Archived: Romney Cottage Residential Care Home

Updated 29 September 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to check if breached regulations, identified during our inspections of 25 and 26 January 2016 and 17 May 2016, had been met. We looked at the overall quality of the service to provide a new rating for the service under the Care Act 2014; prior to this inspection, the rating for the service was Inadequate.

We undertook this inspection of Romney Cottage Residential Care Home on 30 and 31 August 2016. The inspection was undertaken by two inspectors.

Before our inspection we reviewed the information we held about the service including previous inspection reports. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also reviewed action plans and some progress updates sent by the provider following the last inspections.

We met each person and spoke with eight people who lived at the service and observed their care, including the lunchtime meal, some medicines administration and activities. We inspected most areas of the environment and equipment used at the service. We spoke with five of the care staff including a member of the night care staff, the cook and cleaner as well as a visiting health care professional, the acting manager, the provider and a member of the consultancy team appointed by the provider.

We ‘pathway tracked’ three people living at the service. This is when we looked at people’s care documentation in depth, obtained their views on how they found living at the home where possible and made observations of the support they were given. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care. We also looked at care records for three other people.

During the inspection we reviewed other records. These included staff training and supervision records, staff recruitment records, medicines records, risk assessments, accidents and incident records, some quality audits and policies and procedures. We also asked for and reviewed the development plan of the service following the intervention of a consultancy service appointed by the provider.

Updated 29 September 2016

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.