The Kathleen Rutland Home

The Kathleen Rutland Home is a care home registered for up to 44 people with a range of support needs, including sensory impairments. At the time of our inspection there were 29 people using the service, some of whom were in hospital.

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

Staff followed infection control and prevention procedures to protect people from the risk of infections and COVID-19 as far as possible. Staff wore the recommended personal protective equipment, in line with current guidance and requirements, when working in the service and providing care and support. The environment was clean and safe. People were supported to understand measures in place to keep them safe, such as isolating, through personalised approaches. Relatives were kept informed and involved and people were enabled to communicate with their relatives using a range of methods.

Effective systems were in place to check the quality and safety of the service. The registered manager had good oversight of the service and completed regular audits and walk arounds to monitor and improve the service. The leadership of the service promoted a positive culture that was person-centred and inclusive.

Why we inspected

We undertook this targeted inspection to review the management and prevention of infections within the 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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Kathleen Rutland Home on our website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was Good (published 10 July 2019).

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 Kathleen Rutland Home provides care for up to 44 older people who have a sensory impairment or are living with dementia.

People’s experience of using this service:

After the inspection we received concerns in relation to the management of safety and risk for one person living with dementia who had left the service unsupervised and walked a long way on their own. This concern was being investigated by the local authority safeguarding team and by the provider's operations director.

People felt safe and were protected from abuse and avoidable harm. Staff knew when and how to report concerns. Systems and processes were in place to identify and manage risk. Action was taken when things went wrong to reduce the risk of reoccurrence.

There were enough staff with the right skills and experience to meet people’s needs. People’s medicines were managed in a safe way. The service was clean and staff followed infection prevention and control policies to reduce the risk of infection.

People had their needs and choices assessed before they began using the service. Care and support was delivered in line with evidence based best practice guidance. Staff received the training and support they required to meet people’s needs. They had access to ongoing training and opportunities for professional development. People were supported to eat and drink enough and had a varied and balanced diet which they enjoyed. Staff recognized changes in people’s health and supported them to access the healthcare services they required.

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.

People received kind and compassionate care and support. They liked the staff and had developed positive relationships. Staff knew people well and understood how to meet their needs and how to provide comfort and reassurance. People were involved in making decisions about their care and support. People had their privacy and dignity protected.

Care and support was person centred and was delivered in the way people preferred and met their individual needs. Staff understood people’s needs with regards to the protected characteristics of the Equality Act 2010. Information was available to people in accessible formats and staff communicated with people effectively. People were occupied with activities and were able to pursue their interests and hobbies. People knew how to make a complaint and would feel confident doing so. Complaints were investigated and used as an opportunity to learn and improve.

Staff had received training about supporting people at the end of their lives. The service had links with a hospice service for ongoing staff support and guidance about end of life care.

People and staff had confidence in their managers and felt supported. They told us the registered manager was accessible and approachable. There was an effective quality assurance system. Checks were carried out to ensure staff were following polices and procedures and people were safe. Action plans were developed when shortfalls were found and this contributed to continual learning and improvement. The registered manager was supported by senior managers from the wider organization.

People, their relatives and staff were asked for their feedback and this was used to develop the service and ensure it was meeting people’s needs and preferences. The registered manager and staff worked closely with healthcare professionals and other agencies such as the local authority to make sure people received joined up care and support.

Rating at last inspection

The last rating for this service was requires improvement (published 28 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At the last inspection in February 2016 the service was rated overall Good, with a Requires Improvement rating in the Effective domain. This inspection took place on 25 April 2018 and was unannounced. At this inspection we found that improvements were required and the service received an overall rating of Requires Improvement.

This home is required to have a registered manager in post. At the time of inspection, the home did not have a registered manager. 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.

Improvements were required to ensure that people’s medicines were administered correctly and were kept secure at all times. Safeguarding incidents also required attention to ensure that investigation and actions to prevent similar occurrences were taken promptly. Staff responding to people’s call bells required review to ensure people were receiving timely support, particularly when they were in their bedrooms.

The management team needed to ensure that people’s dignity was maintained at all times and that the storage of equipment did not impact this. Further improvements were required to ensure that people and their relatives were involved in regular reviews of people’s care; and quality assurance processes needed to be reviewed to ensure they were identifying where improvements were required and taking prompt action to rectify them.

