Rutland House Care Home

Rutland House Care Home is a residential care home providing personal care to up to 20 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 15 people using the service.

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

The provider was not working within the principles of the Mental Capacity Act. They had not obtained legal authorisations to deprive people of their liberty, where required. This meant people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service at the time of this inspection did not support this practice.

Risks to people’s safety were not always managed well. One person had recently started using the service, but the provider had not assessed risks to their safety and wellbeing at the service. This meant there were no risk management plans for staff to follow, to reduce the risk of injury or harm to the person and/or to others. However, staff had been provided information about risks to other people’s safety and wellbeing. They understood these risks well and what action they should take to help keep people safe.

The provider’s governance systems were not entirely effective, because the provider had not identified and taken action to address the issues above through their own audits and checks. We also found some records were out of date or incomplete because some information about people’s medicines was out of date, some staff files were missing key information about recruitment decisions, and some records relating to the servicing and maintenance of systems and equipment did not contain current information.

The provider took responsibility for the issues we found and responded immediately after the inspection to make improvements that were required. This included submitting applications to deprive people of their liberty to the appropriate authority and putting risk management plans in place for the person that recently moved in.

Staff had been trained to safeguard people from abuse and understood when and how to report safeguarding concerns to the appropriate authority.

There were enough staff to support people and meet their needs. Recruitment and criminal records checks were undertaken on staff to make sure they were suitable to support people. The provider was taking action after this inspection to make sure decisions to employ staff, before all the relevant checks had been completed, were suitably risk assessed and documented.

Health and safety checks were carried out of the premises and equipment to make sure they were safe. The service was clean and hygienic because staff followed current infection control and hygiene practice, to reduce the risk of infection. People’s relatives and friends were free to visit without any unnecessary restrictions.

Medicines were managed safely, and people took their medicines as prescribed. The provider was taking action after this inspection to make sure guidance for ‘as required’ medicines was reviewed, in a timely way, in line with their own policy.

People were satisfied with the care and support they received from staff. People’s feedback indicated staff were kind, caring and they treated people well.

People and staff spoke positively about the management of the service. The registered manager was experienced and understood how people’s needs should be met. Staff felt valued and well supported by the management team at the service.

There were systems in place to obtain feedback from people, staff and others about how the service could be improved. Accidents, incidents and complaints were fully investigated, and people involved and informed of the outcome. Lessons learnt were shared with staff to help them improve the safety and quality of care and support provided.

The provider worked with healthcare professionals involved in people’s care and acted on their recommendations to deliver care and support that met people’s needs.

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

Rating at last inspection and update

The last rating for this service was good (published 14 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and good 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

During a recent outbreak of COVID-19 the provider had followed guidance and advice from the relevant agencies to ensure the safety of people and staff. The provider had been open and transparent with relatives about the outbreak, providing regular updates. They supported relatives in making decisions about visiting their family members and how these could take place in a safe way. Relatives not able to visit, kept in touch with people through video and telephone calls.

Visitors were screened for symptoms of infection and given information about the safety procedures to follow at the service. People and staff were tested for COVID-19 at appropriate intervals. The service made sure staff and visiting professionals were vaccinated against COVID-19. Staff only worked at this location which helped reduce infection risks. The provider had been able to maintain staffing levels to make sure people experienced the same level of service.

Staff had been trained in COVID-19, infection prevention and control (IPC) and in the use of personal protective equipment (PPE). There were designated areas for donning and doffing of PPE and handwashing facilities were accessible to people, staff and visitors. Staff followed current guidance and practice throughout our visit.

The environment was clean, hygienic and well ventilated. Enhanced cleaning took place throughout the environment on a daily basis. Communal spaces were used creatively to ensure people could continue to interact with each other and staff in a safe way.

There was a designated lead for IPC at the service who undertook audits and checks to make sure staff complied with current guidance and practice. The service’s IPC policy and plans for managing an outbreak were up to date and in line with current guidance.

Further information is in the detailed findings below.

At our comprehensive inspection on 11 October 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment and good governance. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well led, to at least good. We undertook a focused inspection on 8 March 2017 to check the provider had followed their action plan and to confirm that they now met legal requirements. We found the provider had taken all the necessary action to make the necessary improvements and improved the overall rating to good.

