About the service: Romney House is a small independent residential care home. At the time of our inspection, 17 people were living at the home.

People’s experience of using this service: At our last comprehensive inspection in November 2017, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We wrote to the provider to ask them what immediate action they would take to make the necessary improvements to meet the legal requirements. The provider sent us an action plan stating what action they were taking and by what date the action would be completed. In addition, they appointed an operations manager to take them forward with improvements and they continued to use support from the local authority quality assurance team.

During this inspection we found the provider had made most of the required improvements. They were no longer in breach of the Regulations in four of the previous five areas. The service continued to be in breach of the Regulations in the area of consent and overall continued and sustained improvements were required.

Risk assessments were not always comprehensive or consistent. Accidents and incidents were not regularly monitored for themes and trends to identify patterns or triggers.

People received support from staff who had appropriate employment checks in place. Staff were knowledgeable about their responsibilities to safeguard people from abuse. Medicines were administered and stored safely.

Staff were supported with regular one to one supervision and appraisal. There was a comprehensive training schedule in place and staff could progress in their skills and qualifications.

People’s needs and preferences were assessed and the service had begun a comprehensive review and re-development of all care plan records. The service worked closely with health and social care professionals to provide appropriate access to treatment and support.

The service was very caring and there was good feedback from people and relatives about the care provided by staff. Romney House was described as being friendly, homely and like a big family.

The service had introduced a new and varied activities programme which included inter-generational experiences for people. Local nursery schools and baby groups visited and people joined in with songs and reading. The feedback from people was very positive and enjoyable.

Rating at last inspection: Requires Improvement (Good in Caring). Report published 16 March 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: This is the second consecutive time the service has been rated as Requires Improvement. We will ask the provider to tell us what action they will take to improve the service to at least Good. We will monitor all intelligence received about the service to inform when the next inspection should take place.

Romney House is a residential care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, 16 people were living at the home and one person staying temporarily on respite. Romney House is a modern building set on the outskirts of Trowbridge in Wiltshire. Bedrooms are located on the ground and first floor with access via a lift. There is a large, enclosed garden with conservatories.

This inspection took place on the 22 November 2017 and was unannounced. At the last inspection on 15 April 2015, we found that the provider was meeting all of the essential standards. At this inspection, we found improvements were needed.

A registered manager was in post. 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 Romney House. We observed staff had developed caring relationships with people and their relatives.

Medicines were not always stored safely and there were inadequate systems in place to receive medicines into the home in the absence of management. People’s topical medicines were not recorded accurately and there was a lack of guidance for care workers to inform them what creams to apply to which areas.

There were ineffective quality assurance systems in place to monitor the care and support people received. Accidents and incidents were not routinely analysed to identify causes, patterns or trends. Risks associated with the premises had not always been identified, assessed or managed.

Care and support plans did not contain enough detail to make sure that people’s needs were being met. People were not involved in their care planning and review of care.

People did not have the opportunity to record their end of life wishes, as these discussions had not always taken place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

There were sufficient numbers of staff to support people’s needs.

The provider had safe systems in place to recruit workers.

People we spoke to were complimentary about the staff and the service in general.

We found five 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 back of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 16 December 2014 at which a breach of legal requirements was found. This was because the provider had not identified, assessed and reviewed potential risks in relation to the electrical systems of the premises. The fire panel was not working properly and the home's electrical system had not undergone a safety check.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 15 April 2015 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Romney House’ on our website at www.cqc.org.uk.

Romney House is a residential care home providing accommodation for up to 20 older people. At the time of our inspection in December 2014, there were 20 people living at the home. Romney House is a modern building set on the outskirts of Trowbridge in Wiltshire. Bedrooms are on the ground and first floor level and some have their own toilet and washing facilities. There is a lift between floors. There is a large garden housing conservatories and a patio.

The home had 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 and associated Regulations about how the service is run.

At our focused inspection on the 15 April 2015, we found that the provider had followed their plan and the legal requirements had been met.

The provider submitted evidence to us that the two areas of concern we had identified around safety had now been rectified. The Wiltshire Fire Service also confirmed they were happy with the actions the provider had taken to ensure the fire and electrical systems were safe. The fire alarm panel had been repaired by a qualified engineer and the ‘common fault’ button was no longer flashing. This meant that the equipment had been passed as safe for its intended purpose. In addition, the electrical systems within Romney House had been checked and passed by a qualified engineer as being safe.

The provider had put in place systems to ensure that all electrical systems and equipment would be regularly monitored and reviewed to ensure they remained safe.

During our last inspection on 15 August 2014 we found the provider to be in breach of Regulation 10 (1) (b) Assessing and monitoring the quality of service provision. The Health and Safety policies for Romney House were out of date. Staff were using information which did not relate to the running of Romney House. There was a potential risk to people of staff following inappropriate practices. The provider wrote to us with an action plan of improvements that would be made. During this inspection we found the provider had made the necessary improvements.

This inspection took place on 01 December 2014 and was unannounced.

Romney House is a residential care home providing accommodation for up to 20 older people. At the time of our visit there were 20 people living at the home. Romney House is a modern building set on the outskirts of Trowbridge in Wiltshire. Bedrooms are on the ground and first floor level and some have their own toilet and washing facilities. There is a lift between floors. There is a large garden housing conservatories and a patio.

