Keychange Charity Romans Care Home

We found the following examples of good practice.

The home had been impacted by an outbreak of Covid-19 early in 2021. The home had introduced and maintained effective systems and processes to prevent the spread of infection. For example, any new admissions to the home were assessed to include any risks posed by Covid-19. People had to isolate in their rooms for 14 days following admission.

Following the outbreak, the home was now clear of Covid-19 and open to visitors from 8 March 2021. Any visitors were subject to checks at the front door before being allowed in. Visitors were required to undertake a lateral flow device (LFD) test; if the result was negative, they were allowed into the home and directed to a separate room adjacent to the front door. A ‘pod’ in the garden, made of clear plastic, enabled people to meet their relatives safely and at a social distance. The visiting room and pod were cleaned after each visit. Masks and hand-gel were supplied to visitors. The provider had an admissions policy which was followed by staff.

Staff were tested weekly for Covid-19 through polymerase chain reaction (PCR) tests and at the start of their shift using LFD tests. Some staff and people were exempt from testing having contracted Covid-19 previously.

Risk assessments had been completed for people and staff. For example, one person made a weekly visit to their relatives’ home, and measures had been taken for these visits to be undertaken safely.

Effective infection prevention and control systems had been implemented. Staff had completed training in infection prevention and control. Personal protective equipment (PPE) was provided and staff knew how and when to use this in line with government guidance. There were PPE stations located around the home, so staff could easily access masks, gloves, aprons and hand-sanitiser. Spot checks had been completed and demonstrated that staff employed hygienic hand-washing practices.

Observations made around the home evidenced that laundry, including soiled washing, was managed safely. Kitchen staff did not have direct contact with care or housekeeping staff. When people were in isolation, their food was delivered on different coloured trays from those people not having to isolate. The red or brown trays in use were handled separately to prevent the risk of spread of infection. The home was seen to be clean and hygienic, with ‘high touch’ areas being cleaned regularly. Regular cleaning schedules, including deep cleaning, had been implemented.

Staff were encouraged to take their breaks separately and anyone who smoked went outside to a designated area.

The registered manager felt supported by the provider and by local health professionals, such as the GP who offered counselling to staff.

Keychange Charity Romans Care Home is registered to provide accommodation and care for up to 30 older people with a variety of health and support needs, including some people living with dementia. At the time of our inspection 23 people were living at the home, including one person who was staying for a short break. Keychange Charity Romans Care Home is a large detached house close to amenities in Southwick. Communal areas include a main lounge, dining room and large conservatory adjacent to the dining room. A secure, fenced garden is located at the rear of the premises. Accommodation is provided for people over three floors, with lift access.

At the time of our inspection, the registered manager had left the service and had applied to de-register with the Care Quality Commission; plans to recruit a new manager had not yet been put 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 day-to-day management of the service was being undertaken by two deputy managers.

Robust systems were not in place to monitor and measure the quality of the service overall at the home. Some monthly checks had been completed, but there was no audit in place for the management of medicines.

Staff had a good understanding of the Mental Capacity Act 2005 and associated legislation. However, one person, who had bedrails, did not have the necessary consent or best interests decision in place. This was discussed with management who stated appropriate steps would be taken to rectify this.

Relatives and people spoke highly of the care they received and written comments were positive. People felt they were involved in developing the service through residents’ meetings and formal monthly surveys about different aspects of the home. Staff felt supported.

People felt safe living at the home. Staff had been trained to recognise the signs of potential abuse and knew what action to take if they had any concerns. Risks to people were identified, assessed and managed safely with appropriate guidance for staff. Staffing levels were sufficient to meet people’s needs, although comments from people were mixed. Some people felt there were enough staff and others said there could be a shortage, especially at busy times of the day. Safe recruitment practices were in place. Medicines were managed safely.

Staff had been trained in a range of areas, received regular supervisions and attended staff meetings. People felt that staff were well trained and approachable. Training was delivered to staff in an electronic format. New staff followed the Care Certificate, a universally recognised qualification. People had sufficient to eat and drink and were offered a range of choices in their meals. Drinks were readily available throughout the day and night. People had access to a range of healthcare services and were supported by healthcare professionals.

People were looked after by kind and caring staff who knew them well. People spoke positively about the caring nature of staff and that staff responded promptly to their needs. People’s spiritual needs were catered for. People were encouraged to express their views and to be involved in all aspects of their care. They were treated with dignity and respect.

Care plans provided information about people and guidance for staff on how they wished to be cared for. Care plans were in the process of transferring from written records into an electronic format. Detailed information had been drawn up on every aspect of people’s care. A range of activities was available to people which were planned by an activities co-ordinator. People felt there was enough to keep them busy. Complaints were managed in a responsive manner.

The staff also told us they felt valued and supported by the management and had their training needs met. The staff told us they felt confident that the quality of individualised care delivered in Romans Keychange was of a high standard. We found care plans, staff records and other records relevant to the management of the home were accurate, reviewed regularly and fit for purpose.

The home had systems in place to assess and continually review the service that it provided and had made improvements where needed. We found that people were involved in all aspects of their care, and in any changes to the service that may have affected them.

We also looked at other records to help us understand the needs and views of the people who used the service. These included residents, relatives and health professional satisfaction surveys, resident's meeting minutes, staff personnel files, the home's incident and complaints log, the communication book and the home's operational policies.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We looked at the records of three people and found that people's care was assessed, and planned and delivered on this basis.

Everyone we spoke with said they were looked after well by staff. One person said "They've been very good to me". We spoke with visitors to the home. Their comments included "Everyone seems happy and there's always a good atmosphere" and "The home is really good and the staff are all very friendly".

We looked at messages of thanks from people who lived at the home and their families. One relative wrote, "Staff at the Romans have been unstinting in their help, advice and support ... they continue to provide safe, kind, caring support ... and their professionalism is outstanding". Another relative had written, "I cannot express how kind and caring all the staff are at Romans ... they gave us all the help that was needed - and more - both physically and emotionally".

We saw that staff had a good understanding of the needs of the people who lived at the home, and received the training and support they needed.

There were systems in place to assess and monitor the quality of service that people received.