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

Rutland House care home accommodates 20 people in one adapted building. Accommodation is provided on two floors with stair lift access. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 17 people living at the home.

At this inspection we found the service remained Good. The registered provider demonstrated they continued to meet the regulations and fundamental standards.

People continued to feel safe and well cared for at Rutland House. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. Risks to people’s health and safety were managed and staff took action to minimise these and keep people safe.

Appropriate recruitment checks were completed to make sure staff were suitable to work at the home. The staff were given ongoing training that enabled them to meet people’s different needs and keep up to date with best practice. Staff were supported appropriately through regular supervision and reviews of their performance.

People's needs were fully assessed and kept under review. Care records were person centred and clearly described people's needs and risks and how these were to be managed. Care plans provided important information about people, their background histories and preferences. Staff had a good knowledge of people's care needs and personalities. People’s wishes, choices and beliefs were reflected in their care plans. People were supported to make decisions and staff encouraged their independence as far as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff showed understanding, patience and treated people with compassion.

There were enough staff on duty day and night to make sure people’s needs were met in a safe and timely way. People experienced care and support which was respectful, dignified and took into account their right to privacy and confidentiality.

People lived in a safe, clean environment that was designed and equipped to meet their needs. The provider planned to refurbish and decorate areas of the home and provide a more stimulating environment for people living with dementia.

Activities were arranged according to people’s needs and interests and were meaningful for people living with dementia. Activities were organised by care staff and entertainers visited from outside the home. Staff understood the importance of social interaction and ensured they offered people support and companionship when needed.

People were supported to maintain relationships with family and friends who were important to them. Relatives and friends were welcome to visit when they wished and invited to join in with social events at the home.

People received the assistance they needed with eating and drinking and to maintain good health and wellbeing. Staff took prompt action when people became unwell and consulted other healthcare professionals for necessary advice and support. People received their medicines as prescribed and medicines were stored and managed safely.

People received dignified care at the end of their lives and their wishes were known and understood by staff. Staff were trained and worked alongside healthcare professionals to support people with their needs and experiences.

There was effective leadership and people, relatives and staff told us the home was well run. People and their relatives found the service continued to be welcoming, open and inclusive. They were given regular opportunities to share their views about the quality of care. Any concerns or complaints were acted on and the provider used feedback to improve the service.

Staff were positive about their experience of working at Rutland House. They knew their roles and responsibilities and felt supported by management and each other.

Management and staff completed regular audits to monitor and check the quality and safety of the service. Where improvements were needed or lessons learnt, action was taken. The provider worked in partnership with other agencies to support the development of joined-up care.

We undertook this focused inspection to check the provider had followed their action plan and to confirm that they now met legal requirements. We found the provider had taken all the necessary action to make the necessary improvements which meant they were no longer in breach of regulations. We are changing the rating for the two key questions ‘Is the service safe’ and ‘Is the service well led’ to Good, and we are therefore changing the overall rating to Good.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rutland House on our website at www.cqc.org.uk

Rutland House Care Home provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 17 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had made improvements to medicines management systems which meant they had taken action to protect people against the risks associated with medicines. The registered manager had put necessary guidance in place for staff to follow in administering some medicines to people and medicines administration was now recorded clearly. Our stock checks indicated people received medicines as prescribed and that records the provider made regarding medicines were accurate.

The provider had reviewed the audits in place to assess, monitor and improve the service. The registered manager had introduced effective medicines audits so they regularly checked that people received their medicines as prescribed. In addition the registered manager had also introduced monthly audits of care plans as well as of other aspects of service provision including accidents and incidents, pressure ulcers and falls. The registered manager had reviewed the medicines and complaints policies which we found to be lacking key details at our previous inspection.

Rutland House Care Home provides accommodation and personal care for up to 20 people. The service specialises in the care and support of older people who may be living with dementia. At the time of our inspection there were 16 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we identified a lack of clear, accessible guidance for staff as to how, when and why some medicines should be administered. Some medicines administration records (MAR) were poorly maintained which did not allow for a clear audit trail and increased the risk of mistakes being made when medicines were administered. We also found the provider’s policy and procedure for homely remedies did not comply with national good practice in this area. A homely remedy is a non-prescription medicine that is available over the counter and can be used in a care home for the short-term management of minor, self-limiting conditions.

