Archived: Rushes House Care Home

About the service

Rushes House is a residential care home providing accommodation and personal care to up to 17 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service. The home is an older building providing single and double occupancy rooms and some rooms have en-suite facilities.

People’s experience of using this service and what we found

Prior to this inspection a newly employed staff team had raised concerns with the local authority about the care and treatment of people living at the home. This information had led to an investigation by the local authority who took immediate steps to safeguard people living at the home and prevent the current registered individual accessing the home, whilst their investigations were ongoing. The local authority also shared information with The Care Quality Commission. During this inspection we found that the new staff team were providing people with kind and compassionate care and had begun to make improvements to care and support delivery. The local authority had provided a package of on and off-site support to the new team. The following statements are related to the care and treatment people were experiencing prior to the arrival of the new staff team and ongoing issues that were still in the process of being addressed.

People had not always been protected from the risk of abuse. We received allegations that people had been subject to institutional abuse by the registered individual. This included visiting and other restrictions, lack of choice, inappropriate use of control and verbal abuse. The local authority safeguarding teams were carrying out several investigations relating to abuse and poor care.

People were at risk from unsafe medicine management and administration. Staff had not had up to date training or competency checks and people did not always receive their medicines as prescribed. People had not had their risks appropriately assessed and safely managed. We found concerns with infection prevention and control, and some people’s bedrooms were unclean and malodourous. We identified concerns with the safety of the environment.

People had not always been supported to eat enough food and have a balanced diet. Appropriate advice had not been sought from the dietician regarding the management of some people who were at risk of malnutrition. 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 and in their best interests; the policies and systems in the service did not support this practice.

People had not always been treated in a kind, caring and compassionate way and relationships with family were not always respected. People’s autonomy and independence to make their own choices and decisions about their care was restricted.

There was a lack of working together with external agencies to deliver effective care and treatment and support people's access to healthcare services. This meant their needs were not being met and had a negative impact on people's well-being. People had not received personalised care that was responsive to their needs.

The management and leadership of the home by the registered individual was inadequate. There were widespread and significant shortfalls in the quality and safety of the service. Systems to monitor, assess and improve the service being provided were ineffective or not in place. There was a negative culture and people’s equality and human rights were not respected.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 July 2019).

Why we inspected

The inspection was prompted due to concerns received from the local authority about allegations of institutional abuse, unsafe management of medicines, unsafe and unclean environment and staffing. A decision was made for us to inspect and examine those risks.

The registered individual agreed to have no contact with people living at the home, relatives and staff. The local authority and a new staff team provided support to people living at the home and a new provider commenced their registration with CQC to ensure people could remain living in their home.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, person-centred care, people being treated with dignity and respect, consent to provide care and treatment, management of people’s risks, safe medicine management and administration, safe environment, infection control, poor nutrition and hydration, staff training and support and poor governance of the home.

The registered individual for the service applied to deregister the service at the time of the inspection. An application to register the service with a new provider has been submitted.

Follow up

We will re-inspect the service under the new registration arrangements.

Rushes House Care Home provides accommodation and personal care for up to seventeen people. At the time of this inspection 11 people were living at the home.

People’s experience of using this service

People and relatives spoke positively about their experiences and the quality of care and support offered. We were told and saw that staff were kind and respectful and were aware of the individual needs, risks and wishes of people.

People received personal care and support from the registered manager/owner and a small staff team who knew them very well in a small homely comfortable home. They enjoyed the homemade food offered.

When taking on new staff the service ensured appropriate checks were carried out to check candidates’ suitability to work with vulnerable people. Ongoing training was provided to staff both face to face and online to help ensure they had the knowledge and understanding of their care and support responsibilities.

People, relatives and visiting professionals were given opportunities to provide feedback on the quality of care and to comment on the service they received.

The registered manager/owner worked at the home on an almost daily basis and lived on the same site. There was evidence of management and oversight of the service. Audits and checks were completed to monitor and review the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated requires improvement (May 2018). The service had breached two regulations of the Health and Social Care Act 2008. The provider completed an action plan after the last inspection to show what they had done to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme.

