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Inspection carried out on 2 February 2018

During a routine inspection

Rathmore 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.

Rathmore House can accommodate up to twenty older people and specifically those who are living with dementia. At the time of our inspection there were nineteen people using the service.

This unannounced inspection took place on 2 and 5 February 2018. At the last inspection on 4 February 2016 the provider was in breach of regulation 11 in respect of gaining consent and the use of deprivation of liberty safeguards. At the subsequent focused inspection on 19 May 2016 the provider had rectified the previous breach of regulation and had met all of the legal requirements. The service was at that time rated as good.

At this inspection we found the service remained Good.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People were supported to consent to care and the service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, consulting with people and their relatives about their wishes and needs.

Staff we spoke with understood their duty to protect the people in their care. Staff knew how to protect people from abuse, how to identify abuse and how to respond if any concerns arose. Staff also knew how to minimise potential risks to people’s health and welfare. Medicines were managed safely and administered in the correct way.

There was a suitable number of staff available to meet people’s needs. No one made any comments to suggest that they did not feel safe in the care of staff.

Care staff were well trained and the training covered the topics they needed to carry out their work and support people. The supervision and appraisal system supported them to carry out their work.

People were supported to maintain good health. The staff team obtained appropriate advice from healthcare professionals when needed.. People received a nutritionally balanced diet to maintain their health and wellbeing.

The service carried out assessments of people’s needs before they moved in. The provider took the appropriate decisions about the suitability of people to use the service. Care plans were person centred and were tailored to each person’s unique needs. Care plans were regularly reviewed and any changes to people’s needs were recognised and action was taken to respond.

The service had a clear management structure in place. The service had a range of quality assurance, consultation and monitoring systems in place. The provider listened and responded to the views of people who used the service, relatives and other health and social care professionals.

Inspection carried out on 19 May 2016

During an inspection looking at part of the service

At the last unannounced inspection on 4 February 2016, we found that the provider was not meeting the regulation with regards to consent to care and treatment and the Deprivation of Liberty Safeguards (DoLS). After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm if they now met the legal requirement. 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 (location's name) on our website at www.cqc.org.uk

Rathmore House is a residential care home for up to 20 people over 65 years of age. Some people or their relatives paid for the care, whilst others had their care commissioned by local authorities. The home is situated in a residential area near Chalk Farm in Camden, North London. On the day of our inspection 16 people were using the service.

A new manager had been appointed and had started in mid-February 2016. They were in the process of registering with the Care Quality Commission to become the 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 last inspection on 4 February 2016, we saw that request for authorisation under the Deprivation of Liberty Safeguards application procedures to ensure people were not unlawfully deprived of their liberty, were not being made appropriately.

We also saw that where a person lacked capacity to sign a consent form for agreeing to their care and treatment at the home, they were not always being signed by an authorised representative. ‘Do Not Resuscitate’ (DNR) forms did not always evidence discussions having taken place with the person or their representative, as required.

At this inspection we saw that the manager had developed a written table where details of the date a request had been made, the person’s name, type of notification and who made the request was recorded. Once an authorisation had been granted the date a notification was sent to the Care Quality Commission was also recorded.

Consent to care and treatment forms were being signed by an authorised representative where a person lacked mental capacity in line with Mental Capacity Act 2005.

There was evidence on the ‘Do Not Resuscitate’ (DNR) forms that a discussion had taken place with the person or their representative, as required.

At this inspection we looked specifically at the previous breach of regulation 11 in the key area of Effective. The service had been rated as good overall at the previous inspection and this rating has not changed.

Inspection carried out on 4 February 2016

During a routine inspection

We carried out an unannounced inspection on the 4 February 2016. At our last inspection 23 April 2015, we found that improvements were required in relation to risk assessments that were not person centred and not reviewed regularly. A general risk assessment of the building had not been carried out since 2013. Care plans and risk assessments were not being checked and audited to ensure a high quality service was being provided.

