Keychange Charity Romans Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were supported by staff who had completed safeguarding training and understood how to keep people safe. The environment provided spaces for people to move around freely and independently. Staff vetted all visitors before they were allowed into the home. Systems had been implemented to record any incidents or accidents, and learning from these events minimised the risk of reoccurrence. People were encouraged with their independence and supported by staff in line with their wishes and choices. No undue restrictions were placed upon people. Risks to people were identified and assessed and care plans provided clear guidance for staff which was followed. There were sufficient staff on duty to meet people’s care and support needs. Call bells were answered promptly and people received help when they needed it. New staff were recruited safely to ensure they were suitable to work in a care setting.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff had completed training on safeguarding, understood the different types of abuse they might encounter and what actions they should take. One staff member provided an example of an incident they had been concerned about, regarding a person and their relative. They said, “Understanding of safeguarding is if you can identify a problem, then raise it so it can be investigated. It would be reported to the local authority. There are safeguarding policies and a chain of people to call.” Occasionally, people might become anxious and upset with each other, so staff may have to intervene to ensure people’s safety. A staff member explained, “We had one resident with a urinary tract infection (UTI) who was going into other residents’ rooms, which upset them, but it’s all sorted out now. Some people living with dementia threaten violence, but it’s more verbal abuse.” Another staff member said, “Safeguarding means making sure everyone is safe in the environment, no hazards, everything is clean, but mainly it’s about the resident’s welfare. You might get the occasional thing between residents, but it can be quickly sorted. We’ve only really had that once, verbal, and a little bit physical. One person has slapped the staff but it was dealt with well.” People were not restricted or restrained unlawfully.

Systems and processes were effective in monitoring and managing the safety of people and the environment overall. We reviewed accidents and incidents records relating to people between June and December 2023. Where incidents occurred, an incident form was completed and this included actions to be taken. For example, when a person sustained a fall, or multiple falls, a referral was made to the local authority falls team. One staff member was a ‘Falls Champion’ and delivered falls prevention training to the staff. Three care plans were reviewed with regard to risk assessments and these provided detailed information and guidance for staff. The electronic planning system in use highlighted to staff when risk assessments were to be reviewed. If an incident occurred, for example a person sustaining a fall, the relevant risk assessments would automatically be reviewed. The registered manager was part of the provider’s safeguarding team and supported other homes (also known as communities) to collect data and information and analyse any trends. For example, in November there had been medication errors, so staff were required to repeat medicines training. Three weekly quality assurance meetings took place and these included discussions on any safeguarding concerns and any improvements to be made. The provider had a whistleblowing policy which staff were aware of. This advised staff of actions they should take, who to report to and how they could raise concerns anonymously. Staff told us they had never had to use it, and if they had any concerns or issues, they would raise these with the registered manager.

People told us they felt safe living at the home. One person said, “I’ve lived here nearly a year now and I do feel safe.” Another person told us, “I feel safe with staff. We’ve got lovely staff here; they’re all helpful and kind.” We observed people were relaxed in their surroundings and comfortable with staff. Staff greeted relatives and friends to the home and they signed a visitors’ book. The front door was locked so anyone entering the home was accounted for. People told us they would raise any complaints they might have with the registered manager or one of the care staff. However, feedback from people was overall very positive with regard to feeling safe.

Staff knew people well, how to mitigate any assessed risks, and how to provide safe care and support. One staff member said, “If someone has a fall, the first thing we do is assess them for injury, make sure there aren’t too many people around, and we would clear the area. We ask the person if they can move their arms, legs and hips. If a person had banged their head and if they’re on a blood thinner, we need to be extra careful because of the risk of bleeding. We would see if the person could get up independently or if they needed a hoist. If someone fell during the night, night staff carry out observations and the senior will pick this up in the morning. If there was a head injury, we would call an ambulance.” Another staff member told us, “We have the care plans to refer to. We always make sure the senior knows if there is an unexplained bruise or cut for example. If a person has a fall, we try and make sure people have their frames with them, use the hand rails and support people who can become unsteady. We also make sure people have access to their call bells so they can ring if they need help. People at risk of falls have a sensory mat next to their beds, so we know when they’re moving around.”

