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Raleigh Court - Care Home Good

Reports


Inspection carried out on 8 October 2019

During a routine inspection

About the service

Raleigh Court – Care Home is a residential care home. It can provide personal care to 56 people aged 65 and over, who may be living with dementia. At the time of the inspection 51 people were receiving the service. People are accommodated on two floors in one building.

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

A new management team in place in the last 12 months meant the service was better managed and directed. Breaches found at last year’s inspection had been met and shortfalls were now being identified by the registered manager and put right. Staff told us they felt better supported and able to call on all managers for assistance when needed.

Staffing vacancies were being safely recruited to, risk was reviewed and reduced and needs assessments and care plans better completed. People were monitored more closely and effectively to improve the management of accidents and incidents. This kept people safe from harm.

Some minor infection control and management issues were found when viewing the premises. We discussed them with the deputy manager and they were given immediate attention.

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. Staff were well supported and trained to carry out their roles and met people’s needs for suitable nourishment and effective health care.

People’s privacy, dignity and independence were respected and encouraged. Their care plans were now up-to-date and person-centred, complaints listened to, communication needs met, and end of life support available when needed.

Quality monitoring was improved. People were asked their views of care and support, governance systems met the requirements of registration and there was a positive desire to learn from lessons and improve the quality of the service. The registered manager had made some changes in how the service was run and had motivated staff to sign up to them with the aim of providing better care to everyone.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (report published 23 October 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 20 August 2018

During a routine inspection

This inspection took place on 20 and 28 August 2018 and was unannounced. Raleigh Court - Care Home 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.

Raleigh Court - Care Home accommodates 56 people in one adapted building, some of whom may have needs associated with dementia. There were 49 people using the service at the time of the inspection. The location is close to the city centre of Kingston-Upon-Hull.

This comprehensive inspection of Raleigh Court – Care Home was already planned, but also prompted in part by notifications we received and information sharing with the local authority safeguarding team, of incidents between people that either put them at risk of abuse or demonstrated they had already experienced abuse from one-another.

At the last inspection in December 2015 the service was rated ‘good’ with the section ‘is the service responsive’ rated as ‘outstanding’. At this inspection the service has been rated as requires improvement and we have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment (Regulation 12); person-centred care (Regulation 9) and good governance (Regulation 17). You can see what action we have told the provider to take at the back of the full version of this report.

The provider was required to have a registered manager, but had not had one since the end of May 2018. At the time of the inspection there was a new manager in post who had not yet applied 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.

We found concerns in relation to the safe care and treatment of people. Risk management was ineffective in both medicine administration and care support. There were concerns with person-centred care. There was insufficient information in care and support plans to ensure staff could effectively meet people’s needs. There were concerns with governance. There was an ineffective quality assurance system. This included problems with processing of information, escalating concerns to higher management and maintaining accurate records.

The assessment of people's needs had not always been carried out thoroughly. We have made a recommendation about the pre-assessment procedures to ensure they are robust and effective tools in identifying people's needs, lifestyles and histories.

Mental capacity assessments were missing for some people in certain areas of need. We have made a recommendation about following the principles of the Mental Capacity Act 2005 more thoroughly to ensure people's rights are protected in all areas when they lack capacity.

Issues identified in staff supervision were ineffectively passed up the chain of command. Management and the running of the service had been in steady decline and had impacted on people’s safety and rights.

Systems in place to report safeguarding incidents were appropriately used to ensure information was shared with the local authority safeguarding team. Staff were aware of their responsibilities to manage, record and report these incidents. Staff were safely recruited using the organisation’s procedures. Staffing levels were appropriate to meet people’s needs. Infection control measures were in place and followed to ensure people and staff safety.

Staff received regular training and their skills were assessed and reviewed to ensure they were competent to provide the care and support that people required. People received su

Inspection carried out on 16 and 17 December 2015

During a routine inspection

Raleigh Court is situated close to the centre of the city of Hull, with public transport facilities and local shops within walking distance. The service is registered to provide accommodation and personal care for a maximum of 56 people some of whom may be living with dementia. There are bedrooms, communal sitting rooms, dining rooms, and bathrooms and toilets on both floors. There is an accessible garden and car parking at the front of the building.

We undertook this unannounced inspection on the 16 and 17 December 2015. There were 50 people using the service at the time of the inspection. At the last inspection on 29 October 2013, the registered provider was compliant in the areas we assessed.

The service 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.

We have made the Responsive domain outstanding. We have done this because we found the registered manager and staff team had developed very creative ways in ensuring people felt part of their local community, which had a positive impact on their wellbeing. People who used the service accessed a comprehensive range of activities and occupations within Raleigh Court but also in the wider community; these provided them with stimulation and a feeling of inclusion.

People who used the service received excellent person-centred care based on their needs, wishes and preferences. We found people and their relatives were fully involved in developing care plans. Relatives told us their family members were cared for in an individual way; they were very happy with the service and had noticed there was a lot going on for people.