People felt safe living at the home and systems were in place to recruit staff from suitable backgrounds. Systems were in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and people’s care needs were effectively assessed when they moved into the home. People’s healthcare and nutrition were well supported and people had access to external agencies when they required additional support. Staff were supported well in their roles and had access to appropriate training.

Staff were friendly, jovial and treated people kindly. Staff were knowledgeable about people’s preferences and supported them to receive the care they liked, particularly if they were anxious or distressed. People were supported to maintain relationships with people that mattered to them and visitors were welcomed at the home.

People’s diverse needs were fully considered in people’s care plans and systems were in place to support people’s communication needs. People were able to try new interests and activities and go on visits out of the home if they wished. Complaints procedures were in place and followed by management, and systems were in place to support people to have the end of life care they would like.

People responded well to the management in place and both staff and people commented that they could approach the management and have any concerns listened to. Systems were in place for people and their relatives to provide feedback and this was considered and responded to by management.

The Kathleen Rutland Home provides accommodation for up to 47 older people who have a sensory impairment. The home also supports people with dementia type conditions. At the time of our inspection 42 people were using the service. The accommodation is over two floors and the upper floor can be accessed via the lift, stair lift or the stairs. All of the bedrooms are single rooms with en-suite facility. There are choices of communal sitting areas for people to use and a large dining room.

It is a requirement that the home has a registered manager. 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. At the time of our inspection a new manager had been appointed who was applying through the Care Quality Commission (CQC) to become the registered manager.

People told us that they felt safe and were supported by staff who knew how to deal with concerns about abuse. The provider had considered risks that people faced and had looked at ways of reducing these. For example, where people had fallen these had been audited and advice sought to support the provider to keep people safe.

The provider had a plan for how to support people to keep safe during an emergency. The premises and equipment were checked regularly although fire drills needed to happen more frequently.

Staffing levels were appropriate. Staff applying to work at the home were checked before they started working for the provider to make sure they were suitable.

People received the medicines that they required in a safe way. Staff were trained to handle medicines and their competency had been checked.

People received support from staff who had undertaken regular training. For example, staff had received training in dementia care. Staff were being supported by having regular meetings with their manager.

Staff understood the need to obtain people’s consent before they carried out care. Most people could make decisions for themselves. However, where people may have lacked the capacity to do this, the provider had not always considered this in line with the Mental Capacity Act 2005. Staff did not always understand this legislation.

People had enough to eat and drink but were not always satisfied with the food offered to them. Where there were risks to people’s nutrition, specialist advice had been sought.

People were receiving support to maintain their health. For example, people had access to a GP where this was needed.

People told us that the staff were caring. During our visit we saw that staff approached people in a kind and compassionate way. People were being treated with dignity and respect. For example, people’s records were being kept secure.

Staff knew about people’s interests and what was important to them. For example, people’s religious needs were being met by staff who understood these.

People were involved in making choices about their day-to-day care and support where this was possible. Staff knew the importance of doing this to support people to be as independent as possible. Where people may have wanted to use an advocate, information was not available.

It was not always documented how people had contributed to their care plans. These documents contained some information that was based on people’s individual preferences but was not always detailed. Staff worked with people in a person-centred way.

People undertook activities that they were interested in and enjoyed. For example, people had been to the theatre recently.

People and their relatives knew how to complain as the policy was displayed. Where complaints had been received, the provider had dealt with these appropriately. People could also offer their feedback to the service as meetings and questionnaires had been arranged by the provider.

Staff received support from the management team. They were clear about their responsibilities and could offer ideas for improvement.

The provider had made arrangements to gain feedback from people’s relatives. Feedback received had been used to improve the service offered.

The manager was clear about their responsibilities and had made a referral where there were concerns about a person. They also had ideas for improving the service. This included making the environment more dementia friendly.

Is the service safe?

People who used the service told us they felt safe and described how staff supported them to keep them safe and well. This included support with their personal care needs, daily lifestyle and social activities that promoted their wellbeing. Throughout our visit we saw staff treated people with respect. One person said, “I am very happy and much safer here because I use to fall at home”.

