Archived: Romford Grange Care Home

At our last inspection on 9 June 2017, the home was rated ‘Requires Improvement’. The home was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as we found that the premises were not being maintained. We also found that room temperatures where medicines were stored exceeded recommended levels, activities did not meet people’s needs and robust audit process were not in place to identify shortfalls. At this inspection we found improvements had been made in these areas and the home has been rated ‘Good’.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

Risks had been identified and assessed, which provided information to staff on how to mitigate risks to keep people safe. Staff had been trained in safeguarding adults and knew how to keep people safe.

Medicines were managed safely. We found that people’s Medicine Administration Records (MAR) had been completed accurately. Medicines was being administered as instructed on people’s MAR, or in accordance with the provider’s policy. Medicines were stored securely and within accepted temperature levels.

Incident records were reviewed and these showed the provider took appropriate action following incidents that had been recorded. Systems were in place to analyse incidents for patterns and trends to ensure lessons were learnt and incidents were minimised.

Systems were in place to reduce the risk and spread of infection. Staff had access to personal protective equipment and used this when needed.

There were sufficient staffing levels to support people. Dependency assessments were carried out to calculate the number of staff needed contingent to people’s needs. Premises safety checks had been carried out to ensure the premises was safe.

Staff had the knowledge, training and skills to care for people effectively. Staff felt supported to carry out their roles. However, supervisions of staff had not been completed regularly, to ensure staff felt supported at all times. We made a recommendation in this area.

People had choices during meal times and were supported with meals when required. People and relatives told us people enjoyed the food. People’s weights were regularly monitored and referrals made to health professionals if there were concerns with people’s weight. People had access to healthcare services.

Some people who lived at the home were deprived of their liberty under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty applications had been made and granted to restrict people’s lawfully. Staff were aware of the principles of the MCA and assessments had been carried out to determine people’s ability to make decisions in certain areas.

People and relatives told us that staff were friendly and caring. Our observations confirmed this. People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights. People had been involved with making decisions about their care.

People received care that was shaped around their individual needs, interests and preferences. Care plans were person centred and staff knew how to provide personalised care to people. People and relatives were aware of how to make complaints if they wanted to and staff knew how to manage complaints.

Regular activities took place in the home. However, there was not a schedule in place for individual activities for people. We made a recommendation in this area.

Staff felt well supported by the management team. People, relatives and health professionals were complimentary about the management of the home. Quality assurance and monitoring systems were in place to make continuous improvements.

On the day of the visit there had been no registered manager since April 2017. There was an acting manager in place pending recruitment of a manager. 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.

People told us they felt safe living at Romford Grange. Staff had received safeguarding training and were aware of the procedures in place to protect people from avoidable harm.

Risk assessments were in place and known by staff in order to protect people from harm.

People and their relative had mixed reviews about the staffing. Although enough staff were deployed some people were not happy with the regular use of unfamiliar agency staff. We noted that recruitment was in process in order to fill the current vacancies.

Medicines were administered safely by staff who had been assessed as competent. However, medicine room temperature checks sometimes went above the recommended storage temperatures. There were no documented temperature rechecks or actions taken to keep the room at a suitable temperature for medicine storage. This increased the risk medicines losing their effectiveness.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff were aware of the Mental Capacity Act (MCA) and how this applied when delivering support to people.

Care plans were person centred, updated regularly and reflected wishes, goals and aspirations. They included life stories and people's current interests.

People told us they were treated with dignity and respect. They were happy about the food and told us they were supported to access health care services when required.

Activities were in place, however people thought they could be more varied and stimulating.

People and their relatives told us they were able to make a complaint. Complaints were investigated and actions taken were known by staff.

People and their relatives thought the acting manager was approachable and had made a few positive changes. However, there was no registered manager in place or deputy manager at the time of inspection. Although renovations were in progress the premises were still in places not maintained and posed a potential safety hazard.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which can be found at the end of this report.