A health professional told us about the exceptional progress their patient had made since admission to the service. They said this was due to the way the staff had responded to the person’s individual needs and how they monitored their physical and mental health needs.

We found the environment had been adjusted very well to respond to people’s individual needs. This included making kitchettes safe so people could potter around without harming themselves on very hot water, moving the staff office to enable more effective monitoring of a specific area where people liked to gather in the evening, having a room for people who wished to smoke and making the service ‘dementia friendly’.

We found people were safe within the service. There were good recruitment systems in place and there were sufficient staff on duty on each shift to look after people and ensure their health and wellbeing.

Staff protected people from the risk of harm and abuse. There were policies, procedures and training to guide staff in how to safeguard people from abuse; they knew how to recognise signs of concern and how to report them. We found risk assessments were completed and kept under review. This helped to minimise risk and prevent accidents and incidents from occurring.

We found people received their medicines as prescribed. Staff managed medicines well by obtaining, storing, administering and recording them appropriately.

We observed positive interactions between staff and people who used the service and also their relatives; staff were attentive to people’s needs. We saw people were treated with respect and dignity and their independence was maintained as much as possible. Staff were overheard speaking with people in a kind and caring way.

Staff were aware of people’s health care needs and how to recognise when this was deteriorating. The support they provided helped to maintain people’s health and wellbeing. Staff liaised with health professionals for advice and guidance when required.

We found staff supported people to maintain their nutritional needs. They assisted people to make choices about their meals and to eat them safely when required. The menus provided were varied and offered choices and alternatives.

We found people were supported to make their own decisions as much as possible, for example staff offered visual choices to them. When people were assessed as lacking the capacity to make their own choices, decisions were made in their best interest in line with mental capacity legislation.

We found the environment was safe, clean and appropriate for people’s needs. Equipment used in the service was maintained and regular checks took place to identify any concerns.

Staff told us they received sufficient training to enable them to support people safely and to meet their assessed needs. Records confirmed this. We found staff received guidance, support, supervision and appraisal. This helped them to be confident when supporting people who used the service.

We found there was an organisational structure in place to support and oversee systems and staff, and a value base aimed at person-centred care, improving the quality of life for people and involving them in decisions. Staff told us there was an open culture where they felt able to raise issues with the registered manager and senior management.

We found the service was well-managed. There was a quality monitoring system that ensured people’s views were listened to via meetings, questionnaires and day to day discussions. Audits were completed, complaints were addressed and any shortfalls were actioned. There was an ethos of learning to improve practice and the service provided to people.

Inspection carried out on 29 October 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because many of the people who used the service had complex needs associated with dementia.

We observed care was personalised and reflected people�s choices and preferences. People spoke appreciatively about their experience of the service. Comments included, �Dad is happy and settled here, when I go home I have peace of mind; they look after him well� and �Staff are good at managing people�s behaviours; they are patient and communicate well with them.�

We found the provider had acted in accordance with the local safeguarding authority�s reporting protocol and had taken all reasonable steps, to try to reduce the number of safeguarding incidents.

Most people we spoke with raised no concerns about the general environment, but we saw some areas of the home were in need of redecoration and refurbishment.

Records and discussions showed staff had received training, which enabled them to be skilled and confident when supporting people. People we spoke with were complimentary about the staff and said they were kind and caring. One person told us, �The staff here are excellent at looking after people with dementia. They are always patient and calm.�

The provider had an effective quality assurance system in place and people�s views and opinions of the service were listened to and acted on where necessary.

Inspection carried out on 5 February 2013

During a routine inspection

We found that people were involved with their care and care plans reflected people choices and preferences. Staff were able to tell us how they would ensure people�s dignity and choices were respected. Families told us they were always informed about their relative�s welfare and were involved in decision making. Comments included, �They always let me know what�s going on, the care here is excellent.�

We found that people were provided with a varied and nutritious diet. People told us �The food is excellent�, �There is plenty of choice� and �It�s very nice.�

We found that people were kept safe from harm due to the provider having polices and procedures in place for staff to follow. We saw that staff had received training about how to recognise and report any abuse they witnessed or became aware of. Families told us they felt their relatives were safe at the home.

We found that there was the right amount of staff on duty to meet the needs of the people who used the service. Staff told us they never felt rushed and always had plenty of time to spend with the people who used the service to make sure they were cared for properly.

We found that people could make complaints and these were acted on and resolved where possible to the person�s satisfaction. People told us they would approach the manager or the care staff if they had any concerns.

Inspection carried out on 11 January 2012

During a routine inspection

We spoke with three people about the implementation of care plans but they could not recall the documents being put in place or signing them.

People told us they cooperated with offers of support from staff and thought the staff were very helpful. They told us that if they respected the staff then the staff respected them.

People told us they were well cared for and had nothing to complain about. They said they had good relationships with the staff and their needs were met.

People told us they had no concerns but would know who to talk with if they had. They said they would not hesitate to pass on their worries to the manager. Some people were seen to be a little anxious about certain events in the home, but were confident enough to talk to staff or ask for assistance.

Reports under our old system of regulation (including those from before CQC was created)