Archived: Roman House

At the comprehensive inspection of this service on 16th and 17th January 2018 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with a requirement notice for three breaches. This was because records of medicines management were not always completed correctly, staff had not received the necessary supervision and training to enable them to carry out their duties and the provider had not always ensured that effective systems were in place to assess and monitor the quality of the service provided and ensure appropriate action was taken to improve the quality and safety of the care people received.

We undertook an unannounced focused inspection of Roman House on 6 April 2018 to check that the provider had followed their plan and to confirm that they now met legal requirements. We inspected the service against three of the five questions we ask about services: is the service safe, effective and well led. This is because the service was not meeting some legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roman House on our website at www.cqc.org.uk

Roman House is a service which provides residential care for up to 26 adults with a range of needs including younger and older adults with mild to moderate learning disabilities. Care is provided to people who also live with additional health conditions such as diabetes, epilepsy, sensory loss and cerebral palsy. Roman House comprises two four bedroomed bungalows and a larger building which has additional accommodation with communal areas such as a sensory room, dining room and a lounge area. The bungalows and the main building have gardens to enable people to enjoy the outside space. The home is in a residential area of Basingstoke. At the time of the inspection 17 people were using the service.

Roman House 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 2008 and associated Regulations about how the service is run.

Roman House was last inspected in January 2018 and was rated as requires improvement. We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014 related to safe care and treatment, good governance and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do to become compliant with the regulations. We received the action plan on 16 March 2018. The provider stated that they would meet the relevant legal requirements by 30 April 2018. Due to a change in registration CQC decided to inspect this service before the provider’s proposed deadline so that we could explore compliance issues relevant to that change in registration. We needed to confirm that the provider would be able to meet the regulatory requirements prior to the change in registration. This was discussed with the provider prior to the inspection commencing.

At this inspection we found that the provider had met the requirements for safe care and treatment, staffing and good governance.

People who lived at the home said that they felt safe. Staff showed a good understanding of safeguarding procedures and actions to take to protect people from the risk of avoidable harm or abuse. People’s safety was promoted as care plans contained specific guidance for staff about how to manage health risks for people.

Staff sought consent to care and treatment whilst supporting people. The provider had complied with the requirements of the Mental Capacity Act 2005.

We observed people living in the home being treated with dignity and respect. People felt that they received care from staff who were kind and compassionate. We observed staff talking to people in a friendly and personable manner during the inspection.

People were supported to eat and drink enough to maintain a balanced diet. Staff supported people’s individual food and drink preferences. People’s dietary needs were catered for.

People received support from healthcare professionals in order to help them lead healthier lives. There was evidence in people’s care plans that they had received visits from professionals such as district nurses and speech and language therapists. Since the last inspection the provider had made improvements to records in people’s care plans. Consistent records were available for those people who had received visits from healthcare professionals.

The building had been adapted to meet the needs of people living in the home. Since the last inspection required repairs had been completed to make the environment more suitable for people. The communal areas had also been redecorated.

The service worked in partnership with other agencies such as the local authority.

At this inspection we rated the home as Requires Improvement.

This inspection took place on the 16 and 17 of January 2018 and was unannounced.

Roman House is a service which provides residential care for up to 26 adults with a range of needs including younger and older adults with mild to moderate learning disabilities. Care is provided to people who also live with additional health conditions such as diabetes, epilepsy, sensory loss and cerebral palsy. Roman House comprises two four bedroomed bungalows and a larger building which has additional accommodation with communal areas such as sensory room, dining room and lounge area. The bungalows and the main building have gardens to enable people to enjoy the outside space. The home is in a residential area of Basingstoke. At the time of the inspection 18 people were using the service.

Roman House 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 2008 and associated Regulations about how the service is run.

Roman House was last inspected in August 2017 and was rated inadequate in safe with an overall rating of requires improvement. We found breaches of five regulations of the Health and Social Care Act 2008 (Regulated activities). Regulations 2014 related to dignity and respect, the need for consent, safe care and treatment and good governance and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do to become compliant with the regulations. We received the action plan on 18th October 2017. The provider stated that they would meet the relevant legal requirements by 31st December 2017.

