16 November 2023
During an inspection looking at part of the service
Rushymead Residential Care Home is a residential care home providing personal care to up to 28 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 22 people living at the service.
The care home is located in a large three storey building. The building is located in extensive grounds in a rural part of Buckinghamshire. People’s bedrooms were located on each floor, each floor had a small lounge and kitchenette area. People had access to two large ground floor rooms where group activities could take place.
People’s experience of using this service and what we found
People were not routinely protected from risk of injury or avoidable harm. Risks associated with fire were not always identified by the registered people or acted upon when they were made aware. Fire risks identified by the provider’s own fire risk assessment in March 2023 and by Buckinghamshire Fire and Rescue Service had not been actioned by the provider in a timely manner.
People were left at risk of potential abuse. Staff did not always recognise when abuse had occurred. For instance, people had been physically assaulted, intimidated and had other residents enter their room without permission. These had not always been referred to the safeguarding authority or investigated by the registered manager or provider to prevent a reoccurrence.
People were put at risk by poor recruitment processes and systems. The registered manager and provider did not ensure all the required pre-employment checks were completed before staff worked with people.
People were at risk of infections due to poor hygiene and a lack of preventative measures to stop or prevent the spread of infections.
People were put at risk of harm as the registered manager and provider failed to ensure all accidents and incidents were recorded, investigated, and analysed to identify trends.
The service was not well led. Both the registered manager and provider failed to ensure they maintained compliance with the regulations. We did not always receive the required legal notifications of certain events, like safeguarding and serious injury.
We found the care records within the home to be disorganised, unclear, not complete or accurate. For instance, some records showed a lack of hydration and personal care offered to people. We found confidential records relating to staff and the home management were easily accessible to unauthorised people.
We have made a recommendation about ensuring guidance for staff on how to give liquid medicines support other risk assessments. For instance, when people require thickened fluids, we found some medicine records contradicted other risk assessments for how medicine should be given and how they should be thickened.
We have made a recommendation about ensuring people are referred to external healthcare professionals in a timely manner to prevent a deterioration in their health.
People told us staff were kind and responded to them when they pressed the call bell. Relatives gave us mixed feedback. Comments included “They really do a wonderful job there,” “Staff know us and always acknowledge our visit,” “All the staff we have seen seem happy in their work,” “They are certainly always busy” and “The carers are all very nice.”
Negative comments from relatives included “I feel it would be better for residents if all carers wore name badges. Especially as some of the weekend staff wear a different uniform,” “There did seem to be activities at first, but they have definitely dropped off now,” “I don’t think that Rushymead is a dementia care home from what I can see,” “The home haven’t really been keeping me posted about what is happening with mum, but then they have a high turnover of staff” and “Sometimes we find him unshaved and his hair has got a bit long.”
People were not always supported to have maximum choice and control of their lives, however, staff supported them in the least restrictive way possible and in their best interests. We found improvements were required in the policies and systems at the service to ensure when people's movements were restricted, legal authorisations were in place.
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 April 2018)
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We received concerns in relation to good governance and safeguarding people. As a result, we undertook 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 inadequate 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rushymead Residential Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to risk management, safeguarding people from abuse, safe recruitment and staffing. We have also identified concerns about infection prevention and control, leadership and governance. The registered manager and provider were unable to demonstrate an understanding of their legal responsibilities to notify the Care Quality Commission of certain events.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.