This unannounced inspection took place took place on 7,8 and 9 August 2018. At our last comprehensive inspection on 10 August 2016, we rated the service ‘Good’.

We brought forward our inspection to look into concerns we received in relation to the safety and the management of the home, including how the service operated at night times.

We carried out an unannounced inspection of the home on one night and on the two following days. We did not find evidence to substantiate the concerns we received and we have found the home remains ‘Good’.

Romford Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Romford Care Centre accommodates up to 114 people across five units, each of which have separate adapted facilities. The units specialise in providing nursing and residential care to older people living with dementia. At the time of our inspection, 95 people were living in the home.

The home did not have a registered manager in post as the person who held this position, left their role a month before our inspection. 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 provider has since appointed a new manager who will register with the CQC.

Each unit in the home was managed by a registered nurse or a team leader, who were supported by a deputy manager and an operations manager. We met with both these managers during our inspection.

Risk to some people had been assessed and identified. However, we noted that risks to some people were not always identified in their risk assessments and there was a lack of overall consistency, to ensure all risks were being managed. We have made a recommendation for the provider to ensure risk assessments are clear and contain relevant and consistent information.

People were involved in the planning of their care and received care and support to ensure their individual needs were met. Care plans contained information on people’s backgrounds and preferences. However, we have made a recommendation for care plans to take a more person-centred approach towards people’s end of life care wishes and for staff to receive further training in this area.

The provider had safe recruitment procedures in place and carried out checks on new employees.

There were enough staff on duty to ensure people's needs were met. Staff rotas were not always completed to show that staff cover had been arranged when required.

The management team was committed to developing the service and this was done through quality assurance systems that were in place. Some further improvements were required to ensure people received a responsive service because some people and relatives did not always feel listened to.

Medicines were stored, managed and administered by staff who were trained. We saw that medicines on all units were managed and used safely.

Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met. People were provided with a choice of meals and were able to make specific requests.

Feedback was received from people and relatives in the form of questionnaires and surveys to help drive quality improvements.

Records of accidents and serious incidents showed that the provider learned from mistakes to prevent reoccurrence.

People and relatives were able to make complaints, which were investigated by the management team. Complaints were planned to be used to also learn lessons and make improvements in the service.

The premises were clean and regularly maintained.

This unannounced inspection took place on 10 August 2016. At our last inspection on 22, 23 and 30 June 2015 we found the provider did not appropriately assess the risk of, and prevent, detect, and control the spread of, infections. During this inspection we found that the provider had made improvements and the now met the required standards.

Romford Care Centre is a large, purpose-built care home providing accommodation, personal care and nursing care for up to 114 people. At the time of our inspection there were 62 older people, many of whom have dementia, using the service. Each person who lives at Romford Care Centre has their own room with ensuite bathroom, and the service premises are suitable for people with mobility needs. The service is divided into five units, however only three were in use at the time of our visit due to the number of people living in the service.

Following the resignation of the last manager, the service did not have a registered manager in place. However, the provider had employed an acting manager who was running the service. 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.

We found that Romford Care Centre had a team of new managers who were willing to listen to people, people's relatives and staff to make improvements to the service. People, their relatives and staff spoke positively about the management of the service and told us the acting manager was approachable. They told us they were happy with the service and they knew how to make a complaint if they had a concern with it.

People’s care and health plans were detailed, person centred and described the individual care, treatment and support people needed and preferred. People or their representatives were involved in the review of care plans and risk assessments and it was evident that care was delivered in line with the principles of the Mental Capacity Act 2005 (MCA).

We found that new staff were appropriately checked to ensure they were suitable to work with people. People told us and records and observation showed that there were enough staff at the service who were kind, caring and friendly with people and relatives. We noted staff ensured people's privacy and treated them with respect and dignity when delivering care. Staff were trained and supported and these gave them opportunity to develop skills and experience necessary to support people. However, we recommended that the provider ensures that all staff have regular formal supervision, annual appraisal, training including attending refresher courses in MCA.