The issues we found with the management of medicines did not give us full assurance that the provider’s quality assurance systems were fully effective. Although managers carried out medicines audits they did not check that current arrangements reflected best practice so there was a risk that people would not always experience the best care and support they needed to keep them safe and promoted their wellbeing.

We also found some of the information contained in records or policies and procedures was out of date or inaccurate. We found on one care record two different versions of a person’s support plan, which could have been confusing for staff unfamiliar with their needs. People were also not correctly informed about how they could take their concerns or complaints further if they were dissatisfied with the service.

We found two breaches of regulations during the inspection. These were in regards to safe care and treatment and good governance. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

The home manager acknowledged that more thorough checks and audits of key aspects of the service were needed and had employed a member of staff to specifically support them with this. The home manager had been proactive in making improvements when shortfalls in the service had been identified. Following an inspection of the home by London Fire Brigade this year, they made considerable investment in making the required improvements to bring the home up to the required standard.

Relatives told us their family members were safe at Rutland House Care Home. Staff were clear about their duty and responsibility to safeguard people from abuse. Managers worked proactively with other agencies to ensure action was taken to sufficiently protect people. This included taking action when allegations were made about the inappropriate conduct of staff towards people they supported. Staff knew how to minimise identified risks in order to keep people safe from injury or harm. Managers ensured maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of obstacles so that people could move freely and safely around.

People and their relatives were involved in planning and making decisions about their care and support. People’s support plans reflected their specific needs and preferences for how they were cared for and supported. People’s care and support needs were reviewed monthly to identify any potential changes to these. Staff had a good understanding of people’s needs and how these should be met. Staff supported people to keep healthy and well, to drink and eat sufficient amounts to meet their needs and to do as much as they could for themselves. Despite the issues described above, our checks of stocks and balances confirmed people had received their prescribed medicines. These were stored safely at the home. Staff ensured people were able to promptly access other healthcare services and professionals when needed.

People were encouraged to develop and maintain social relationships with others in the home. Relatives and friends were welcome to visit with people at the service and no restrictions were placed on them. People were supported to undertake activities to reduce risks to them of social isolation.

Staff ensured people’s right to privacy and to be treated with dignity were maintained. They spoke with people respectfully and supported them appropriately when they became agitated. Staff made sure confidential information about people was kept securely. The way they supported people during the inspection was respectful, patient and considerate.

Relatives were satisfied with the care and support provided to their family members. Relatives said they were comfortable talking to managers about any issues or concerns they had and they told us they felt listened to. Relatives and staff said managers were open and approachable and asked them for their ideas or suggestions about how the service could be improved.

There were enough suitable staff to care for and support people. Managers carried out appropriate checks on staff to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. They told us they were well supported by managers and encouraged to deliver care to a good quality standard.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and conditions on authorisations to deprive a person of their liberty were being met. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests, and there is no other way to look after them.

We were able to see that there were now procedures in place to ensure that people were being supported by staff who were appropriately experienced, skilled and fit to support people using the service.

Three relatives told us they thought staff were 'patient,' 'calm,' and 'really kind and caring.' The atmosphere was relaxed on the day of the inspection and in the afternoon we observed an activity of 'reminiscent therapy (people discussed past events).'

We reviewed the care files of four people who used the service. We observed that staff respected and involved people in their care. People received the care and support that met their needs. We saw that medicines were managed in a safe way.

We found that insufficient checks were made on staff before working at the home. We saw that there was adequate information about how to complain and complaints were managed in a robust manner.

Visitors were free to come in whenever they wanted to. They told us that they were always welcomed warmly and they were kept informed about any changes in people's health. One relative liked the fact that they could come and help their loved one at lunch time. They told us 'that's what I like about it here the homeliness'. Another relative commented 'I just want to tell you its fantastic here'.

Staff we spoke with displayed an understanding about the people that they were supporting and we saw that they were able to attend training to help them in their role. Supervision and appraisal procedures ensured that their performance was monitored and any individual training needs were identified.