This unannounced inspection took place took place on 7,8 and 9 August 2018. At our last comprehensive inspection on 10 August 2016, we rated the service ‘Good’. We brought forward our inspection to look into concerns we received in relation to the safety and the management of the home, including how the service operated at night times.
We carried out an unannounced inspection of the home on one night and on the two following days. We did not find evidence to substantiate the concerns we received and we have found the home remains ‘Good’.
Romford Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.
Romford Care Centre accommodates up to 114 people across five units, each of which have separate adapted facilities. The units specialise in providing nursing and residential care to older people living with dementia. At the time of our inspection, 95 people were living in the home.
The home did not have a registered manager in post as the person who held this position, left their role a month before our inspection. 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 has since appointed a new manager who will register with the CQC.
Each unit in the home was managed by a registered nurse or a team leader, who were supported by a deputy manager and an operations manager. We met with both these managers during our inspection.
Risk to some people had been assessed and identified. However, we noted that risks to some people were not always identified in their risk assessments and there was a lack of overall consistency, to ensure all risks were being managed. We have made a recommendation for the provider to ensure risk assessments are clear and contain relevant and consistent information.
People were involved in the planning of their care and received care and support to ensure their individual needs were met. Care plans contained information on people’s backgrounds and preferences. However, we have made a recommendation for care plans to take a more person-centred approach towards people’s end of life care wishes and for staff to receive further training in this area.
The provider had safe recruitment procedures in place and carried out checks on new employees.
There were enough staff on duty to ensure people's needs were met. Staff rotas were not always completed to show that staff cover had been arranged when required.
The management team was committed to developing the service and this was done through quality assurance systems that were in place. Some further improvements were required to ensure people received a responsive service because some people and relatives did not always feel listened to.
Medicines were stored, managed and administered by staff who were trained. We saw that medicines on all units were managed and used safely.
Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met. People were provided with a choice of meals and were able to make specific requests.
Feedback was received from people and relatives in the form of questionnaires and surveys to help drive quality improvements.
Records of accidents and serious incidents showed that the provider learned from mistakes to prevent reoccurrence.
People and relatives were able to make complaints, which were investigated by the management team. Complaints were planned to be used to also learn lessons and make improvements in the service.
The premises were clean and regularly maintained. The environment was suitable for people who had specific needs such as dementia.
Infection control procedures were followed by staff to ensure the home remained safe and clean.
Staff knew how to keep people safe and protect them from abuse. They were able to describe the actions they would take if they had any concerns about people’s safety. The provider also had a whistleblowing policy, which staff were aware of and they knew how to report concerns both internally and to external organisations.
Staff were supported with regular training, meetings and supervision. Staff performance was reviewed on a yearly basis and they were encouraged to develop their skills.
The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff had received training on the Mental Capacity Act 2005. They were knowledgeable of the processes involved in assessing people’s capacity.
Staff were aware of people’s preferences, likes and dislikes. They also had an awareness of equality and diversity and challenged any discrimination they encountered.
People were encouraged to participate in activities and remain as independent as possible. Their choices were respected.
Staff were able to communicate with people in order to understand their needs.
Staff felt supported by the management team, who reminded staff of their responsibilities and requirements when providing care.