Medicines were stored and administered safely and there was evidence that people had access to healthcare professionals. People's dietary needs were met through proper monitoring and provision of meals that reflected their preferences.

The premises were clean, bright and spacious with appropriate facilities and equipment available for people's use.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was a responsive/follow-up inspection to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was unannounced and was carried out by three inspectors.

Romford Care Centre is a nursing home registered to provide accommodation and support with personal care and nursing for 114 adults. At the time of our visit there were 67 people using the service in three units.

The home did not have a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. At the time of the inspection the service was managed by an interim manager, who has since resigned and replaced by a temporary acting manager.

During the inspection we spoke with seven people 12 visitors and 10 staff members. We reviewed 11 people's care files and the home's various records including health and safety records, complaints procedures, staff rota and the menus. We observed people in communal areas and bedrooms. Visitors told us staff were attentive to people's needs.

However, we found that people who used the service were at risk because risk assessments about a prolonged use of wheelchairs were not completed and agreed; people with wound management plans were not turned as stated in their care plans; some people did not receive care and support they needed with changing clothes and shaving. We found a number of staff had recently left the organisation and the staffing level was not sufficient and people were at risk of not having their needs met. The provider told and showed us they had completed and reviewed dependency level assessment for each person. We saw the completed dependency assessment forms but people we spoke with told us there were not enough staff at the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. We found that the provider had made 11 DoLS applications and was in the process of completing the forms for the rest of people to apply to the local authority.

Most parts of the home was clean and tidy on the day of our visit. However, there were some parts where we noted malodour.

The five questions we ask about services and what we found

We always ask the following five questions of services.

The service was not safe. There were not enough qualified and experienced staff to meet people’s needs.

Is the service effective?

The service worked well with health and social care providers. People and their representatives were involved in their care plans and staff received supervision from the new interim manager. People were satisfied with the choice of meals provided.

Is the service caring?

The service was not caring. Visitors told us people's clothes were not changed regularly and some people were not shaved. people's privacy and dignity was not always respected. Care plans were not being followed to reposition people with wound management plans.

Visitors were not happy about management, which they described as intimidating. The last registered manager was de-registered on 6th May and the service had been managed by acting managers who had not been registered. An interim manager, who had been employed by the provider, has resigned after this inspection was carried out. We have sent a letter to the provider asking them what action they would take to address the lack of a registered manager.

Is the service responsive?

The service was not responsive. Care plans were reviewed and updated. Information about the processes of complaints procedures was available; but some people told us the provider had not responded to their complaints.

Is the service well-led?

The service was not well-led. There was no registered manager and people told us the management was "intimidating".

Following inspection visits in November 2013 and March 2014, the service sent us action plans to explain how they would address compliance actions within an agreed timescale. The non-compliance was found in Outcome 13, Staffing and Outcome 16, Assessing and monitoring the quality of service provision. During this inspection we spoke with 18 people who used the service, 10 relatives and 16 staff. The relatives of people who used the service told us they were satisfied with the quality of care but concerned about the staffing levels, the high turnover of managers and the lack of information and consultation by the provider.

Comments from the relatives of people using the service included, "We have been coming here for about 5 years. We've had loads of different managers. We ask them, "are you going to stay?" but they always leave" and "Staff are very considerate. The biggest problem is the lack of them." Another relative said, "They have started to have separate relatives' meetings on each floor. So you don't know what's going on now."

At the previous inspection we identified issues of concern about the delivery of care and treatment, and the documentation, for people with pressure sores. At this inspection we looked at the care plans for people with pressure sores and people at risk of developing pressure sores. We spoke with people and their relatives as well as staff, and looked at the policies for preventing and managing pressure damage. The relative of a person on a nursing unit told us, "[My relative] is safe. They (nursing staff) will do dressings in front of us and we have been told we can look at the dressings anytime." At this inspection we found that improvements had been achieved in regard to managing and preventing pressure sores, although the frequency for carrying out clinical assessments for nutritional status and susceptibility to developing pressure sores was not consistently correct.

