Archived: Rapkyns Care Centre

We considered our inspection findings to answer questions we always ask. 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. The summary is based on our observations during the inspection and information from records. These included policies and procedures, minutes of meetings, care records, staff files and records related to quality monitoring and quality assurance systems. We spoke with six people who used the service, four visitors, eight staff and the registered manager. A registered manager is a person who has 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.

Is the service safe?

People who used the service had complex needs and multiple disabilities and most had minimal or no verbal communication. Staff demonstrated significant skill in their understanding and interpretation of people's non-verbal methods of communication. They used observations to determine whether people without verbal methods of communication were happy or upset and explored and reported any concerns, ensuring people's safety.

Staff treated people with respect and dignity and ensured consistency of their care and support. We saw people react to staff contact in ways indicating they were relaxed and comfortable with them and they showed no obvious signs of distress when receiving support. People's needs had been fully assessed and their care and support was provided in accordance with their personal support plans.

A range of risk assessments had been undertaken, for example, relating to moving and handling, prevention of pressure sores, nutrition and falls. Risk management plans had been produced and staff followed them. Care plans and risk assessments had been reviewed monthly and updated, as necessary. This meant changes in needs had been identified and responded to, ensuring people were not exposed to unnecessary risk.

Suitable arrangements were in place for obtaining and acting in accordance with people's consent in relation to their care and treatment. Where people did not have capacity to consent the provider had acted in accordance with legal requirements.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and DoLS, although to date, no applications had needed to be made. Records showed mental capacity assessments had been carried out for people. There was an on-going programme of staff training. This helped ensure staff understood their responsibilities under the Mental Capacity Act and DoLS. The registered manager was clear in what circumstances a DoLS application should be made and knew how to submit one.

The environment was clean and well- maintained. A range of audits had taken place to ensure the safety of the environment.

Systems were in place to make sure staff learned from events such as accidents, incidents, practice shortfalls, complaints and concerns. This minimised risks to people and promoted continuous service improvements.

Staff recruitment practice was safe and thorough. People were protected from abuse or risk of abuse because staff were suitably trained and followed appropriate procedures.

Is the service effective?

Records showed people's health and care needs had been assessed and their support plans reflected their current needs. The plans took account of peoples' diversity, rights and preferences. People and/or those acting on their behalf had been involved in the care planning process. People had access to health and therapeutic services and had equipment to meet their individual needs. We saw staff were competent in the use of assistive technology, enabling people to maximise their potential.

People's needs had been taken into account in the design and layout of the premises, enabling free and safe movement around their home.

Staff had received necessary training to ensure they had the relevant skills and competencies to meet people's needs.

The registered manager and senior staff were accessible to staff for advice, guidance and support.

Is the service caring?

We received positive feedback from people's relatives during the visit. Comments included, 'We are thrilled with the home, staff couldn't be better.'

We found staff to be knowledgeable about people's preferences and lifestyle choices. They were attentive to people, with high levels of engagement. We observed staff interactions with people and found their general approach to be friendly, cheerful, caring and respectful. When speaking with staff it was evident they genuinely cared for the people they supported. They showed commitment to enhancing people's life experiences, assisted them to make the most enjoyable and beneficial use of their time.

Is the service responsive?

The home had a robust safeguarding procedure that ensured an appropriate response to allegations or suspicions of abuse. This was in line with the local multi-agency safeguarding procedure and protocol. This ensured people were protected from abuse or risk of abuse.

People and those acting on their behalf had been informed of the procedure for making a complaint or expressing a concern. People could be assured the home had effective systems for investigating and responding to complaints.

Systems were in place for analysing incidents, complaints and safeguarding alerts. Learning from these events had been constructively used to promote continuous service improvement and developments.

People and others involved with the service completed an annual satisfaction survey. Where shortfalls or concerns had emerged these had been addressed.

Is the service well-led?

The service employed a registered manager and deputy manager who were both

registered nurses. They were positive about the training opportunities available to them within the company. Their continuous training had enabled them to perform their roles and manage the home effectively. They felt well supported by the provider's representative who visited regularly and was always accessible for advice and guidance.

The registered manager and the provider's representative monitored and assessed quality within the home in various ways. Staff demonstrated they were clear about their roles and responsibilities. They felt supported by management and had a good understanding of the home's ethos and of quality assurance processes. This helped ensure that people received a good quality service.

We also spoke with four members of staff, a physiotherapist and the manager. We found that people who lived at the service benefitted from an established manager who understood her role and responsibilities. Consequently, people's care and support needs were being met.

Staffing levels met people's needs. Systems were in place to ensure suitable numbers of staff with the right knowledge and experience were on shift. Arrangements were also in place to cover staff absence. However, at times these were not implemented.

Staff understood the importance of assessing if people who were unable to communicate verbally were happy. For example, one told us, "Some people communicate with facial expressions and body language. We look for non verbal signs that they might be unhappy. Sometimes it's a judgement call. We try and consider what could be affecting them such as they might be tired and want to rest or they might be unhappy in their surroundings so take them to a different part of the home or out in grounds. If we still have concerns we report to the manager".

We spoke with six members of staff. They told us that they felt supported in their work. One said, 'I'm really comfortable working here', another, 'It is a very loving and kind environment'. The manager told us, 'Parents entrust their care to us, we have to give them the best'. A relative said, 'The staff are brilliant, I won't have anything said against them'.

The atmosphere throughout the visit was good. We observed that people were involved in activities and that staff were aware of their individual abilities, likes and dislikes. One person told us, 'I did some cooking yesterday; today I'm going in the day centre'. One member of staff said, 'We do cooking, they get stuck in, you see them giggling and laughing'. We saw that the lodges were decorated for forthcoming events such as Valentines Day and that people were engaged in what was going on.