At this inspection we saw improvements had been made. Risk assessments and care plans were person centred and reviewed regularly and care plans and risk assessments were being regularly audited by senior staff and managers. Risk assessment relating to the building had been undertaken in 2015.

Rathmore House is residential care home for up to 20 people over 65 years of age. Some people or their relatives paid for the care, whilst others had their care commissioned by local authorities. The home is situated in a residential area near Chalk Farm in Camden, North London. The provider, Central and Cecil Housing Trust, runs seven other homes throughout London and the southeast. On the day of our inspection 16 people were using the service.

Steps had now been taken to de-register the current registered manager as they had resigned from post. A new manager had been appointed and was due to start in mid-February 2016. We were assured that the new manager would apply for registration soon after they start.

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.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf for people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedure is for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We could not be sure that managers and staff fully understood their responsibilities for gaining consent to care and treatment and for legally depriving a person of their liberty if they lacked capacity. This meant they did not act in accordance with the MCA and the DoLS application procedure.

There were systems in place to safeguard people and staff had a good understanding of the different types of abuse and how they would look out for signs.

Risk assessments formed part of the person’s agreed care plan and covered risks that staff needed to be aware of to keep people safe.

People had a Personal Emergency Evacuation Plan on their record (PEEP). Their PEEP identified the level of support they needed to evacuate the building safely in the event of an emergency.

Recruitment practices ensured staff were appropriately checked prior to employment to ensure they were suitable to work with the people using the service.

Medicines were stored, administered and recorded appropriately by staff who had undertaken relevant training.

Staff received training and support to help them carry out their work role and demonstrated good knowledge on the subjects they were asked about.

People were supported to eat drink and maintain a balanced diet and they were supported appropriately during meal times.

Inspection carried out on 23 April 2015

During a routine inspection

This unannounced inspection took place on 23 April 2015. Our previous inspection took place on 7 March 2014 and we found the service met the regulations inspected.

Rathmore House is a residential home specialising in dementia care for up to twenty people over 65 years of age. The home is situated in a residential area of Swiss Cottage, North London.

There was a registered manager was in place at the time of our visit. 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.

Documentation at the service stated that risk assessments should be reviewed monthly but in the files we saw that documentation did not support this. Some reviews that were undertaken were not specific and did not include all the relevant information relating to that specific risk or need being reviewed.

Forms we saw requiring people to consent to care and treatment were not signed by them or an appropriate legal representative. We also noted that the documentation in some care files regarding the development of care plans, were not signed by people who use the service or other parties to confirm any involvement in the process. We saw that ‘Do Not Attempt Resuscitation’ (DNAR) forms that were used for recording resuscitation decisions were not recorded on the correct forms.

Some assessments and information on care files were incomplete. Some reviews of risk assessments were not specific.” Reviews, including reviews of care plans, were not carried out monthly as stated in the documentation at the service. This meant that any changes to the way people needed to be supported safely may not have been identified effectively and may lead to inappropriate and unsafe care being provided.

A complaints log was completed but we did not see evidence of feedback regarding the outcome of the complaint being given to people or their relatives and there was no information to indicate if they were satisfied that the complaint had been resolved effectively.

Monthly care plan and risk assessment reviews were not being audited effectively and had not identified the shortfalls found during the inspection.

Staff had received training in safeguarding adults and we saw a safeguarding adult’s policy in place. Staff were aware of what constituted abuse, the types of abuse and the steps to take if they were concerned.

We found suitable numbers of staff to support people on each shift. There were recruitment procedures in place to help ensure people were safe and not at risk of being supported by unsuitable staff.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed. Weekly medicine audits were undertaken.

We saw evidence that a fire safety risk assessment had been completed and weekly fire alarm testing had been undertaken.

Senior staff had a good understanding of the Deprivation of Liberty Safeguards (DoLS) process and had actively referred people to the local authority for a DoLS authorisation. DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff had the knowledge and skills needed to perform their roles. There was an induction programme in place for new staff that covered training in in mandatory areas such as, health and safety, moving and handling, fire safety, safeguarding adults and food hygiene.

