Roland Residential Care Homes - 231 North Circular Road

The care home accommodates people in 1 adapted house across 3 floors. People had access to communal bathrooms, living/dining room, kitchen and garden.

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

People received care and support according to their individual needs. However, we recommended the service to make sure staff fully understood the principles of person-centred care and how to apply them effectively.

People using the service felt safe and protected from abuse. Staff knew how to identify abuse and raise concerns. Risks to people’s health, care and safety were assessed and reduced. People received their medicines on time and as prescribed. Staff followed infection prevention and control measures to keep people safe from infections.

There were sufficient and suitably qualified staff on shifts. They received appropriate training and support to perform their work.

Manager’s assessed people’s needs prior to them moving to the service, and reviewed these as needed. People’s eating and drinking needs were met. Staff supported people to access healthcare services and to lead healthy lives.

Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff cared for people well and treated them with respect, while promoting their independence. People were involved in making decisions about their care as much as possible.

Staff supported people to remain socially engaged, which promoted their wellbeing. Staff also respected people’s equality and diversity needs. There was a system to record and investigate complaints.

Managers and staff were aware of their roles and responsibilities, and worked as a team. Staff carried out regular checks on different aspects of the service to monitor and improve the quality of care delivered to people. The service worked in collaboration with other organisations to provide effective joined-up care to people.

There was a positive atmosphere in the service and people were happy with the care and support they received.

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

Rating at last inspection

The last rating for this service was good (published 28 November 2017).

Why we inspected

This inspection was prompted by the time since the service was last inspected and rated.

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.

Recommendations

We made a recommendation about person-centred care.

Follow up

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

We found the following examples of good practice.

¿ Information was available to all visitors which specified the processes in place to facilitate safe visits. Due to limited availability of indoor space, 231 North Circular Road was unable to facilitate safe visiting for relatives. However, alternative measures were in place at one of the providers other locations. and information had been provided to all relatives on how to facilitate this safely.

¿ Where other visitors arrived at the home such as health and social care professionals, they were screened for symptoms of COVID-19, asked to completed lateral flow device tests and provided with Personal Protective Equipment (PPE). This enabled the service to protect people, staff and visitors.

¿ The service, however, does have an open garden area with separate access to allow safe visiting weather permitting.

¿ The service ensured all staff received appropriate training, support and guidance throughout the pandemic period. Observation and reflective practices were used to assess staff competency in these areas.

¿ Staff were observed to be wearing PPE in line with government guidance and the providers policy.

¿ Individualised risk assessments had been completed for people, which considered risks associated with their health and medical support in relation to COVID-19. The assessment also provided guidance to staff on how minimise risk.

¿ The service monitored and screened people living at the home and staff daily for any signs or symptoms of possible infection. This enabled the service to take immediate action if anyone was identified with symptoms of COVID-19 to prevent and minimise the risk of transmission.

¿ People and staff had access to regular COVID-19 testing as per government and Public Health England guidance.

¿ New staff rotas had been devised to minimise staff movement across services especially where active outbreaks had been identified within the providers other registered locations. This minimised and prevented the risk of transmission.

¿ The home was clean and hygienic. Robust cleaning processes in place followed the providers Infection Prevention and Control policy and procedures. Overall cleaning responsibilities was the responsibility of the entire staff team to ensure good infection prevention and control.

¿ The home worked towards supporting social distancing, but this was not always possible due to the layout and small size of the home.

¿ The provider followed current guidance and directives in relation to the COVID-19 pandemic. All information was shared with all staff through regular meetings and daily handovers.

Further information is in the detailed findings below.

This inspection was carried out on 25 October 2017 and was unannounced.

At the last inspection on 22 July 2015 the service was rated ‘Good’.

At this inspection we found the service remained ‘Good’.

People told us that they felt safe living at the home and with the care and support that they received from care staff. Care staff demonstrated a good understanding of how to safeguard and keep people safe and how concerns should be reported.

Risk assessments identified and assessed people’s individual risks associated with their care, support and health needs and provided guidance on how care staff were to support people to mitigate or reduce risks.

Medicine records confirmed that people were supported with their medicines safely and appropriately. Systems were in place to ensure medicines were handled and stored securely.

Safe recruitment practises were noted to ensure that only care staff suitable to work with vulnerable people were recruited.

Appropriate staffing levels were in place to ensure people were supported according to their needs.

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.

Records confirmed that all care staff received an induction followed by on-going training in a variety of topics to support care staff in carrying out their role effectively. Staff confirmed that they were supported appropriately through regular supervision and an annual appraisal.

