3 August 2023
This was a targeted inspection to check whether the provider had met the requirements of the 2 Warning Notices served in relation to Regulation 12 Safe Care and Treatment and Regulation 13 Safeguarding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The concerns we had were in relation to people’s safety, risk management, infection control and medicines management.
The inspection was completed by an inspector and an Expert by Experience on the first day and a medicines inspector on the second day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Remyck House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Remyck House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 9 people, 2 relatives, a visiting professional, 4 staff and the registered manager. We reviewed aspects of 6 people’s care records and a further 6 people's medicines records. We also reviewed records related to the safety of the service.
3 August 2023
About the service
Remyck House is a residential care home, which can accommodate up to 29 people. The service supports older people who may have a diagnosis of dementia. At the time of our inspection there were 21 residents living at the service.
The service has been extended and adapted. It has 2 floors, with a lift to access the upper floor. There is a communal lounge and a dining room. All bedrooms have a wash basin and some also have an ensuite toilet and shower. There is a paved, secure outside area.
People’s experience of using this service and what we found
People had not been kept safe from the risk of harm from other people. The registered manager had taken action to prevent the risk of repetition but there was an ongoing risk, whilst alternative accommodation was arranged for 1 person. Staff had not ensured people were always provided with safe care and people were at risk from unsafe aspects of the environment. People’s medicines were not always managed safely. People were not always protected from the risk of acquiring an infection. There were not sufficient skilled staff deployed at all times. Staff had not been required to complete all of the necessary pre-employment checks.
Staff had not all received sufficient training for their role or supervision of their work. The decoration of the home was not dementia friendly. People’s modified dietary needs were not always documented. It was not always clear the activities provided were sufficiently personalised.
We have made a recommendation about how people’s well-being is supported.
There was a lack of robust processes to monitor and audit the service, in order to identify emerging risks or areas for improvement. Staff liked working at the service, but the culture was not totally person centred or consistently achieving good outcomes for people. Some attempts had been made to seek people and relative’s feedback.
People told us overall they liked the service, but some aspects could be improved. People’s feedback included, “What’s missing here is strong team management,” “Staff, well some are excellent and I’d say, others are supportive” and “The staff do their job and help you when necessary and are considerate.”
Staff documented incidents and these were then reviewed to identify any actions required for the individual’s safety. People received sufficient food and drink for their needs. Staff worked together and with external professionals to ensure people’s healthcare needs were met. Staff had good working relationships with professionals.
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 12 March 2019).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about safeguarding, staffing and admissions. A decision was made for us to inspect and examine those risks.
We inspected and found there were also concerns with people’s safety, the environment, medicines, governance and infection control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.
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 the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Remyck House on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safe care, safeguarding, premises, medicines, infection control and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.