Roman Wharf Care Home

Roman Wharf is a residential care home providing regulated activities of personal and nursing care to up to 50 people. At the time of our inspection there were 18 people using the service.

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

The manager had been in post approximately 4 months, during this time they had worked with the provider to improve the quality monitoring processes to enhance the standard of care for people. Presently there are only 18 people living in a service registered for 50 people. Consequently, we would need to see the improvement in quality monitoring processes seen at this inspection, sustained over a longer period of time to be assured good outcomes for people would be maintained.

People told us they felt safe at the service. The manager and their deputy worked with the provider to ensure all safeguarding concerns were dealt with appropriately. There were processes in place to enable learning from events.

The environmental and personal risks to people’s safety were well managed. Assessments of people’s needs had been undertaken using nationally recognised assessment tools, and measures to reduce risks had been put in place using these risk assessments.

People were supported by adequate numbers of staff who had been recruited safely and received appropriate training for their roles

People received their medicines safely, and there were good quality monitoring systems in place to manage medicines to highlight and reduce possible errors.

The service was clean and there were good infection prevention and control processes in place to reduce the risk of infections to people.

People’s nutritional needs were well managed. People enjoyed the food served to them. They were given choice and supported with their meals by a staff group who showed good knowledge of their nutritional needs.

Peoples’ health needs were well managed and there were good working relationships with external health professionals to provide good outcomes for people.

The environment people lived in was well maintained and the provider had an ongoing improvement and refurbishment plan in place.

People were supported by a staff group who treated them with respect and maintained their dignity. They were supported to be involved with their care, which was provided in a person-centred way. Staff had good knowledge of people’s needs and used their care records to ensure people’s current needs were met.

People were supported to maintain relationships with their families and there was a clear activities programme to reduce people’s feelings of boredom or isolation.

The provider had systems to manage complaints and concerns from people or their relatives and people told us they felt listened to.

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.

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 inadequate (published 26 May 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 17 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate to Good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Roman Wharf Care Home is a residential home that provides accommodation and personal care for up to 50 people, some of whom were living with dementia. There were 21 people using the service at the time of our inspection.

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

Governance systems and processes had failed to make significant improvements to concerns since the last inspection.

People were not protected from avoidable harm or abuse. Incidents of alleged abuse were not always reported and investigated safely, and risks were not managed to help keep people safe. Systems for accidents and incident reporting had not improved since the last inspection and left people at risk. Medical advice following incidents was not always followed.

Medicines were not always administered, stored and documented safely. Extra measures had been taken to protect people from infection, but these were not always effective. Staff recruitment was not always safe. Quality assurance systems did not always identify risks or concerns.

The environment required updating with more dementia friendly signage to support people finding their way around the service. People were supported to eat and drink, but fluid chart recording was not effective. People and relatives were, however, positive about food provided.

People did not always receive personalised care. Staff were not trained in areas relevant to their role, including communication, equality and diversity and person-centred care. People’s life histories were not always documented. Written records and staff descriptions of people were not always respectful of people’s needs.

Activities were provided for people by an activities co-ordinator, but this was limited in their absence. People were supported to maintain relationships. People’s complaints or concerns were responded to. People had end of life wishes documented in their care plans. People felt staff were kind and caring.

People’s current needs were documented in their care plans. The staff team worked with other agencies to support with people’s needs. Staffing levels were safe, and people told us they felt safe. Staff felt supported by the manager and people told us the manager was approachable.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests, however, the policies and systems in the service did not always support this practice.

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 inadequate (published 19 October 2022) and there were breaches of regulation. At this inspection we found the provider remained breaches of regulation.

Why we inspected

At the last inspection, we carried out an unannounced comprehensive inspection of this service on

10 May 2022. Breaches of legal requirement were found. The provider was served with a Warning Notice with a compliance date by when to improve.

We undertook this comprehensive inspection to follow up on action we told the provider to take at the last inspection and to check whether the Warning Notice we previously served in relation to Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding, risk management, need for consent, governance and staff training and development at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Roman Wharf Care Home is a residential home that provides accommodation and personal care for up to 50 people, some of whom were living with dementia. There were 30 people using the service at the time of our inspection.

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

Medicines were not always managed safely at the service. Staff were not following the providers policy on keeping medicine keys secure. Staff did not have robust guidance in how and when to administer “as and when required” medicines. Medicine records were not always kept up to date with people’s personal information.

Risks were not always managed safely at the service. Not all accidents and incidents were recorded correctly on the services electronic system. Leading to a lack of management oversight as well as missed opportunities to learn from incidents. Following the inspection, the manager put in place training for both themselves and staff to ensure the systems were used more effectively.

There were measures in place to reduce the risk of infection. However, there were areas of the environment that required work, not all of these issues had been recognised during quality audits or actioned.

Records we reviewed showed there were enough staff deployed at the service. However, people living at the service said more staff were needed, that there had been times when they had to wait for care as no staff were available.

The registered provider carried out sufficient pre- employment checks. Not all staff had received mandatory training, putting people at risk of unsafe practices.

Mental capacity assessments had not always been completed to ensure people could have maximum choice and control of their lives. The policies and systems in the service did not support this practice.

Some staff showed fewer caring interactions than others. However, we received positive feedback from relatives about the caring nature of the staff team.

Governance systems were not always effective at ensuring high quality care across the service. However, the management team were responsive to feedback and had begun to make changes while we were inspecting.

People were supported to eat and drink enough to prevent malnutrition and dehydration. External health and social care professionals were involved with the service where needed.

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 25 March 2021 and this is their first ratings inspection.

The last rating for the service under the previous legal entity, Roman Wharf Nursing Home, was requires improvement published on 27 February 2021.

Why we inspected

The local authority had received some safeguarding concerns about the service. We had also received concerns related to safety and governance at the service. We made the decision to complete an unannounced comprehensive inspection of the service to assess the overall safety of care provided.

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.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well led sections of this full report. The provider was responsive to our concerns and took some action during the inspection process to improve the safety of the service.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, consent, poor governance and staff training at this inspection. We wrote to the provider regarding areas of concerns that we felt need to be addressed urgently. They responded with an action plan reassuring us that improvements would be made.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.