We observed people had developed caring relationships with care staff that were based on mutual respect. Care staff knew people well and were aware of their needs, preferences as well as their personalities and how they wished to be supported.

Care plans were detailed and person centred and were reviewed on a monthly basis through key worker sessions in partnership with the person.

People participated and were supported to take part in their choice of activities as and when they so wished. People were supported to maintain their independence and took active roles in taking care of their home and environment.

The service had not received any complaints since the last inspection. Systems were in place to address any complaints received.

The registered manager and provider had a number of systems in place to monitor the quality of care that was being delivered.

Further information is in the detailed findings below.

During this inspection we spoke with two people who used the service and one relative of a person who used the service. We also spoke with five members of staff who included the registered manager, senior manager, who was responsible for overseeing the registered manager and care staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Two people who used the service told us that they felt safe in the home and that staff treated people with respect and dignity. One person said, 'Staff are marvellous. They are very polite and respectful'. People who used the service told us that they felt safe living in the home.

The home had a safeguarding policy which included guidelines on how staff should respond and act if they suspected abuse was taking place.

We looked at the training records for four members of staff and noted that the records indicated that they had received in-house safeguarding training. When we discussed safeguarding with staff, the majority of staff were aware of the signs of abuse. All staff we spoke with were aware of the action to take when responding to allegations or incidents of abuse and were also aware that they could report allegations to the local authority, the Care Quality Commission (CQC) and the police.

We saw evidence that necessary employment checks had been carried out to ensure that people were cared for by suitably qualified, skilled and experienced staff.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. There was evidence that staff had received appropriate supervision and appraisals which enabled them to perform their work appropriately and ensure people using the service were safe and protected.

We saw that people were able to move around the home freely. We also noted that people living in the home were not subject to continuous supervision and control by staff.

Is the service effective?

People we spoke with said that they were satisfied with the care provided in the home and felt that people's needs had been met. One person said, "Staff listen to me. I like it here'. People were positive about staff and said that they were helpful and listened to them.

We looked at three care files and saw that people's care needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out where necessary and there was evidence that these were reviewed. Care plans included information about people's preferred routines and healthcare needs.

All the staff we spoke with told us that they were well supported by the registered manager and felt able to ask the registered manager questions. One member of staff said, 'I am very well supported. The staff are friendly and helpful'.

Staff had received appropriate training in various areas to meet the needs of the people living in the home.

Staff, family members, healthcare and social care professionals were involved in decisions about people's care and we saw evidence of this. Relatives of people who used the service told us that they were kept informed about people's progress.

Is the service caring?

People told us that they had been treated with respect and dignity in the home.

During our inspection, we found that people who used the service approached staff without hesitation and people appeared comfortable around members of staff. There was good interaction between staff and people who used the service. People looked well cared for and we saw that the atmosphere in the home was relaxed.

Staff we spoke with said that they were aware that all people should be treated with respect and dignity and were able to give us examples to demonstrate how they ensured this.

Is the service responsive?

People who used the service and a relative we spoke with told us that if they had any concerns or complaints, they would feel comfortable raising them with staff or the management at the home.

We saw that the home had a complaints policy and procedure and we noted that the home had not received any complaints since our last inspection.

People's care and health progress were monitored closely. People's care plans and their health needs were regularly reviewed.

The senior manager confirmed that they completed regular audits which included audits of health and safety, care plans and staff files and we saw evidence of this.

Is the service well-led?

We found that adequate arrangements were in place for monitoring and reviewing the quality of the service provided to people.

At the time of our inspection, the provider did not have a quality assurance policy. Following our inspection, the provider sent us evidence of their quality assurance policy and procedure.

Resident's meetings were held monthly which enabled people to discuss issues regarding the running of the home. This encouraged people to raise queries and concerns with management and members of staff.

Staff meetings were held every two months and we saw evidence to confirm this.

All staff we spoke with told us that they felt able to consult the registered manager if they had concerns or queries and said that they felt supported. Staff were positive about working at the home.

Systems were in place to ensure people were able and supported to take their own medications safely. We saw that people's rooms and all communal areas were well maintained. People were asked for their views about the home, these were listened to and action taken where the service needed to make improvements.

The provider had systems in place to protect people from the risk of abuse. We found that staffing levels were sufficient for the needs of people who use the service. The provider had an effective system in place to acknowledge concerns and complaints and dealt with them promptly.