Rathmore Care Home

Rathmore Care Home is a residential care home providing personal care for up to 8 older people. There were 8 people using the service at the time of the inspection. The service is provided from a large property close to the town centre, with communal areas and provides people with their own private bedrooms.

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

The provider did not take a systematic approach to assessing staffing levels. Governance systems had not been operated effectively. Staff had not received practical training and the management of risk was not always safe. Staff were recruited safely and the home was clean and maintained.

The provider had not held any meetings with staff, people using the service or relatives, to gain feedback about the service provided. Some practices were not person-centred. The service worked with other agencies and was receptive to feedback.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 4 March 2020).

Why we inspected

We received concerns in relation to the management of risk and people’s care needs. As a result, we carried out a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rathmore Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to staffing, safe care and treatment, person-centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had implemented additional infection prevention and control measures in response to the risks posed by the current pandemic. There were plentiful supplies of PPE and stocks were carefully monitored. Staff had been trained in infection control practices and posters were displayed to reinforce procedures. We observed staff were using personal protective equipment (PPE) appropriately. There were sufficient staff to provide continuity of support should there be a staff shortage.

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection. The provider explained people’s health and well-being was carefully monitored during this time. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken if any positive results were received.

People were supported to stay in contact with their relatives and friends. The provider explained arrangements were in place for any person living in the home who wished to have a designated visitor.

The layout of the service and the communal areas were suitable to support social distancing. The premises had a good level of cleanliness and was hygienic throughout. Care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was calm and peaceful, and we observed staff were attending to people’s needs.

The provider had updated their infection prevention and control policies, which included a business continuity plan. The provider had regular contact with the local authority and kept abreast of any changes in policy provided by Public Health England, Care Quality Commission and the Department of Health and Social Care.

Rathmore Care Home is a residential care home providing personal care for up to eight older people. There were seven people using the service at the time of the inspection. The service is provided from a large property close to the town centre, with communal areas and provides people with their own private bedrooms.

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

People received safe care and were protected against the risk of abuse and avoidable harm. Staff assessed and managed risks to people to help keep them safe. Staff managed people’s medicines safely and kept the home clean and hygienic.

People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively. Staff supported people with their healthcare needs and worked well with external healthcare professionals. The service met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about staff knowledge in relation to the Mental Capacity Act 2005.

People were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be as independent as they were able. We received positive feedback about the caring approach of staff.

The service put people at the centre of the care they received. Staff used detailed assessments to identify people’s needs and preferences and worked to ensure people were happy with the care they received. If people were not happy, they were confident they could speak with staff to make improvements. The service made sure people were supported to communicate and supported people with activities to enhance people’s wellbeing.

The service was led by an established registered manager who people felt was approachable and caring. People felt the care they received was of a good standard and liked living at the home. The registered manager understood their responsibilities and monitored the quality of the service using a range of systems.

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

Rating at last inspection

The last rating for this service was good (published 03 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rathmore Care Home is a small residential home situated close to local amenities in the town of St Annes. The home is registered to provide accommodation for up to eight people who require help with personal care.

At the last inspection in December 2014 the service was rated ‘Good’. However, a rating of ‘requires improvement’ had been identified in the ‘well-led’ domain. This was in relation to a lack of recording of checks that were undertaken to monitor and improve the quality of the service. This had now been addressed by the registered manager. At this inspection we found the service remained good.

The registered manager had implemented recording of checks to monitor and improve the quality of the service provided. They used a variety of methods to assess and monitor the quality of care at Rathmore Care Home. These included regular audits of the service, satisfaction surveys and day to day conversations, to seek the views of people about the quality of care at the home.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. Safe systems were in place to manage people’s medicines.

Safe systems of recruitment of staff were in place. Checks were carried out to ensure suitable people were employed to work at the home. Staff confirmed they only commenced employment when all checks had been completed.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Sufficient staff were on duty to support people.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate, their relatives were involved in decisions and consented to their care.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments from people who lived at the home were all positive about the quality of meals provided.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home told us they were encouraged to participate in a range of activities that had been organised and were happy with the level of activities provided.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

During our inspection we used a number of observational tools to gain evidence about what it was like to live at the home. We did this by looking at care planning, staff recruitment and training records. We also looked at how the home managed the quality of the service and listened to people. In addition we spent time in communal areas in order to speak with a range of people as well as making general observations of the routines in the home. One person told us they liked the way they could personalise their room. As part of the inspection we also looked at the general environment in which people lived to give us an overview of the services available to them. A staff member told us, 'It's a nice place to work, very homely'.

People were seen to be cared for in ways that suited them. We saw that people were given opportunities to inform staff of their personal support requirements. Staff were involved in assessing people's needs, and there were systems in place to monitor how those needs were met. One person told us, 'Couldn't think of living anywhere else. We have everything we need living here. It's like home from home'.

People we spoke with including the visitor, told us that staff were always respectful and treated people with dignity and care. People told us that there was a relaxed and homely environment and that they never felt rushed. One person said, 'The staff are brilliant, very good and always obliging. I always feel safe here and well looked after. I enjoy my meals. It is very comfortable, my bedroom is lovely and to my liking with my own things'.

Another person told us, 'All of them are super, any problem I have they try and sort out for you. The staff are all very kind and helpful and everything is free and easy, if you want some help it is always immediate'.

The relative we spoke with told us that, '***** is as happy as Larry they look after her very well and they look after me as well. They are fantastic, all of them'.

A member of staff described staff as, 'Always upbeat and cheerful. If somebody is feeling low there are positive vibes from staff that puts the resident at ease. We also know the families very well. The care is great and personal to the individual. There is never a rushed pace everything is nice and relaxed, there is always time for brew, sit down and a chat with the people living here'.