Staff we spoke with showed a good understanding of each person’s needs and how they wished to be supported. Care plans and risk assessments were personalised and provided staff with the guidance to help keep people safe.

Staff were trained to look after vulnerable people and how to protect them for any harm or abuse. Systems were in place to help ensure people were supported to look after their own money.

People told us they felt safe and secure because they were cared for in an environment that had been maintained. All areas of the service were accessible. All the bedrooms had an en-suite facility, which promoted people’s privacy, dignity and safety. Bedrooms were decorated to a good standard and people had personalised their room to reflect their interests. There was a choice of communal lounges and dining area which were furnished to a good standard, which made it homely and comfortable. The outdoor space included a patio and a wooden gazebo, which provided a shady place for people to sit.

We, the Care Quality Commission, monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had proper policies and procedures in place and staff understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Records showed that DoLS applications had been made, which showed the manager had adhered to the legislation that protected people’s human rights.

Staff rotas we checked showed there were sufficient staff on duty to meet people’s needs at all times. Staff we spoke with had the knowledge, skills and training required to support people to ensure they received a consistent and safe level of support.

Is the service effective?

People told us they were satisfied with the care that had been delivered and said their needs were met. People’s care needs and measures put in place to minimise risks were regularly reviewed to help ensure any new needs could be met and risks managed. Care records and staff training records we looked at showed that people’s care needs were met by reliably by trained staff.

People told us that staff help them to maintain their independence; take part in meaningful activities and to use other community amenities. The home’s own transportation and qualified driver’s enabled staff to take people out on day trips.

People had access to a range of health care professionals to ensure their health needs were met. One person said, “I only mentioned that my back was hurting and I went to see the doctor a short while later.” Staff were confident and acted quickly when they had any concerns about people’s health. This showed that staff monitored people’s wellbeing and took action promptly if a person become unwell.

Is the service caring?

Throughout our inspection visit we observed staff were attentive, understood people’s needs and helped them to do things at their own pace. People told us that staff were kind and caring, and they complimented the entire home’s staff. One person said, “I have nothing but praise for them [staff]. It takes a certain kind of person to genuinely care for people and everyone does here.”

The health care professional told us that people were cared for properly. They found the home’s staff knew the people they looked after and understood their needs and how to help them safely.

Is this service responsive?

People’s needs had been assessed before they moved into the home and checked regularly to make sure any new needs would be met. People told us they were asked how they wished to be supported and the records we looked showed that people were involved in reviewing their care needs. This helped ensure people’s needs, preferences, decisions made and expectations were known to the home’s staff.

Is this service well led?

People who used the service and their relatives were supported to make comments and share their views about the service. Regular meetings were held at the home where people could share their views and experiences. Satisfaction surveys were also carried out to gather the views of people who lived at the home, relatives and/or representatives. The complaints policy and procedure was used effectively for the benefit of people living at the home and to improve the quality of service provided.

People’s personal care records and other records kept in the home were accurate and up to date. People knew what information was kept in their care records because the content was discussed with them. People‘s care needs were reviewed regularly to make sure any new needs could be met reliably. Records showed the home’s staff worked with other agencies and services to help ensure people received their care and support that was co-ordinated and managed.

Systems were in place for regular checks to be carried out that ensured the health and safety of everyone was protected. Information from incidents and accidents had been analysed and used to identify changes and improvements, and minimise the risk of them happening again. The manager took prompt action to improve the quality of service provided, put right any shortfalls that were found and act on concerns raised.

People told us they received their medication on time and were supported to take it where necessary. We looked at records and these showed that peope were receiving their medication as prescribed by the doctor, we saw that medication was stored securely and that measures were taken to get rid of out of date and excess medication.

People told us that they had the equipment they needed to ensure they remained as independent as possible. We looked at records that showed that equipment was routinely maintained and people who needed equipment such as hoists, specialist beds and mattresses received this equipment.

Staff recruitment was carried out centrally ensuring that people completed applications, references were sought and appropriate police checks were carried out. We saw that there was a complaints procedure and people spoken with all knew who to speak to and felt confident that nay complaints would be listened to and dealt with by the manager.