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Archived: Romney Cottage Residential Care Home Inadequate

We are carrying out a review of quality at Romney Cottage Residential Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

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.

Inspection areas

Safe

Inadequate

Updated 29 September 2016

The service was not safe

Working practice did not ensure people were not safeguarded from abuse.

There were not sufficient numbers of suitably skilled and knowledgeable staff to meet people�s needs. Some staff recruitment processes were incomplete.

Medicines were not always administered and managed as should be expected; plans to deal with emergencies were not always complete and aspects of the building were not properly maintained or promote safety.

Risk assessments had been reviewed and accidents and incidents investigated.

Effective

Inadequate

Updated 29 September 2016

The service was not effective.

Training for new and existing staff had lapsed, staff were not trained in or assessed as having some key skills to support people�s needs.

Requirements of the Mental Capacity Act and Deprivation of Liberty safeguards were not fully understood or always correctly applied.

Health action plans were in place but staff did not always recognise when people needed support. People were supported to attend appointments.

People told us they enjoyed their meals

Caring

Requires improvement

Updated 29 September 2016

The service was not always caring.

Care planning did not reflect the involvement of the people they were intended to support.

Staff interactions were compassionate and well-intended but knowledge levels and a lack of awareness did not always enable staff to recognise poor care.

Staff were mindful of people�s communication needs.

Responsive

Inadequate

Updated 29 September 2016

The service was not responsive.

Activities were limited and did not meet people�s expectations and interests.

Care planning was not sufficiently developed to provide sufficient guidance to staff about how some people needed to be supported.

Some people�s needs assessments were not correct; it was evident their needs were not being fully met.

An accessible complaints procedure was in place but people did not wish to raise any concerns.

Well-led

Inadequate

Updated 29 September 2016

The service was not well led.

Leadership and management of the service was inadequate. Concerns identified at our last inspection had not been fully addressed; new concerns were identified at this inspection.

Checks and audits had not enabled the provider to meet regulatory requirements.

Notifications were not always made to the Commission when needed.