Staff had received one to one supervision at variable intervals ranging between monthly and six monthly. One staff record we saw had a recent appraisal recorded. An appraisal is an overview of the year’s work performance, training and development and should be conducted annually for all staff.

People’s nutritional needs were assessed and recorded in their care files and menus we saw indicated they were receiving a balanced diet.

People were supported effectively with their health needs. The GP visited once a week and more often if staff requested. Relatives and visitors told us that their relatives and friends were able to see the GP when they needed.

We saw that thought had gone into the physical environment to support independence and to aid familiarity, particularly for people with impaired memory. Staff completed life histories with people and told us they used the information to ensure equality and diversity was upheld.

We saw some evidence of activities at the service but some people in the session did not appear to be engaged in the activity being presented.

People and their relatives felt confident to raise any concerns they might have with the care workers and the managers.

Inspection carried out on 7 March 2014

During an inspection looking at part of the service

This inspection was a follow up to our visit of the 21 November 2013. At that time we had found that the provider�s staffing records did not contain all the information required in accordance with Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We also found gaps in the care records of people using the service, relating to their daily activities, making it difficult to assess their continuing wellbeing. This meant that the provider was not complying with the requirements of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Following our inspection, the provider informed us of the action it proposed to take to meet the requirements of the regulations. We made this visit to check that the actions had been implemented. We saw that the provider had taken appropriate action to comply with the regulations.

The building work that was taking place at our last visit was still ongoing at this inspection. Accordingly, we looked at three other outcomes, relating to cleanliness, suitability of the premises and suitability of equipment. We found that the provider was fully compliant.

Inspection carried out on 21 November 2013

During a routine inspection

We inspected Rathmore House on the 21 November 2013. The named registered manager had left the home a few months prior to our inspection. A new manager had just been appointed and was present during our inspection. We spoke with them as well as the deputy manager and a number of other members of staff.

There was building work being carried out at the home. This reduced the number of rooms available and there were 7 people staying there. We spoke with people using the service and observed care being provided. We looked at people�s care records and other records relating to the service.

People living at the home were generally happy with the service they received. They felt safe at the home and we saw them being given appropriate care and support in accordance with their individual needs.

The records of people�s activities were not maintained consistently, making it difficult to monitor and assess their continued wellbeing. We had brought the provider�s attention to the issue at our last inspection and have now set a compliance action.

Records relating to the recruitment of staff were not maintained in accordance with regulatory requirements and we have set a compliance action.

Inspection carried out on 5 March 2013

During a routine inspection

We spoke with several of the people living at the home as well as some relatives who were visiting. We also spoke with the manager and some staff members, as they carried on their work and in private. We looked at records regarding people�s care and support and other records relating to the service. We spent some time observing care being provided throughout the day.

People living at the home and the relatives we spoke with were very positive about the home. One person said they were �very happy here� and that the home had �given me a new lease of life.� A relative said the �care is very good� and that �everyone�s friendly and kind.� Another said the staff members �do their job well.�

Records relating to people using the service were generally well-maintained and easy to use, although we noted a number of gaps in the records of activities people took part in. People�s care plans were regularly reviewed and updated to ensure their continuing needs were met. Staff were appropriately qualified and experienced and we saw that regular refresher training was provided. There were systems in place for monitoring the quality of the service, but we noted a lack of a formal procedure for regularly seeking feedback from people living at the home and their relatives.

At the time of the inspection, the provider was reviewing Rathmore House�s continued operation as a home with nursing care. The uncertainty over the future was a cause of concern for people, relatives and staff.

Inspection carried out on 14 April 2011

During a routine inspection

People we spoke to were content living at Rathmore House. Relatives reported that they were happy with the care given to their family members. The 2010 satisfaction survey showed that staff appeared to know all the service users very well and attended to them with care and respect. It also showed 100% satisfaction with choices given at the home.