Romford Grange Care Home is registered to provide accommodation for 41 people

who require nursing or personal care. The home provides services to adults who have a physical disability, people with dementia care needs, older people who are physically frail and those in need of nursing care. On the days of our visit there were 38 people using the service.

There was a registered manager in place. 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 service was not always well-led. Although a lot of progress had been made to implement changes and manage poor performance, there was still a divided culture with some staff resistant to change. We have made a recommendation about motivating staff and team building.

Quality monitoring systems were in place. However we identified shortfalls with the cleanliness, maintenance of premises and record keeping.

People were supported to eat but were not always supported to drink sufficient amounts. We have made a recommendation about hydration.

The premises and equipment were not always clean or well maintained.

Care plans included people’s preferences and involved people and their relatives as much as possible. We saw people participate in various activities such as doing puzzles, playing bingo and gardening. We noted that people in their rooms did not receive much stimulation compared with those who chose to stay in communal areas and recommend more effort is made to address this.

There were robust recruitment procedures in place in order to ensure that only people who had undergone the necessary checks were employed.

However we noted that people were supported by staff that were not always able to support them effectively. Which meant people sometimes received inappropriate care that did not meet their needs.

People told us that they were happy living at the home and that their wishes were respected. Staff were aware of the procedures in place to protect people from harm. They were able to demonstrate understanding of emergency procedures including fire and accident reporting.

Staff had attended relevant training and were aware of how to apply the Mental Capacity Act in their daily role. They were supported by means of regular supervision and annual appraisal. Staff meetings were held to enable them to share their views.

Medicines were managed safely. Any complaints made were acknowledged and responded to in accordance with the service’s policy.

Care plans were in place to help people maintain their health and safety. There were also procedures to ensure that people who were using the service were involved in their care and asked for their consent before they received any care or treatment. In cases where people were not able to make a decision about their own care because of capacity the provider adhered to relevant guidance on how to work in that person's best interest.

The provider had an effective system of audits which monitored the quality of the service and there were action plans in place for when any problems or improvements were identified.

People were provided with a choice of suitable and nutritious food and drink. There was a good range of food choices available and the options were clearly displayed. We observed that people who had difficulty with eating and drinking were supported by staff so that they could eat and drink sufficient amounts to meet their needs.

There were enough qualified, skilled and experienced staff to meet people’s needs. Staffing levels had recently increased in response to staff requests to have additional cover during the early evening period. Staff worked on a six-weekly rota and staff absences were adequately covered by the provision of 'bank' staff.

The manager told us that she has had meetings with staff and relatives about the concerns raised over standards of care and to inform people about the plans for improvement. Relatives told us that things had changed for the better, one relative said “the difference now is there is someone to talk to about issues and she will do something about it”.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risk assessments were in place and reviewed on a regular basis. This meant the risk of people receiving unsafe or inappropriate care was avoided.

People were cared for in a clean, hygienic environment. We looked at all the communal toilets and bathrooms at the location and found that they were all clean. We examined the sluice room and found it to be clean and tidy.

We spoke to the manager of the home who told us that an effective monitoring system had now been put in place to ensure that the home remained clean and properly maintained at all times. We examined the cleaning records that showed all rooms and equipment had been cleaned on a daily basis.

People had mixed views about the service. One of the relatives told us, “the food is good but it’s not always passed on to the residents, they make some nice cakes, but leave them on the trolley in the corner and do not go around asking people if they would like one”. A person who lives at the service said, ”they don’t always come straight away, they are very busy”.

Staff we spoke with had a good knowledge of how to identify and reduce the likelihood of pressure sores but the six care plans we examined contained inconsistent information about the care people with pressure sores should receive. For example one care plan had no treatment plan for a person who had been identified as at high risk of developing sores.

There were not effective systems in place to reduce the risk and spread of infection. We examined the commodes in nine of the bedrooms and found that seven of them were dirty with yellow or brown stains. We examined the sluice room and found a bedpan on the floor with faeces on it. This meant that people were at risk of infection from bacteria that grew in these unhygienic areas.