Relatives told us they felt that staff worked very hard and there were not enough staff. We found that one unit did not have enough staff and this meant staff did not get their morning break. The rotas we looked at showed that there were customarily sufficient staff rostered on each shift, and we saw staff spending time with people and supporting them in an unhurried manner.

The relatives we spoke with told us they felt worried about the frequent change of manager at the service. There were many expressions of disappointment that the most recent manager was no longer at the home, as relatives felt improvements were being made and the service had entered a more stable period. Relatives told us there had been a lack of information about the change of manager and they generally did not feel that their views were being sought and utilised.

People told us that they received appropriate care that met their needs. One person said, “I like the care. It is very good.” People told us that the service was kept clean, one person said, “It’s always nice and clean here, the staff do a good job.” We were told that people are supported to manage their medication, and that staff responded to their needs in a prompt manner.

People we spoke to said staff were very good but they sometimes had to wait to be assisted as staff were always busy.

We heard several people calling for help and some became frustrated when they did not get their needs met when they asked. One person said they had been waiting a long time for staff to support them to get undressed so they could go to sleep. They appeared very upset and were heard shouting at staff for making them wait so long.

Some people were seen to be upset by particular situations and interactions with other people who use services. Immediately following a meal, we were told, “It’s like feeding time at the zoo” and “It’s like this every meal time, it drives you mad”. One person who had been calling for staff attention for over ten minutes told us sarcastically, “Give her a cup of tea that will make everything alright”.

Other people told us that they felt they had some control over their day to day care, but we were told by one person that they had made a request to be supported to mobilise but this had not been followed through. We heard this person tell the manager about this who said this would be prioritised and written into their care plan.

During our visits, most people were seen to be either in their bedrooms or walking around the units with very little focus or proactive intervention from staff. We were asked by some people to carry out tasks for them which we passed onto the appropriate staff. Staff were seen and heard to respond appropriately to these requests.

People looked cared for and said they were happy with the support offered.

This unannounced inspection took place on 22, 23 and 30 June 2015. At our last inspection on 17 October 2014 we found the provider did not meet required standards for care and welfare of people who use services, safeguarding people from abuse, and staffing. During this inspection we found that improvements had been made in each of these areas and the service now met the required standards.

Romford Care Centre is a large, purpose-built care home providing accommodation, personal care and nursing care for up to 114 people. At the time of our inspection there were 49 older people, many of whom have dementia, using the service as the home had been subject to an embargo by a local authority and restricted admissions. When we visited the embargo had very recently been lifted as improvements had been made, and up to two people were being admitted each week.

Each person who lives at Romford Care Centre has their own room with ensuite bathroom, and the service premises are suitable for people with mobility needs. The service premises are divided into five units, however only three were in use at the time of our visit due to the number of people living in the service.

The service 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 2008 and associated Regulations about how the service is run.

We found that Romford Care Centre had undergone a number of significant changes shortly before our inspection and these changes resulted in better care for the people who lived there. People were provided with care and support that was personalised and met their needs, and delivered in line with the principles of the Mental Capacity Act 2005. Staff were appropriately checked to ensure they were suitable to work with people in need of support before they started work.

Staff received training and support to ensure they delivered appropriate care. Staff were kind and gentle, and respected people’s individual needs, privacy and dignity. The quality of the service was regularly checked by managers and improvements made, and feedback was sought from people who use the service, their representatives and staff.

Activities were a particular highlight of the service, with full time activities staff placed within each unit and a range of one-to-one and group activities offered, both within and outside the service premises.

People were well-supported at the end of their life and the service was building a portfolio to attain ‘Gold Standards Framework’ accreditation. Staff supported people to eat and drink enough to meet their needs, and supported them to access health services when required.

Staff generally provided safe care, however we found some concerns relating to cleanliness and infection control and have made a recommendation to improve standards of care relating to pressure ulcer prevention and management. We also noted that medicines were often not recorded correctly, however the service had taken steps to address this.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.