor. The provider had not ensured previously notified breaches of regulation were properly addressed.

Notification, required by law, was not always made to the Commission when people had passed away.

Incidents and accidents had reduced and some risk assessments reviewed.

People were happy with the choice and quality of food; they told us staff were friendly, happy and did what they thought they should to support them.

The provider recognised the requirement to improve the service and had enlisted the support of a consultancy service to help them do this. However, this had not brought about any change to the service people received.

The overall rating for this provider remains ‘Inadequate’. This means that it has remains in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

This inspection took place on 17 May 2016 and was unannounced.

Romney Cottage Residential Care Home provides care and support for up to 22 older people. There were 14 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes and epilepsy. Some people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.

Accommodation is provided over two floors with communal lounges and dining areas. People had their own bedroom, shower and bath facilities were shared. Access to the first floor is gained by stairs, making some areas of the service inaccessible to people with limited mobility.

The service did not have a registered manager in post at the time of our visit and had not had one since February 2016. 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 provider had appointed a manager to manage the service who had taken up the position in March 2016. They confirmed their intention to register with the Care Quality Commission (CQC). The new manager was present throughout our inspection.

At the last comprehensive inspection on 25 and 26 January 2016 this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Action plans submitted by the provider following the last inspection had not been fully met, or we identified continued concerns in areas where the provider had taken action to address them.

People remained at risk of harm as incidents and accidents lacked investigation and oversight; management of the risk of falls was poor and people continued to experience falls as the provider had not ensured known risks to people were mitigated.

People with diabetes remained at significant risk of harm as they did not have their healthcare needs met or regularly reviewed. Staff did not have the knowledge or resources to accurately measure blood sugar levels; a device used regularly for the measurement of blood sugar levels could not be calibrated and placed people at risk of receiving the wrong dosage of insulin. Diabetes reviews were only recognised as overdue following prompting by health care professionals.

Staff shortages meant the service had operated below the numbers of staff it said it needed; no method was in place to establish if the numbers of staff on duty could safely meet people’s needs. Prominent information indicating a lack of staff was not recognised or considered.

People were not safeguarded from abuse because action was not taken to minimise the risks of preventable injuries.

New staff were undergoing final recruitment procedures.

Aspects of the service that were previously poorly maintained or presented a risk to people had been addressed.

Fire safety checks had been routinely undertaken and equipment serviced regularly.

We undertook an unannounced inspection of this service on 25 and 26 January 2016. Romney Cottage Residential Care Home is registered to provide accommodation and support for up to 22 older people. There were 16 people living at the service. People at the service are older people living with dementia, some of whom have limited mobility. Accommodation is provided over two floors with communal lounges and dining areas. Most people had their own bedroom, although some were shared. Access to the first floor is gained by a stairs, making some areas of the service inaccessible to people with limited mobility.

Our previous inspection on 2 October 2014 found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to take action in relation to the governance of the service, aspects of staff training and to ensure that Deprivation of Liberty Safeguards (DoLS) were in place for people unable to consent to care and treatment at the service. The provider gave us an action plan and told us the work needed to meet these requirements would be complete by the end of April 2015. The registered manager further informed us August 2015 all shortfalls identified were addressed.

At this inspection we found the provider had not met all elements of each requirement action. As a result, we found the service continued to breach regulations relating to fundamental standards of care. In addition, other serious failings placed people at risk.

Risk assessments did not reflect people’s changing needs and reviews of incidents and accidents did not result in action for staff to take to try to prevent people being at risk again. People suffered repeated falls.

People were risk of not receiving appropriate care and support because guidance about how people should be supported was not always in place where needed.

Unmonitored temperatures meant that medicines may become desensitised and ineffective, administration of medicine was not always recorded and management of medicines did not meet with published best practice.

People received poor care because there were not enough staff on duty, this meant people were left unsupervised and caused a delay in the administration of one person’s medicine.

People were at risk of scalding because excessively high water temperatures were not addressed. The service was not adequately maintained, identified works had not taken place and damp or water ingress affected on person’s bedroom.

Induction training had not been signed off as complete or evaluated; staff operated equipment that they were not trained to use. Staff did not have the necessary skills to support some people.

