Archived: Randolph House Care Home

Randolph House is a residential care home providing accommodation and personal care to up to 70 older people some of who have dementia or a physical disability. At the time of the inspection 35 people lived at the service.

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

Improvements had been made to ensure people received their medicines safely. Medicine administration record (MAR) were completed and medicine audits ensured any errors were actioned timely.

For people who had ‘as required’ medicines, the process of recording when medication had been administered was not consistent.

We have made a recommendation about recording ‘as required’ medicines.

Staff were recruited safely. Checks were completed to ensure they were safe to work with vulnerable people. They received an induction, training and shadowing prior to starting work.

People were supported by staff who knew them well which enabled positive relationships to develop. One resident told us, “The staff are all really good, they are smashing.”

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.

The registered manager and staff had a clear understanding of their roles and responsibilities and staff understood when to escalate any concerns for further investigation and transparency.

There was a positive approach to continuous improvement in the service. Regular checks, audits and feedback were reviewed to ensure standards were maintained. Where improvements were required, these were actioned to ensure the safety and quality of the service people received.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 April 2019) and there was a breach of regulations. 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Randolph House on our website at www.cqc.org.uk.

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.

People’s experience of using this service: Records in relation to the safe administration of medicines were not always completed and people did not always receive their medicines as prescribed.

The systems and processes used to monitor and deliver improvements required embedding further to ensure improvements would continue.

Relatives told us their family member was safe. Risks to people were assessed and how to reduce risks and respond to possible harm were recorded. Staff followed infection prevention and control guidance when supporting people.

The service had skilled and experienced staff and staffing levels were measured against a dependency tool. At times during the inspection there did not seem to be enough staff on duty to meet people’s needs and staff seemed rushed for example at lunchtime. Staff received appropriate training and support to enable them to perform their roles effectively. Safe recruitment processes were in place and followed.

Staff involved healthcare professionals to ensure people's health care needs were met. People received support with eating and drinking, when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before providing personal care and support.

Relatives said and information in people’s satisfaction surveys confirmed staff were kind and caring. The staff described how individual people preferred their care and support delivered and the importance of treating people with dignity and respect. Care plans showed people were involved in their care and they contained details for staff to provide effective care and support. The manager said these records were currently being reviewed to ensure they were up to date.

People, relatives and staff had the opportunity to provide feedback about the service. Information was provided so people knew who to speak with if they had concerns. There was a system in place to respond to any complaints.

The provider worked in partnership with other services to support people’s care and quality of life.

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: Requires Improvement (report published 27 March 2018

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Randolph House Care Home accommodates 70 people across two separate units, Poppy and Primrose, each of which have separate adapted facilities. Poppy Unit provides residential care support and Primrose Unit specialises in providing care to people living with dementia. At the time of our inspection there were 43 people using the service.

We undertook this unannounced inspection on 25 and 29 January 2018. The last inspection took place on 21and 22 February 2017 and the service was rated ‘Requires Improvement.’ Issues were identified in relation to the deployment of staff, standards of hygiene and governance systems.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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. Following the inspection, we were informed the registered manager had resigned and left the service and the provider had appointed an experienced interim manager to oversee the service, until a new manager could be recruited.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans. Examples included shortfalls in care plans, supplementary and consent records, topical medicines and training in behaviour that challenged the service.

There was inconsistency with the application of mental capacity legislation. This had led to one person potentially being deprived of their liberty unlawfully, as staff had not recognised they met the criteria for a Deprivation of Liberty Safeguard. Some people had assessments of capacity and records of best interest decisions when restrictions were in place, but this was not consistent throughout the service. One person was subject to low level physical interventions, which had not been agreed or assessed as being in their best interest. However, we found staff had a good understanding of the need to gain consent from people prior to carrying out care tasks.

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

The management of medicines was safe with the exception of the recording and administration of some topical medicines. The regional manager took action during the inspection to ensure staff administered these as prescribed.

Improvements had been made to the staff supervision and appraisal programmes. There were staff meetings which enabled them to receive information and express their views. Although staff completed a thorough induction and range of essential training, we found gaps in the training to meet the needs of people who used the service, including the management of behaviour that challenged the service. We have made a recommendation about staff training on the subject of the needs of older people.

People received the support they required to maintain adequate nutrition. People told us there was a choice of food and it was of good quality. We found staff were not always responsive when people had a poor fluid intake. We spoke with the regional manager about this during the inspection and they took immediate action to improve the monitoring of people’s intake and the recording of follow up action taken by staff.