A range of systems had been developed and implemented to manage risks. Fire alarm checks were completed every Friday, with fire drills. Fire doors were checked for closure and a senior staff member was nominated as fire safety warden on each shift to oversee evacuation of the building. An incident reporting group discussed any incidents or accidents that had occurred in the previous week, and measures to be put in place to mitigate any future risks. Care plans identified people’s individual risks such as falls, choking, and moving and handling. Staff demonstrated they knew people well, understood their particular risks and how to support them.

People’s independence was promoted and encouraged. Any risks were identified, assessed and managed well. One person said, “I can go out if I want to. I have a care button which means I am safe when I go out as well, so if I have a fall, they’d come and get me. I feel quite confident when I go out. I can go out for lunch or coffee with friends without having to have anyone with me.” Another person told us, “I have to have a wheelchair when I go out, and I have a Zimmer frame for walking indoors. I can go downstairs by myself.” Each person had a personal emergency evacuation plan written and this described the individualised support they needed. For example, one person who was at high risk of falls required 2 staff to support them if they needed to leave the building in the event of an emergency.

People were involved in the management of risks. We observed people having their lunchtime meal. The majority were able to eat without any assistance from staff. However, staff were on hand to support people when needed. For example, some people needed their food to be cut into smaller pieces to make it more manageable. Where assessed as needed, the texture of people’s food was modified to enable them to eat safely and with minimal intervention from staff. People were able to move freely around the home. Their independence was encouraged with the support of walking frames or assistance from staff. A lift enabled people to access the first floor. Ramps supported people to access outside areas. Calls bells were within reach for people to use.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall, staff felt there were enough staff on duty. The registered manager explained staffing levels were assessed according to people’s support needs. Agency staff were not required, and the registered manager told us they had no difficulty in recruiting to staff vacancies. One staff member said, “We have 5 care staff in the morning, 3 in the afternoon plus a team leader. With these levels, everything is perfectly manageable and we have time to spend with residents.” Another staff member felt there were not enough staff at the moment, but this was because of illness, and the challenges when staff went off sick. They explained, “People get all the care they need, but if staff go off sick, then it can be difficult. I always prioritise people who need me most. If someone was end of life, you need to spend time with them. It is hard sometimes, but you do your best.”

There were sufficient staff on duty to meet people’s needs and people confirmed this in their conversations with us. One person said, “I couldn’t wish for a better place. Everyone is lovely and all the carers, they can’t do enough for you. There might only be 2 staff on at night, but I don’t usually call; I don’t need anything. Staff come as quick as they can, you rarely have to wait for long.” Another person commented, “I don’t think you can ever have enough staff in a place like this, but staff usually come quickly.” Many staff had worked at the home for a number of years, were experienced in delivering care, and knew people well. Throughout the day of inspection, we observed staff were attentive to people’s needs, and call bells were responded to promptly. Staff were on hand in communal areas. For example, staff were responsive to people when they needed assistance at lunchtime. The registered manager oversaw the lunchtime experience in the dining room, prompting and directing staff as needed to ensure people received their meals quickly.

Robust recruitment systems ensured new staff were recruited safely. Checks were made with the Disclosure and Barring Service (DBS), which identified their suitability to work in a care setting and any criminal prosecutions. DBS checks were renewed every 3 years. Application forms were completed, and employment histories of potential new staff were checked; references were obtained. Staffing rotas were reviewed for the month of December. These corroborated 5 care staff, a senior, head of care and registered manager were on duty in the morning. In the afternoons, there were 3 care staff, a senior, head of care and the registered manager. At weekends, there were 5 care staff and 1 senior on duty. In addition to care staff, there were catering and domestic staff, a laundry assistant, activity assistant and handyperson. Agency staff were not required and the registered manager explained they had access to bank staff if required to fill any rota gaps. Some staff were trained to work flexibly. For example, laundry staff could deliver care and another member of care staff could also cook. This ensured a continuity of care from staff who knew people well. Staff received regular supervision from their line managers. There were plans to hold monthly meetings with care staff to discuss any issues, look at some case studies, and complete some training. Team leaders would run these meetings. The registered manager said falls had been quite prevalent when people went out, and arrangements had been made for a falls expert to come in and give a talk to staff.

There were sufficient, experienced and suitably qualified staff on duty at the time of our inspection. Call bells were answered promptly, and if people called out for assistance, staff attended to them quickly. In the dining room, staff were on hand to assist people if needed. Some staff were delivering lunchtime meals on trays to people eating in their bedrooms. Where required, staff provided 1:1 support for people who were unable to eat or drink independently.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.