Mental capacity assessments had not been completed to determine if some people could consent to care and treatment at the service or before restrictions on their liberty was imposed. This did not meet the requirements of the Mental Capacity Act.

Assessments had not been completed to determine if people needed adapted utensils to help them eat and none were provided. Some peoples did not receive appropriate support to eat when they were unable to eat independently.

Staff did not have sufficient knowledge or benefit from best practice procedures to identify early signs that may indicate deterioration in a person’s condition. This meant people did not always benefit from the opportunity of early intervention or, if needed, medical referrals.

Care plans did not always reflect the involvement of people. This meant care provided may not meet their preferences or some needs; in some instances care planning did not establish individual needs and preferences, for example, in relation to continence care.

Most people felt the activities were too limited and would only take place if staff had time. People’s hobbies and interests had not been explored and activities particularly beneficial to people with dementia were not practiced.

Leadership at the service had not ensured that all requirement actions issued following our last inspection were met. The service lacked an effective oversight, quality assurance framework and management action plan for ongoing improvement and development.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We inspected this service on 2 October 2014 and this was unannounced. We previously inspected this service in October 2013 and there were no concerns.

Romney Cottage provides care and support for up to 22 people who are living with dementia, have mental health needs or have substance misuse related needs. At the time of the inspection there were 21 people living there.

People told us that they felt safe and spoke positively about the support they received from staff. Relatives also said they felt their particular relative was safe and well cared for. One commented that the home was like “one big family”.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home and has the legal responsibility for meeting the requirements of the law; as does the provider.

Emergency procedures were in place but staff were not fully familiar with these. Important and appropriate checks were made of new staff before they commenced work but gaps in employment histories explored at interview were not well documented. Minor improvements were needed to ensure medicines were managed safely.

We found that newly employed staff did not receive an appropriate induction to ensure they had the right skills and had understood what they had learned, to support people safely and effectively and this could place people at risk. We found that whilst the home was guided by the principles of the Mental capacity Act 2005 to ensure decisions made on people’s behalf were in their best interest they were not fully meeting the requirements of the Deprivation of Liberty Safeguards. People did not have enough meaningful activities to do during the week and at weekends. People’s support at night was not fully recorded and this could lead to inconsistencies in delivery of support.

Some audits of environment and medicines were completed on a regular basis, but there was an overall lack of systems to assess and monitor service quality, those audits in place were insufficiently in depth to provide assurance that a good standard of quality in each area was being delivered. There were weaknesses in recording which meant that some information about how people were supported although carried out by staff was not recorded. Policies and procedures had not been kept updated to ensure staff worked to the most up to date guidance.

The providers visited regularly to talk with the manager about the home. However, systems were not in place to provide broad assurance that assessment and monitoring of quality of care was in place and would drive improvement of the home.

The home was kept clean and tidy. Communal spaces were comfortable, but overall décor throughout the home was tired and in need of refurbishment, and planned upgrades had not happened to the proposed timescales. Medicines were managed safely.

Staff were provided with a programme of essential and specialist training, to ensure that the care provided to people with a wide range of needs was safe and effective.

Throughout the inspection we saw examples of staff treating people with dignity and respect, being mindful of their privacy and interacting with them in a kind and friendly manner. Staff showed they understood people’s individual needs and consulted with them about all aspects of their support and protected them from unnecessary risks. People told us there were enough staff to support them, more staff could be provided if dependency levels changed. There was a clear management structure in place and staff understood their roles and responsibilities

Staff understood about safeguarding and knew how to keep people safe. Records showed that the home used advocates for some people when important decisions needed to be made for them and there was no one else to assist them in making these decisions.

People and their relatives were encouraged to give their views about the home and their comments were analysed and acted upon to drive improvement. There was a complaints process in place and this showed that complaints were fully investigated and resolved in a timely way.

We recommend that consideration is given to current guidance regarding the development of emergency plans and also ensures that agreed places of safety are recorded clearly within this and made known to all staff.

We recommend that consideration is given to current NICE guidance regarding the management of medicines in care homes

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to 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 this report.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We observed how people spent their time during the day, how staff met their needs and how people interacted with staff. We spoke individually with two people and with two members of staff.

We observed that people were encouraged to make choices about their daily lives. Their choices and preferences were recorded on their care records and respected by staff.