The quality and range of activities had improved since the previous inspection. Feedback from people who used the service and relatives was positive about the activity programme, which included one-to-one sessions, group activities, entertainers and community trips. Relatives told us they could visit at any time and staff supported people who used the service to maintain relationships with their family.

Sufficient staff were on duty to meet people’s needs. People told us staff responded quickly when they needed assistance. Throughout our inspection we observed there was a visible staff presence at all times. The management team had recently completed a staffing review and changes were being made to the deployment of staff across the units to strengthen the skill mix. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience and were suitable to work with people who used the service.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.

The registered manager and staff worked closely with other healthcare agencies to ensure people received all of the support available to them. Prompt referrals were made to healthcare professionals regarding health concerns.

People who used the service and their relatives were complimentary about staff approach. They said staff were kind and caring and respected people’s privacy and dignity. Staff had a good knowledge of what people could do for themselves, how they communicated and where they needed help and encouragement.

The building was adapted to meet people’s individual needs. Equipment used in the service was maintained and any repairs were completed in a timely way. There was effective infection control training and procedures in place. People told us they were happy with the cleanliness of the service. Accidents and incidents were recorded and investigated.

There were systems in place to enable people to share their opinion on the service and the general facilities at the home. People told us they felt able to make a complaint in the knowledge that it would be addressed. They said the registered manager and unit managers were approachable and available when they wanted to speak with them.

Randolph House is registered with the Care Quality Commission (CQC) to provide accommodation for up to 70 people who require nursing or personal care. The service can provide support to people who are living with dementia. There are three separate units within the service, Bluebell providing nursing care with 11 beds, Poppy unit providing residential care for 23 people and Primrose unit providing elderly mentally infirm care for up to 17 people. Bluebell unit is in the process of closing.

This service has 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood how to protect people from harm and abuse. They knew how to report abuse and told us they would report issues to the registered manager and the local authority, or directly to the Care Quality Commission.

Staffing levels within the service were increased during the inspection process. We observed that the staff were very busy and they told us they were under pressure. Staff reported to us they felt the senior staff needed to work more closely with the care staff. Staff meetings were not held regularly and this was a concern voiced by staff working at the service. These issues were discussed with the registered provider and registered manager. Immediately action was taken to increase the staffing levels on the dementia unit. The management team agreed to undertake regular staff meetings and monitor how staff worked together to improve team work and communication at the service, at every level.

Environmental issues and concerns found regarding the services food hygiene records and cleanliness of the Bain Marie’s found during the first day of our inspection were rectified immediately.

The care records for people on the nursing unit were basic. Staff we spoke with and relevant health care professionals confirmed that people were receiving the nursing care they currently required. The nursing records were being reviewed and updated as people were moved from the nursing unit. People’s care records on the other units were personalised, detailed, person centred and reflected their full and current needs.

Staff understood people’s needs and they were aware of risks present to their health and wellbeing. Staff placed their emphasis on providing care and support to people.

Training was provided for staff in a variety of subjects to maintain and develop their skills. Induction training needed to be reviewed to make sure staff had understood what they had learnt. Staff supervision was in place; however appraisals had not been undertaken and we saw they had been scheduled. These helped to support the staff and develop their skills. The senior management team were looking at how to develop better teamwork at the service.

People’s food and fluid intake was monitored, However, one relative raised concerns about the monitoring of their relations fluid intake with us. The registered manager was looking into this. People were prompted or assisted with meals and drinks by patient, attentive staff who understood people’s dietary needs and preferences.

People’s privacy and dignity was respected by staff. People made choices and decisions about how they wished to live their lives, where this was possible. Staff supported people to make choices about their daily lives.

Staff contacted health care professionals to discuss people’s changing needs and their advice was acted upon to help maintain people’s wellbeing.

Some activities were provided and these were to be enhanced to make sure people received adequate stimulation.

Pictorial signage was in place throughout the service, which helped people find their way around. People’s bedrooms were personalised. The building was maintained and service contracts were in place.

People’s privacy and dignity was respected by staff. People made choices and decisions about how they wished to live their lives, where this was possible. Staff supported people to make choices about their daily lives.

There was a complaints procedure in place, issues raised were investigated and the outcomes were recorded.

The registered manager and registered provider undertook audits covering aspects of the service provision. Action plans were generally put in place to help evidence that issues were dealt with. One action plan had not been created following a resident and relatives meeting. The registered manager confirmed they would address this.

People’s views were asked for by the registered manager and registered provider. Information received was reviewed by the management team to help them improve the service. We received mixed comments from relatives about the communication within the service, which some relatives felt could be improved.