Archived: Rutland Home

We found the following examples of good practice.

• There was a booking system in place for spacing out visitors and guidance had been shared with people’s family and friends to support safe visits to the service during the COVID-19 pandemic.

• All care staff had completed training about COVID-19 and how to prevent the spread of the virus. This included training about how to use personal protective equipment (PPE) correctly. The provider had ensured there was plenty of PPE available for staff.

• Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and were supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection. People having to isolate in their rooms received frequent support from staff to engage with activities that would interest them personally

• All staff had an individual risk assessment to evaluate their level of risk to COVID-19. Where necessary changes were made to the tasks carried out by those staff assessed as being at a high level of risk.

•The service was uncluttered, clean and hygienic. Cleaning had increased during the COVID-19 pandemic and frequently touched surfaces were cleaned regularly throughout the day to reduce the risk of infection.

Rutland Home is a residential home providing accommodation, nursing and personal care for up to 18 people aged 65 and over. Some people living at the service are living with dementia, others are elderly and frail or have medical conditions that require them to live in this type of service. At the time of our inspection, there were 14 people living at Rutland Home.

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

People gave mixed reviews on staffing levels at the service. Some people told us they had to wait for staff. We have issued a recommendation to the registered provider in relation to staffing levels.

People said they felt safe with staff and we read risks to people had been identified and action taken to help keep them free from harm. Where people had accidents and incidents these were responded to. People lived in an environment that was regularly cleaned.

People said staff were kind and caring and that they had access to activities. People enjoyed the food they were provided with and told us staff looked after their medicines for them. People said they felt staff were well trained and where people required the input of a healthcare professional this was sought.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.

Management carried out a range of audits and looked for ways to improve the service. Some improvements had been made to the service since our last inspection and others were planned. There was a good team spirit within the service and staff worked well together. Staff worked with external agencies and the outside community to increase opportunities for people. Staff received appropriate training and support.

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

Rating at last inspection: The service was rated Good at our last inspection (report published 7 September 2017). We found at this inspection, the service had retained their Good rating.

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.

The inspection took place on 01 August 2017 and was unannounced. We had carried out an unannounced comprehensive inspection of this service on 30 April and 5 May 2015. At that inspection a breach of the regulations had been found with regards to records management. After that comprehensive inspection, the provider wrote to us to say what they would do to meet the regulations. The provider had taken appropriate action and addressed the concern we had raised.

There was a registered manager 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 were safe at Rutland. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

There were sufficient numbers of staff deployed to meet the needs and preferences of the people that lived there. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. They had also checked to ensure staff were eligible to work in the UK.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to support people if the building needed to be evacuated. Regular checks were completed around the home to ensure it was safe, such as testing fire detection systems, and maintenance of equipment.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and specialist diets either through medical requirements, or personal choices were provided. People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

There was positive feedback about the home and caring nature of staff from people who live here. The staff were seen to be kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection between staff and the people they cared for. People could have visitors from family and friends whenever they wanted.

Care plans gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details in the care plans matched with what we saw on the day of our inspection, and with what people told us.

People had access to a wide range of activities. People and relatives were positive about the choice of activities, and how there was always something interesting to do.

People knew how to make a complaint. No complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

People were happy living here, and their relatives were positive about the care and support given to their loved ones. One person said, “I find it very comfortable here, there are plenty of activities and all in all it is very good.” Another person said, “I wasn’t sure what to expect when I came to live here, but it is good, and I am happy.” A relative said this has been “By far the best option for my family member.”

Below is a summary of what we found. The summary is based on our observations during the inspection, talking to people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff at most times. However we saw over lunch that staff were required to support two people at once. Staff were unable to give their full attention to the people they supported. This was not a dignified or relaxed experience for the people or the staff. We have asked the provider to make improvements in this area.

Systems were in place to make sure that the registered manager and staff learn from events such as accidents and incidents, concerns, whistleblowing and investigations. Risks to people's welfare and safety had also been assessed. Appropriate action had been taken to minimise the risk of harm coming to people.

Is the service effective?

People's health and care needs were assessed with them or their family members, and they were involved in their care planning. We saw examples where reviews were held by the service to ensure that care plans reflected their current and changing needs.

Although there were procedures in place that said staff had regular one to one meetings and appraisals, the records we saw showed us this was not happening. We have asked the provider to make improvements in this area.

Is the service caring?

All of the people we spoke with said they were very happy with the care and support they received. One person told us that 'I can't fault the girls they are very good.'

We were told by the people who used the service and their families that their preferences and interests had been recorded and care and support had been provided in accordance with their wishes.

People using the service, their relatives, friends and other professionals involved with the service were asked to provide feedback on the service they received.

Is the service responsive?

At our last inspection in October 2013 we saw that people had given feedback to the service about the lack of activities at the home. During this visit we saw that no improvements had been made. People were seen to be left in lounge areas with no meaningful or appropriate activities. This meant that the service had not been responsive to people's needs. We have asked the provider to make improvements in this area.

We looked at the complaints record and found there had been three complaints made to the provider. The complaints policy we looked at had been designed, written and developed to be user friendly. However where shortfalls or concerns were raised, people told us they felt that these were not always appropriately addressed by the provider. One family member stated that they were made to feel that they had 'No right to make a complaint'. We have asked the provider to make improvements in this area.

Is the service well-led?

The staff and the registered manager worked well with the other professional bodies and authorities that had placed people with them. This ensured people received their care in a joined up way.

The registered manager carried out regular checks around the home to ensure people received a good standard of care. We saw audits had been completed of the care plans of people who used the service. These were carried out to ensure the information was complete and up to date, and that people had received care that met their needs. Other audits that had been carried out included appropriate checks in relation to the health and safety monitoring of equipment used at the service To ensure all equipment that was used was safe.

You can see our judgements on the front page of this report.

People who lived at the service were supported and enabled to eat and drink sufficient amounts to meet their needs. Most people ate their meal from lap tables while remaining seated in lounge chairs in the sitting room. We were told that this is because they have chosen to do so. We observed that some people were provided with support to eat their meal by staff and that people were given appropriate time to eat their meal.

We found that the general environment of the communal areas were cluttered and the decoration was compromised and in need of remedial works. Overall the service was in need of a firm maintenance program to be developed for both inside and in the garden.

We looked at the provider's quality assurance (QA) system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk. We were told that the QA provided feedback on the quality of the services and if it is achieving its aims and objectives. This included: residents meetings and feedback questionnaires. We noted that changes to menus, activities, maintenance issues and care practices had been influenced by this

feedback.

People told us that that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received. One person told us that "although I would rather live in my home, Rutland is the next best thing".

We saw that staff interacted well with the people who used the service. Staff interactions often resulted in positive outcomes for service users.

There were systems in place for maintaining a clean and hygenic environment although the staff did not always complete the relevant internal audit tools. We have since received assurances and information from the registered manager that internal audit tools and appropriate records of cleaning are now kept and are up to date.

We found that there were sufficient levels of staff with the appropriate skills and qualifications to meet the needs of the people living at the home. One person we spoke to told us that the staff were "simply excellent... we can always have a laugh and a joke with the nurses and carers which helps cheer me up".

There was a complaints procedure available to all people living at the service and additional information was available in large print format for those with sight problems.