People's needs were assessed before they moved to the service to make sure that it could meet them. We saw that people's care records were mostly kept up to date. Any changes in needs were recorded and the service made sure that people's health needs were met and they saw health care professionals when they needed to. We telephoned a social care professional who told us that the service made sure they were contacted if there were any concerns or queries about the health or welfare of the person they supported, and that staff followed the advice they gave.

We observed that staff were respectful towards people and treated them in a dignified way. A person told us 'If I ask them (staff) something they always answer it if they can'.

At the time of the inspection 20 people were living at the service. We spoke with five people who were living there and with four members of staff. Some people were not able to talk to us directly about their experiences due to their complex needs, but we observed how they spent their time and interactions with staff.

People said they received the care and support they needed and staff understood that they liked to be as independent as possible. They said they were given choices about their daily routines such as when to get up and go to bed and what to do. A person said 'I like to go to bed late and get up early, I watch television late in my room or sometimes in the lounge' and 'We get up when we want to really'.

People said they saw health and social care professionals when they needed to. A social care professional who was visiting said the service followed through suggestions and guidance well.

People said they were satisfied with their rooms. One person said improvements to the environment had made the home 'Look better'.

People told us they liked the staff, that staff were kind and supported them in the ways they preferred. People said 'Staff are pretty good, 'They are very kind and polite' and 'The staff are mainly ok'.

We spoke with five people who were using the service. Some people living there were not able to talk to us directly about their experiences due to their complex needs, which included dementia, so we used a number of different methods to help us understand their experiences. We spoke with staff, spoke with a relative visiting the home, read records, looked round the home and made observations of the care and support they received.

People we spoke with told us they liked living at Romney Cottage and were involved in making decisions about their care and support. They said they were given choices about their daily routines such as when to get up and go to bed, what to eat and what to do each day.

They said they liked their rooms, a person who shared a bedroom said they were happy with this arrangement and had always shared with the same person. People said staff kept their rooms clean and tidy.

People told us they liked the meals and there was enough variety and choice of food on offer.

We spoke individually with six people using the service. Some people were unable tell us about their experiences of living at the home because they had complex needs, so we used some other methods of to gain information about what it was like to live there. We spoke with four relatives who were visiting, spoke with staff, read records including care plans, and observed people during the day.

People we spoke with told us that they liked the home and that staff gave them the support they needed. They were happy with their bedrooms and said they were comfortable. People said they liked the meals provided and they could choose what they did during the day.

The people living at the home who were most independent said they liked helping out, for instance with laying tables and washing up. A person who was being supported to move to independent living in the community said he had reached that stage due to the support the home had given him.

One person we spoke with said they would like to be offered more activities and that there was not enough to do. People said they liked going out for local walks or shopping with staff if they were not able to go out by themselves

Relatives we spoke with told us that the care given at the home was good, communication was good and staff always informed them if there were any concerns.

Some comments made by people living at the home were,

'Can't fault the staff, they are lovely people'

'My room is clean and comfortable'

'They have done work to motivate me'

'I sometimes help to make cakes, I like helping in the kitchen'

Comments made by relatives included,

'We are very happy with the care'

'We feel it is a family home'

' He enjoys his meals'

'The staff are very,very,patient'

'There is enough for him to do, he did gardening last year but found it too much'

The people we spoke to said they liked the staff at the home and they chose what they wanted to do each day.They liked the staff and their own bedrooms.

People told us that they were consulted about the care and support they received and there were opportunities for them to give thier views on the service.They could make choices although they were not always offered enough choice of activity and of meals.They did not always know what the main meal would be.

People told us the home was kept clean and they were happy with thier rooms.They said staff were kind,caring and respectful.

Archived: Romney Cottage Residential Care Home

All Inspections

30 August 2016

During a routine inspection

17 May 2016

During an inspection looking at part of the service

25 and 26 January 2016

During a routine inspection

2 October 2014

During a routine inspection

28 October 2013

During an inspection in response to concerns

14 May 2013

During a routine inspection

6 August 2012

During an inspection looking at part of the service

9 May 2012

During an inspection looking at part of the service

4 November 2011

During an inspection looking at part of the service

25 May 2012

During a routine inspection