Rushes House Care Home provides personal care and accommodation for up 17 older people in a domestic style property. Accommodation is provided over three floors with a lift servicing each area. A further additional floor was only accessible via staff. Single and double bedrooms are available. The home is non- smoking and is situated in the village of Marple, close to local shops, parks and the canal. At the time of our inspection 12 people were living at the service.

The registered provider had systems in place to monitor the quality of the service provided. Some areas needed improvements as some issues, such as out of date maintenance certificates, had not been identified within the service’s own monitoring procedures. We found the system to provide good governance had not always identified where updates were needed to show appropriate quality assurance systems were in place.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated activities) regulation 2014 Good Governance.

Out of date maintenance of main systems such as the electrical installation systems can put people at risk within the building and needed improvements in their management to make sure the building was safely maintained. We found the systems to monitor the safety and quality of the service required further development to ensure full compliance with the regulations.

This is a breach of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment.

We saw there was a concerns and complaint policy accessible to each person on admission to the home. People living at the service and visiting relatives we spoke with told us they had no concerns or complaints.

We saw the food looked and smelt appetising and was mainly homemade and attractively presented. People told us they enjoyed the food.

From our observations of staff interactions and conversations with people living at the service, we saw staff had good relationships with the people they were caring for. The atmosphere was relaxed and people told us they felt comfortable. We observed staff being kind, patient and caring to people.

The registered provider reviewed staffing levels using a staffing calculator but there was no information to show other people were included in feedback about the staffing levels. We recommend the registered provider includes staff, people receiving support and relatives to obtain their feedback to help review assessments to provide suitable numbers of staff each day.

Procedures were in place to minimise the risk of harm to people using the service. Staff understood how to recognise and report abuse which helped make sure people were protected.

Staff were recruited following a safe process to make sure they were suitable to work with vulnerable people. The registered provider had not always stored interview notes taken during the recruitment and interview of staff. We recommend the registered provider takes appropriate guidance regarding employment law and reviews their process for storing records relevant to their recruitment of staff.

The building was clean and well maintained. We saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection for example disposable gloves and aprons.

The environment was comfortable and homely with domestic style décor in place. We discussed published guidance for adapting environments to meet the needs of people with dementia. We recommended the registered provider look at published guidance to consider further adapting the environment to meet people’s dementia needs if applicable.

Staff understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.

People had access to healthcare services for example from the district nurse, GP and visiting consultants. The registered provider had received positive comments from visiting professionals over the last few months.

Staff were receiving regular supervision sessions and appraisal. This meant that staff were being appropriately guided and supported to fulfil their job role effectively. Staff received regular training and support to ensure they had the necessary skills and updates to meet people’s needs.

We considered the evidence collected under these outcomes and addressed the following questions, is the service safe and is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that following our previous inspection the provider had taken steps to improve and maintain the standard of the home's environment. We saw that some action had been taken by the provider in response to recent inspections carried out by the local fire safety officer and infection control nurse. We were told that follow up inspections with these organisations, to check that the required improvements had been made, were yet to take place.

Is the service well led?

We were shown a fire risk assessment tool introduced by the provider, however this had not been completed. This meant that the provider did not demonstrate they had robust measures in place to assess and address fire safety risks at the premises.

The provider did not have sufficient time to carry out their management duties for the service. There were not effective systems in place for the provider to identify risks or shortfalls in the service that people received, which included the quality of people's care records. We also saw that records relating to people who used the service were not always kept securely.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people were treated with dignity and respect by staff. The people we spoke with who lived at the home or were visiting relatives, all made positive comments about the service, they told us they had no concerns about people's safety or the care provided. One person told us 'it's wonderful, [the manager] looks after us well'. We also spoke with a member of care staff who told us they thought people were well looked after and commented 'it's [the home] a good environment for residents and staff', 'it cheers me up coming to work'. During our visit we spoke with a visiting GP, they also told us they had no concerns about the care people received, they commented '[people are] cared for very well' and 'everyone seems happy'.

During a tour of the building we noted several concerns. We saw that the environment was cluttered, which not only had a negative impact on the appearance of the home, it also posed a 'trip hazard' and a fire risk. Following our inspection, we referred our concerns to the local fire service for them to consider and take appropriate action to ensure fire safety regulations were complied with. We also saw areas where cleaning products and prescribed medications were easily accessible to vulnerable people, which posed a risk to their health and wellbeing.

