We carried out a review of the data available to us about The Rambles Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Rambles Care Home, you can give feedback on this service.
The Rambles is a residential care home. People in a residential care home receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The Rambles accommodates up to 6 people with a learning disability. At the time of the inspection 4 people were living there.
People’s experience of using this service and what we found
People received safe care that was person-centred. Staff had checks undertaken prior to starting their employment. People were support by enough staff who knew them well and care plans contained risk assessments and important information. People had communication and hospital passports these had information such as what people liked to do and what they liked to eat and drink.
The environment was clean and odour free. Staff and visitors had access to plenty of personal protective equipment (PPE) including hand sanitiser. Visiting procedures were in place and staff were part of regular testing each week. All staff and service users have received two vaccines and people were supported to have maximum choice and control of their lives in the least restrictive way as possible.
People received their medicines safely and records confirmed this. Incidents and accidents were monitored and reviewed for any trends and themes. Improvements had been made to the environment. This included refurbishment of the two bathrooms, a new boiler and radiators, decorating areas of the home and new outdoor seating and a vegetable patch. Relatives spoke highly of the support and care people received.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. For example, the model of care was set to maximise people’s choice and independence. Care was person - centred and people were supported by staff who valued people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection; Requires improvement (Published February 2020)
Why we inspected; This was a based on the previous rating. At this inspection we found the overall rating had changed from Requires Improvement to Good.
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 Rambles accommodates up to 6 people with a learning disability. At the time of the inspection 4 people were living there.
The service is in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service:
People and staff could be at risk of hot water that posed a risk of scalding due to temperatures exceeding recommended temperatures. Some radiators were too hot to touch, and people could be at risk of touching some due to them being hot and uncovered. One person had no environmental risk assessment that identified a risk relating to ingesting liquids. The environmental risk assessment had failed to identify measures in place relating to the lack of effective hand washing within toilets and communal bathrooms.
People received their medicines safely and records were accurate and up to date. People were supported by staff who knew them well and were felt well supported. Staff had checks undertaken prior to working with vulnerable people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People were supported by staff who were kind and caring and staff felt it was a nice place to work. Care plans were individual and personalised and included how staff could support with people’s routines, so they had a good day. Staff used various communication methods and they knew people’s hand gestures and body language to know if they were happy or not.
People and relatives had a complaints policy in place. People had their views sought through regular reviews and conversations about how their care was going. People were supported by staff with their medical appointments and referrals to health professionals were made when required. People were supported by enough staff to access the community and activities that were important to them.
Rating at last inspection: Good (published June 2017).
Why we inspected: This was a planned inspection based on the previous rating. At this inspection we found the overall rating had changed from Good to Requires Improvement.
Follow up: We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the last inspection, the service was rated Good. At this inspection we found the service had met all relevant fundamental standards and remained rated as Good.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.
Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff completed training to ensure they were suitably skilled to perform their role. Staff were supported through a supervision programme
People were supported to maintain good health and had access to external health care professionals when required.
Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated an in-depth understanding of the needs and preferences of the people they cared for.
Support provided to people met their needs. Care plans provided information about what was important to people and how to support them. People were involved in activities of their choice.
There were systems in place to assess, monitor and improve the quality and safety of the service. Staff described the registered manager as supportive and approachable. Comments from surveys and compliments received by the service confirmed that people were happy with the service and the support received.
Further information is in the detailed findings below
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The Rambles Care Home provides care and accommodation for up to six adults with learning disabilities who have complex support needs. Four people were living at the home at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.
We found the service was safe for people, both in terms of their physical safety and in ensuring their rights were protected. Staff had got to know the people at the home well. This helped to ensure support was provided in ways which people liked and met their needs.
Staff received training which helped them to do their jobs well. They felt supported by the home’s manager and they worked well as a team. One staff member told us the staff team "Share the same values." This meant that people at the home received consistent support from staff who understood their roles.
Each person had an individual support plan which reflected their current needs. Staff were well informed about people’s health care needs and the support people required to stay healthy. Records contained guidance for staff so that unforeseen incidents affecting people would be responded to.
One person at the home commented "I like it here" and "I like talking to the staff". Staff responded to people in a friendly and respectful way. Staff sought to obtain people’s views and to involve them in planning their support. There was a thoughtful approach to supporting people with social activities. In recent months, people had attended local events as part of ‘summer road trip’.
Systems were in place for monitoring the service. Different methods were being tried to ensure that the views of people at the home were taken into account.
We reviewed three people's care plans so we could find out how people were supported with their care needs. We saw people had individual care plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. People told us, "the staff help me."
We saw the premises were well maintained. The toilets were clean and hygienic and all communal areas were tidy and organised. A staff member told us,' we all take responsibility for cleaning the house and we support people to clean their rooms.'
People told us they knew how to make a complaint and were confident the manager would resolve any complaint they had.
One person we spoke with told us they liked living at the home and they liked the staff. They told us that they enjoyed going out and confirmed that staff took them out regularly.
The staff we spoke with demonstrated that they had a good knowledge of people's needs and how they liked to be supported.
We found that staffing levels in the home were appropriate for the needs of the people who lived at the home. We were told by the staff that staffing levels at the home had been increased for a short period to suit the individual needs of a person living at the home.
People living at the home were encouraged to be independent and they were involved in planning their activities and how they spent their time.
Care and support delivered by the home was tailored to people's individual needs.
People were supported to make complaints and could be confident that these would be listened to and dealt with appropriately.
One person told us 'I do not have to do things I don't like'.
When we visited the home we found that the people living in the home appeared to be relaxed and there was a good rapport with those staff on duty. The staff were attentive to people's needs and acted appropriately. All staff demonstrated a good understanding of each person's needs and how each person liked to be cared for.