Archived: Christopher Grange Rhona House

Christopher Grange Rhona House is a residential care home providing personal and nursing care to 25 people at the time of the inspection. The service can support up to 28 people in one adapted building.

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

People received safe care and treatment. Staff administered people’s medicines in a safe and effective way.

Staff safeguarded people and understood the importance of supporting people to make their own choices and decisions where possible.

The environment was safe and clean. Staff followed good practices in relation to the prevention and control of infectious disease.

Staff were checked for good character before being recruited and staff told us they were supported by managers and encouraged to develop their skills and knowledge during their induction period.

The registered manager quality assured the running of the service and lessons were learnt when things went wrong.

Staff did not always maintain accurate and contemporaneous records in relation to the support they had provided people. The manager had identified this before the inspection and showed us an action plan which showed progression was being made.

Staff told us they were able to seek support from the managers and enjoyed working at Rhona House. A large number of staff had worked at the service for many years. The managers submitted statutory notifications and were aware of their regulatory responsibilities. People who lived at the service told us they felt involved and in control of their lives.

Information technology systems were used to monitor and improve the quality of care. The provider had implemented CCTV in communal areas without consultation with people who lived at the service, relatives and staff. The manager assured us they would look at building a new policy and procedure in line with best practice standards around use of CCTV in care homes. After the inspection the manager sent us further evidence to show this had been actioned.

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 June 2018).

Why we inspected

We received concerns in relation to safe care and treatment and staff conduct. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has not changed.

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.

Christopher Grange Rhona 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.

Rhona House is part of a larger complex that also provides a separately registered care home without nursing. The site has a reception area, chapel, main kitchen and laundry which are shared by both care homes. Some staff including activities, laundry and maintenance staff work across both homes and people can attend activities held anywhere on the site.

All accommodation at Rhona House is provided in single bedrooms and is at ground floor level. An enclosed garden and shared lounge and dining room are also available within Rhona House.

Rhona House accommodates up to 28 people. At the time of the inspection 26 people were living there.

At our last inspection of the home in October 2016 published in January 2017 the service was rated requires Improvement overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 9 and17.

This was because people's care was not always designed in such a way as to meet their needs and reflect their preferences and the provider's systems and processes to assess, monitor and improve the quality of the services, required further development to ensure they were consistently effective.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of these regulations.

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.

Comments we received from relatives and people living at Rhona House included, “They get very good care here. I wish they were all like this,” and “The care is very good.”

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. Staff had received training and knew what action to take if they felt people were at risk of abuse. A system was also in place for raising and addressing concerns or complaints and people living at the home and their relatives told us they would feel confident to raise a concern.

Equipment and the building were monitored regularly to ensure they were safe. The building had adaptations and equipment to support people with their mobility and personal care. This included hoists, stand aids and call bells.

People’s medication was safely managed and they received it on time and as prescribed. Staff provided people with the support they needed to manage their personal and health care needs.

Assessments of people’s care needs had been carried out and where they required support this was detailed in their care plans which provided guidance for staff on how to meet people’s needs safely and well. These had been regularly reviewed to check they were up to date and accurate.

There was enough staff working at the home to meet people’s care needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

People liked the staff team and told us they were kind and caring. Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us they felt supported and we saw that they had regular staff meetings and supervisions with senior staff. They told us that the registered manager listened to their point of view and was clear about the standards she expected from them.

Staff spent time interacting with people as well as meeting their care needs. They were attentive to and anticipated people’s care needs and tried to make people as comfortable as possible. They spent time with people and took time to understand people’s different ways of communicating.

When with people living at the home staff were respectful and treated them with dignity. Some of the language used within care records and by staff was old fashioned and not dignified. We discussed this with the registered manager who told us she would make a concerted effort to support staff to update their terminology.

A number of activities took place on the overall site including at Rhona House. People were welcome to attend any activities they enjoyed. These included attending services at the on-site chapel, armchair exercises and entertainers.

The provider met the requirements of the Mental Capacity Act 2005. People were supported to make choices and decisions for themselves. Where people lacked the capacity to make important decisions for themselves then the provider took steps to protect them. This included applying to the local authority for a Deprivation of Liberty Safeguard (DoLS) for the person.

Mealtimes were relaxed social occasions with people able to eat in the dining room or their bedroom as they preferred. People had a choice of meals and we saw that staff offered people support to eat, drink and monitor their nutritional needs.

Systems were in place for checking the quality of the service provided. These were used to plan improvements to the service provided and ensure the improvements had been made.

The home is registered to provide nursing and personal care to up to 28 older people, some of whom are living with dementia. At the time of our inspection 25 people were living at the home.

The home had 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.

The provider had breached the regulations relating to good governance and person centred care. Care plan audits had lapsed and some training had not been completed. Staff one to one supervisions were also overdue. Care plans were not personalised or detailed enough to describe the care people needed. Some people did not always have a positive lunch time experience.

You can see what action we have asked the provider to take at the back of the full version of this report.

People and family members told us they felt the home was a safe place to receive care. Care workers told us they felt the care they provided was safe.

Care workers had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to raise concerns. Care workers did not have any concerns about people’s safety.

People confirmed there were sufficient staff on duty. They said if they needed assistance this was provided quickly.

Medicines were managed appropriately. People only received their medicines from trained and competent nurses. Medicines records were accurate and medicines were stored securely in a locked treatment room.

Recruitment checks including requesting references and Disclosure and Barring Service (DBS) checks had been completed to ensure new care workers were suitable to work at the home.

Incidents and accidents were logged and investigated. Where required action had been taken to help prevent the incident from happening again.

Regular health and safety checks were carried out, such as checks of the fire safety systems, water temperature, gas and electrical safety. Risk assessments were in place to help minimise potential risks to people’s safety.

Procedures and guidance to help care workers deal with emergency situations were available.

Staff confirmed they felt well supported by the registered manager and their colleagues.

The provider was following the Mental Capacity Act (MCA) 2005 and had submitted Deprivation of Liberty Safeguards (DoLS) applications to the local authority. Care workers had a good understanding of how to support people with decision making.

People were accessing external health care services when required, such as GPs, community nurses and other specialist services.

People had been involved in assessing their needs. Care records contained some information about people’s preferences including any allergies, likes and dislikes they had.

People knew how to complain but told us they did not have any concerns about their care. Previous complaints had been logged, investigated and resolved.

People said there was a good atmosphere in the home. They also told us the registered manager was approachable if they needed to speak with them.

There were effective recruitment and selection processes in place which meant people were cared for, or supported by, suitably qualified, skilled and experienced staff. There was a complaints system in place at Christopher Grange which aimed to listen to and respond effectively, within a stated time-scale, to any complaints that had been received. In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still a registered manager on our register at the time.

This service cares for people with a range of conditions and conversation with most residents was limited due to their complex needs. We therefore spent much of the time in the communal areas making observations of how people were being cared for. We observed staff assisting people who required care and support with personal care. From our observations we saw that staff treated people with respect and ensured their privacy when supporting them. We saw the staff provided support and attention as people requested it.

Everyone we spoke to gave us good feedback about the service and said they felt the standards of care were good. People told us they had never had reason to make a complaint and that they felt the atmosphere at the service was welcoming and that staff communicated well with them.