At this inspection we found that the provider had met the requirements for dignity and respect, and the need for consent. There were however three continued breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 in safe care and treatment, good governance and staffing.

The provider had not always ensured that effective systems were in place to assess and monitor the quality of the service provided and ensure appropriate action was taken to improve the quality and safety of the care people received. The provider’s service improvement plan and quality assurance audits had identified a number of required improvements however several actions identified since the last inspection had not been met by the proposed deadlines.

People’s care plans and risk assessments were not regularly reviewed to ensure that the information was updated. The provider had not taken appropriate action to ensure that risks to the health and safety of people receiving care had been appropriately documented. Clear guidance was not available to support staff in managing people’s health conditions and the related risks.

The provider had not maintained an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided

There were not appropriate arrangements for the safe storage and administration of medicines and the provider had failed to document each person’s allergies on their medicines administration records. Charts were not available for staff to record the application of creams to people’s skin. This presented a risk that people could suffer harm from receiving the medicines or creams they were allergic to.

Some improvements had been made to ensure that safe and effective control measures were in place to prevent the risk of people acquiring an infection, however we found that people were still at risk as the outside bin area was dirty and clinical waste bins had not been kept locked.

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The provider had ensured that they were consistently deploying the numbers of staff to meet people’s personal care needs. People received care from staff who were not always given the right training and support. Records had not been fully updated for staff appraisals at the time of inspection. The provider had not ensured that staff received the required induction, training and support required to enable them to provide person centred care which met people's individual needs and preferences.

People who lived at the home said that they felt safe. Staff showed a good understanding of safeguarding procedures and actions to take to protect people from the risk of avoidable harm or abuse. However people’s safety was not always fully promoted as full and explicit guidance as to how to manage certain health risks had not been provided for staff to support some people.

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The registered manager aimed to develop a person centred, inclusive and empowering culture in the home but the large number of actions from the service improvement plan meant that they were not able to fully engage in this. The registered manager had begun to use some methods to seek feedback on the quality of the service from people, relatives and the public. There was however a lack of evidence to show that the information had been used to drive service improvements.

Most people told us that they felt able to express their views and opinions. There was however a lack of consistent methods for gathering the views of people living in the home. People told us that they knew how to complain, however, there was no record of how people’s complaints were used to drive service improvements.

Staff sought consent to care and treatment whilst supporting people. The provider had complied with the requirements of the Mental Capacity Act 2005.

We observed people living in the home being treated with dignity and respect. Most people felt that they received care from staff who were kind and compassionate. We observed staff talking to people in a friendly and personable manner during the inspection.

People were supported to eat and drink enough to maintain a balanced diet. Staff supported people’s individual food and drink preferences.

People received support from healthcare professionals in order to help them lead healthier lives. There was evidence in people’s care plans that they had received visits from professionals such as district nurses, although this was not seen consistently in all people’s records. .

The building had been adapted to meet the needs of people living in the home. Some repairs were outstanding. The registered manager had arranged for these to be completed.

The service worked in partnership with other agencies such as social services.

At this inspection we found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of this report.

At this inspection we rated the home as requires improvement. This was the second consecutive requires improvement rating.

Roman House is a service which provides residential care for up to 26 adults with a range of needs including younger and older adults with mild to moderate learning disabilities. Care is provided to people who also live with additional health conditions such as diabetes, epilepsy, sensory loss and cerebral palsy. Roman House (also to be referred to as the ‘the home’ throughout the report) comprises two four bedroomed bungalows and a larger building which has additional living accommodation with communal areas such as sensory room, dining room and lounge area. The bungalows and the main building have gardens with a number of seating and shaded areas to enable people to enjoy the outside space. The home is in a residential setting on the outskirts of Basingstoke. At the time of the inspection 19 people were using the service.