Is the service effective?

People's care needs were assessed with them, and where appropriate their families were involved. People's care plans were person centred and generally provided clear guidance for staff in how to deliver people's care. We did find some examples where people's care records were not as complete as they could have been; however there was no indication that people were receiving poor care.

Staff demonstrated a good understanding of the needs of the people they worked with. The people we spoke with all made positive comments about the staff and the care they or their relatives, living at the home received. A visiting relative told us they had seen improvements to their relative's condition during their stay. They told us 'the care is very good', '[the home is a] small place, with good individual care'. This relative also told us they had confidence in the staff and that they were involved in their relative's care.

Staff understood the importance of working with the other professionals involved in people's care and people were supported to access medical advice and treatment. Staff felt they had good working relationships with local medical professionals. During our inspection, we spoke with a GP who regularly visited people living at the home. They told us that the service made appropriate and timely referrals to them and that the manager had a good understanding of peoples' needs, care and treatment. They told us staff were available to assist them on their visits and advice was followed by staff. They felt people received good care at the home.

We saw that staff received training and support to enable them to carry out their role. The staff member we spoke with told us they felt supported and that the manager was approachable. We saw that staff received regular supervision sessions and annual appraisals.

Is the service caring?

The atmosphere in the home was relaxed and friendly and we saw that people were treated with warmth and respect. The care we observed was provided in a sensitive, unhurried and personal way. All the people we spoke with made positive comments about the care they or their relative received. A visiting relative told us '[their relative was]always well presented, dressed nicely, hair nice'. We were told that before people started using the service, they were encouraged to spend some time visiting the home, where they could enjoy a meal or a short stay to experience the environment. This was to help them to settle in.

Is the service responsive?

We saw that reviews of people's care were generally carried out and people's preferences and preferred routines considered. We saw that people's independence was encouraged.

The manager was aware of the importance of engaging medical practitioners and other professionals involved in people's care and worked alongside them to help ensure people's changing needs were met.

We saw that there was a complaints procedure in place. All the people we spoke with told us they had had no cause to complain, but would feel comfortable in doing so if needed.

Is the service well led?

The manager assessed people's needs before they started using the service to ensure that their needs could be effectively and safely met.

The manager took the lead in liaising with other professionals required to meet people's needs. We spoke with a visiting GP who made positive comments about their working relationship with the manager, commenting '[the manager] gets things done'.

We saw that due to staff recently leaving the manager was spending half their time providing care assistance to people. This meant that they were not able to spend the majority of their time on their management duties. We saw that the home did not have an effective systems in place to monitor the quality and the safety of the service that people received. This meant that the service was unable to reliably identify and respond to shortfalls in the service.

At this inspection we looked at Regulation 22 which requires the registered person to take appropriate steps to ensure that at all times there are sufficient numbers of suitably qualified, skilled and experienced persons employed. We were provided with a training record and was able to speak with a member of staff which showed that training was taking place in order to meet with this requirement.

We also looked at Regulation 20 which requires the registered person to keep an accurate record in respect of each service user which shall include appropriate information and documents in relation to the care and treatment provided to each service user. We found that everyone had in place a care plan which showed what their care needs were and how the staff should meet these needs.

We spoke with one of the people who lived at Rushes House and they told us that they were happy living at the home and that they were well looked after.

This inspection visit was carried out to check if improvements had been made. At the time of our visit new recording systems were still being put in place therefore it was too soon to judge the long term impact or effectiveness of the new processes. We will therefore look at record keeping during our next visit when we expect them to be completed to a standard that meets with requirements. Until all the records including assessments, plans of care and training records are in place we have minor concerns that people may be at risk from unsafe or inappropriate care.

We spoke with a number of people during our visit including people who use the service, family members and care workers. Everyone we spoke with said that they were happy with the care people received and no one had any complaints.

One person said; 'Couldn't be better'; 'Food very good'; 'Mary (provider) very good gets me what I want, food lovely'; 'Can go to bed and get up when I want, saw GP when I was not well, I play bingo'; 'I like it, I agreed to come because I liked it'

However, we found that the home's medicines policies were not always followed, increasing the risk of errors.