Archived: Rushall Care Centre

In this report the name of the last registered manager appears. They were not in post and not managing the regulatory activities at this service at the time of this inspection. Their name appears because they were still the registered manager on our register at the time of the inspection.

They told us the home had gone through a period of change since the last inspection. A number of safeguarding investigations had taken place in the last quarter of 2013, which led to staff and management changes. They told us the management team had previously been 'fire fighting' and working to build a new culture at the home. They told us they had been working closely with staff to make necessary improvements. They told us they were working to embed new ways of working to include staff having greater accountability for the work that they undertook.

Previously, we completed an inspection in June 2013, where we found the provider was not meeting requirements for outcome 1: Respecting and involving people who use services.

After the last inspection, the provider sent us an action plan. This told us the action the provider would take to make the necessary improvements and by what date.

At this inspection we checked whether required improvements had been made since the last inspection. We also completed a combined scheduled inspection and looked at other essential standards of care.

We found that the provider had made improvements in respecting and involving people who use services. Where there were shortfalls in this area, the manager told us they had identified these issues and they would provide additional training for staff.

Below is a summary of what we found. The summary is based on our observations during the inspection. At the time of our inspection 17 people lived there. We spoke with three people who used the service and two visiting relatives. We completed two informal observation exercises to help us understand the experience of people who could not talk with us directly. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us that staff met their care and support needs. We found that the provider had suspended some staff where there were allegations relating to their conduct and care delivery. We received information from the provider to advise us of the measures they had taken in light of safeguarding allegations reported to them. We found that the provider had not consistently updated staff checks to ensure staff were fit for their role.

We found that policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) were in place. This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had needed to be made. The manager told us they had identified a need to review mental capacity assessments for people who used the service in line with new legislation. They told us they were looking at local training resources available to ensure staff had updated training in this area.

We saw that risk management plans were not up-to-date in the care plans we looked at. We saw that progress notes for each person had been updated to ensure that people's current needs and risks were recorded. The manager had identified the need to ensure updates to general care plans were made as soon as possible.

Is the service effective?

We found that people had an individual care plan which set out their care needs. Assessments included people's needs for any equipment, mobility aids and specialist dietary requirements. This was intended to ensure that people's individual care needs and wishes were known and planned for as part of their care service.

People had access to a range of health care professionals who visited the home. People told us that staff helped them to access support services when needed. One person told us: 'They are in tune with [my relative's] needs. They keep me informed about doctor's visits'.

Is the service caring?

We asked people who used the service for their opinions about the staff that supported them. One person told us: '[My relative] always looks nice and clean. The staff are gregarious and have a smile on their face' and another person told us: 'I love it here I can do anything I want as long as I have my [walking] frame'.

People said their preferences, interests and diverse needs were respected and care and support had been provided in accordance with people's wishes. We could not consistently find records which documented people's likes and dislikes in the care plans that we looked at.

People we spoke with told us that they felt their privacy and dignity were always respected by care staff. From our observations and discussions with the manager we saw evidence of good practice in this area. We found there were some areas where improvements were needed to ensure people's dignity and privacy were routinely respected.

Is the service responsive?

We looked at examples of investigations which had been completed in line with the complaints policy. We saw that complaints were investigated and action taken as necessary. We found that systems were in place to make sure that the managers and staff learned from complaints. This reduces the risks to people and helps the service to continually improve.

We saw that people received surveys every year to give feedback about the care and support they received. We saw that meetings had recently been set up to enable the manager to get feedback from people who used the service, their relatives and staff. We did not have enough evidence that the service was responsive to people's requests and needs as this had been set up a few weeks before the inspection.

Is the service well-led?

We found that the service had a quality assurance system in place to ensure the quality of the service continuously improved. We found that where issues had been identified it was not always clear when shortfalls would be addressed.

Staff told us they felt supported by the new manager and had effective working relationships with their team.

We have asked the provider to tell us what they are going to do to make the necessary improvements in relation to staff requirements.

At the time of our inspection there were 19 people living at the home. We spoke with seven people who lived in the home and two relatives visiting on the day. After the inspection we spoke with two healthcare professionals who visited the home.

One person who used the service told us: 'I'm looked after well here'.

One relative told us: 'I have no concerns about the care here. Staff let you know if there are any problems'.

We checked how people were involved in the service they received. They attended resident and relative meetings and participated in their care reviews. We found that there were some occasions when people's dignity, privacy and independence had not been respected.

We found that people's care needs were being adequately met. We saw that people were supported to see healthcare professionals where required.

We found there were some concerns about staffing levels at the home. We found morale amongst staff was generally low as they perceived staffing levels to be too low. The staff told us that this did not negatively affect people living at the home.

We found that there was a system in place for monitoring the availability, safety and hygiene of equipment used in the home.

We found there was a system to record and respond to complaints made.

People who lived at the home that we spoke with were positive about living there.

One person told us, 'I love living here'.

Another person told us, 'I am delighted to be here'.

We spoke with four relatives who were visiting the home. They told us they were happy with the home and the staff.

One relative told us, 'I am happy. I have no issues or complaints about the home'.

Staff we spoke with told us they had appropriate training to undertake their work competently and had the right level of support from the management team.

We looked at five key outcomes to establish whether people were involved and participated in the service they received; whether care was provided appropriately; whether the home could adequately ensure people's safety; whether there were sufficient staffing levels and whether there was a system for ensuring ongoing quality assurance within the home.

At the last inspection the provider was found to be non-compliant with minor concerns for outcome four. This was due to insufficient activities at the home to provide adequate stimulation to people living there. We looked at this outcome area again to assess whether the provider had made necessary improvements since the last inspection.

We found that Rushall Care Centre was compliant in all five outcomes and had made the necessary improvements since the last inspection.