Care was provided by support workers who will be referred to as staff throughout this report.

Roman House did not have 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 2008 and associated Regulations about how the service is run. The registered manager left the home seven weeks prior to the inspection. Managerial support was being provided by a manager from another service, the home’s team leader, the provider’s area manager and quality team.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. However people’s safety was not always promoted as risks which may cause them harm had not been identified. Guidance had not always been provided to staff to help them manage these risks appropriately for people.

People were not supported by sufficient numbers of staff to meet their needs. The provider was unable to show they regularly reviewed staffing levels to ensure sufficient staff were deployed to meet people’s changing needs. People had to wait to receive care and those people receiving individualised care from one member of staff were not always accompanied to ensure they remained safe from risk of harm.

People did not always receive their medicines safely. Staff responsible for managing medicines had not received the appropriate training and competency assessments to ensure their suitability for the role. Medicines were not always stored, administered and documented appropriately.

People were not always supported by staff who received appropriate training enabling them to meet people’s individual needs. Staff had not received regular supervision to ensure they felt supported and able to perform effectively in their role.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in place did not always support this practice. It had not always been clearly documented where people lacked the capacity to make specific decisions for themselves that actions taken on their behalf were always in their best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The manager showed an understanding of what constituted a deprivation of a person's liberty however had been required to submit any applications since starting work at the home. Previously submitted applications however had not been correctly completed to ensure people were not being deprived of their liberty without appropriate legal authority.

People told us they were able to choose their meals and were offered alternative meal choices where required. People's food and drink preferences were documented in their care plans and were understood by staff.

The provider’s values and people’s rights whilst receiving care were documented in people’s care plans. However, staff did not always understand these and we could not see these standards were always followed in the way care was delivered.

Most people told us care was delivered by caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them as they moved around the home. However, we did not see that people’s privacy and dignity was always respected and promoted by staff.

People’s care plans and risk assessments were not regularly reviewed to ensure they remained accurate to enable staff to effectively meet people’s needs. Care plans and risk assessments did not always contain the detailed information to assist staff to provide care in a manner that respected each person's individual requirements.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints. However, it was not shown these complaints were used as a way to drive the improvement in the quality of the service people received.

The manager wished to promote a culture which focused on being positive, open and honest. However, changes in the management structure of the home, uncertainly and lack of communication regarding a new provider takeover had impacted on the morale and overall positive atmosphere of the home. The manager was in the process of providing positive leadership to ensure the quality of the service people received would improve and was enthusiastic about people receiving care and support that helped them live happy, independent and fulfilled lives.

Quality assurance processes were not always effectively completed to ensure that people, staff and relatives could provide feedback on the quality of the service provided.

Where concerns had been effectively identified by the provider we saw immediate action was being taken to address the shortfalls identified to ensure people received the care they required.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People’s health needs were met as the staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified healthcare needs were met and to maintain people’s safety and welfare.

The previous registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

At this inspection we found eight breaches of five Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the end of the full version of this report.

On the day of our inspection we were told there were twenty three people in the home. We spoke with thirteen people who used the service were positive about their care and support and the conduct of the staff towards them. They told us that their dignity and privacy was respected and that staff were polite and caring in their approach. People told us that staff supported them to maintain their independence. One person told us ''staff are helpful'. People we spoke with said they were assisted to be as independent as they wished to be.

We noted people were encouraged to choose and take holidays in the UK and in Europe. On the day of the inspection, we were told that two people were on a Mediterranean cruise with support from two staff members.

All people we spoke with, who used the service told us that they were happy with the support they received in relation to their personal care. They told us that they were happy living in the home.

The thirteen people, spoken with told us they felt safe and were well treated by the care staff and the manager. They told us that they felt able to approach the manager and the team care coordinators if they had any concerns.

We found that people had been involved in planning their care and staff were familiar with people's needs. Staff had received appropriate induction and training and their manager provided them with regular supervision. Staff were also supported through a system of supervision and appraisals.