This inspection was carried out on 3 and 17 March 2015 and was unannounced. Keychange Charity Romans Care Home is a service which is registered to provide support and accommodation for up to 30 older people some of whom were living with dementia. Accommodation is provided over three floors and there was a lift available to access all floors. There were a total of 34 members of staff employed plus two deputy managers and the registered manager. On the day of our visit 23 people lived at the home.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.
People told us they felt safe. Relative’s told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.
Care records contained risk assessments to protect people from any identified risks and helped to keep them safe. These gave information for staff on the identified risk and guidance on reduction measures. There were also risk assessments for the building and emergency plans were in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.
Recruitment checks were carried out on newly appointed staff to check they were suitable to work with people. Staffing levels were maintained at a level to meet people’s needs. People told us there were enough staff on duty and this was also confirmed by staff.
People told us the food at the home was generally good. However some people said there could be more variety and one person told us they liked a cooked breakfast but they had only had this once in three months. Four people told us they were disappointed that their access to fresh fruit at all times had been stopped recently. There were facilities for people using the service and their visitors to prepare their own drinks when required.
People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. The provider’s medicines policy was up to date. There were appropriate arrangements for obtaining, storing and disposing of medicines
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no people living at the home who were currently subject to DoLS. We found the manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. People were able to make day to day decisions for themselves. There were no restrictions imposed on people. The manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.
Each person had a plan of care which provided the information staff needed to support people and staff received training to help them meet people’s needs. Staff received regular supervision including observations of staff carrying out their duties. Monitoring of staff performance was undertaken through staff appraisals which were conducted every six months.
Staff were supported to develop their skills by receiving regular training. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications (NVQ) or Care Diplomas (These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard). All staff completed an induction before working unsupervised. Staff had completed mandatory training and were encouraged to undertake specialist training from accredited trainers.
People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff. Regular competency checks were carried out on the standard of care provided.
Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handovers at the beginning of each shift. The home was well supported by a range of health professionals. We contacted a GP practice who provided a service to some of the people at the home. They told us that the manager and staff were very approachable and had good communication skills; they said the staff were open and transparent and worked well with them to meet people’s needs
The registered manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication between all staff was good and they always felt able to make suggestions and confirmed management were open and approachable.
The registered manager acted in accordance with the registration regulations and sent us notifications to inform us of any important events that took place in the home of which we needed to be aware.
The provider had a policy and procedure for quality assurance. The registered manager was visible and the area manager visited the home regularly and visits from trustees also took place from time to time. The registered manager operated an open door policy for both staff and people using the service and their relatives. Weekly and monthly checks were carried out to help monitor the quality of the service provided. There were regular residents meetings and their feedback was sought on the quality of the service provided. There was a complaints policy and people knew how to make a complaint if necessary.