The service had a registered manager who was responsible for the day to day operation of the home. 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 who lived at Romney House told us they felt safe living there. However, the provider could not provide evidence that the electrical systems in Romney House were safe. We asked the Wiltshire Fire & Safety service to investigate this.

People and their families were positive about staff and the care they received. Staff treated people with respect and protected people’s privacy and dignity. Staff supported people to make their own decisions and were aware of people’s likes and dislikes and preferences for their care routines. There were a range of activities which people could take part in if they wished.

People enjoyed the food and had enough to eat and drink. There were alternatives available if people did not like what was on the menu for that day. Snacks and drinks were available throughout the day. People could eat in the dining room or in their own room if preferred.

Staff had received appropriate training to ensure they had the necessary skills and knowledge to support people appropriately and safely. There were systems in place to ensure that staff received support through supervision and an annual appraisal to review their ongoing development. Supervision and appraisals are processes which offer support, assurance and develop the knowledge, skills and values of an individual, group or team. The purpose is to help staff to improve the quality of the work they do, to achieve agreed objectives and outcomes.

People were involved in writing up their care plan. This was reviewed each month with the person and their family, if they wished. The care plans detailed what care people received and how they wished their care to be given.

Health and social care professionals were involved in people’s care and staff supported people to attend medical appointments as required. When people’s care needs changed, the person’s care plan was reviewed to reflect this.

People told us they knew how to make a complaint if they wished to. People and staff felt they could approach the registered manager if they were not happy with the care or service provided.

Staff and the registered manager were committed to providing a high quality of care in a friendly, homely environment.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We considered all the evidence we had gathered under the outcomes we inspected. We carried out an inspection in April 2014 where we found that improvements were required in outcomes 14, 16 and 17. We asked the provider to make improvements and we carried out an inspection on 15 August 2014 to see what improvements had been made.

We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic.

Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of people living at the home.

The staff personnel records contained all of the information required by the Health and Social Care Act. This meant that the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our inspection on 15 August 2014, we found that staff were knowledgeable about DoLS in relation to the people they cared for. There was a detailed safeguarding policy in place which outlined clear procedures for the reporting of safeguarding alerts.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. People told us that staff knew them well and their likes and dislikes. We found through observation and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. One person said "I am more than happy with my care here". A relative told us, "the staff are wonderful, really caring". We observed that people had easy access to their wheelchair or walking frame and people were able to move around the home independently.

The provider ensured that care staff attended regular supervision and all staff had completed an appraisal.

Is the service caring?

People told us that staff always enabled them to go at their own pace. We saw that care workers showed patience and gave encouragement when supporting people. One person said, "I've been here for two weeks for a break and it's been lovely, I am very happy with the support I have been given". One person told us that "the staff go through my care plan with me and explain if anything needs to be changed". Care workers confirmed that they were responsible for reading through the care plans with people to ensure that people understood and agreed to their support. Records confirmed people's preferences and interests and people told us that their care was provided in accordance with their wishes.

People had access to activities that were important to them and we observed that family and friends visited.

Is the service well-led?

People told us they were listened to if they had a comment or complaint. The complaints policy now included information on who to contact if people did not feel that the home had dealt with their complaint to their satisfaction.

Care staff told us they felt supported and involved in the running of the home and attended team meetings. The home had carried out a satisfaction survey in May 2014 to gain the views of people who used the service. The feedback was very positive and residents meetings now minuted what actions the home took in response to people’s views.

The home had made many changes to their policies and procedures. However, there were some policies which had not yet been updated and the provider had employed the services of a consultancy firm to do this. We have asked the provider to tell us what they are going to do towards compliance in this area.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of people living at the home.

The staff personnel records contained all of the information required by the Health and Social Care Act. This meant that the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had not been trained to understand when an application should be made and how to submit one. Proper policies and procedures were not in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. People told us that staff knew them well and their likes and dislikes. We found through observation and from speaking with staff that they had a good understanding of people’s care and support needs and knew them well. One person said “I am more than happy with my care here”. A relative told us, “the staff are wonderful, really caring”. We observed that people had easy access to their wheelchair or walking frame and people were able to move around the home independently. Care staff had not received regular supervision or appraisal. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that staff always enabled them to go at their own pace. We saw that care workers showed patience and gave encouragement when supporting people. One person said, "I’ve been here for two weeks for a break and it’s been lovely, I am very happy with the support I have been given”. One person told us that “the staff go through my care plan with me and explain if anything needs to be changed”. Care workers confirmed that they were responsible for reading through the care plans with people to ensure that people understood and agreed to their support. Records confirmed people’s preferences and interests and people told us that their care was provided in accordance with their wishes. People had access to activities that were important to them and we observed that family and friends visited.

Is the service well-led?

People told us they were listened to if they had a comment or complaint. Care staff told us they felt supported and involved in the running of the home. The management had not consulted with people to gain their views on the running of the home and the service provided. The home did not have a robust system of auditing in place. The homes policies and procedures were out of date, not relevant to the current practice in the home or lacked sufficient detail to provide guidance to staff. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.