All inspections: Raymond House - Care Quality Commission

Raymond House provides accommodation and personal care for up to 39 older people. The inspection took place on 2 September 2015 and 3 September 2015. Some people living at Raymond House had care needs associated with living with dementia. At the time of our inspection 33 people were living at the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.
Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Managers, 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. At Raymond House the registered manager is also the owner/Registered Manager of the service.

At our last inspection in March 2015 the service had an overall rating of ‘Requires Improvement’ as the views about staffing levels were mixed and some people felt that there was not enough trained and experienced staff available to meet their needs. We also found that people or their families were not fully involved in planning and making decisions about their care. The service was found not to be responsive in identifying and meeting people’s individual occupational needs.

At this inspection we found that the overall quality of the service had not improved and in some areas it had deteriorated further. The Registered Manager could not demonstrate the service was being run in the best interests of people living there.

Arrangements in place to keep the registered Manager up to date with what was happening in the service were not effective. As a result there was a lack of positive leadership and managerial oversight. Systems in place to identify and monitor the safety and quality of the service were ineffective as they either did not recognise the shortfalls or when they did there was a lack of action to rectify them.

Staff did not have the skills and experience and they were not deployed effectively to meet the needs of people. We found that staff did not always have enough time to spend with people to provide reassurance, interest and stimulation. There was a lack of knowledge around supporting and caring for people living with dementia including understanding how it affected people differently and how each individual should be cared for to promote their wellbeing as far as possible.

Medicines were not stored safely and the Registered Manager could not demonstrate that people received their medication as and when they needed it and/or as it had been prescribed. In addition medication was not always stored safety to ensure its quality and integrity.

People enjoyed the meals but arrangements were not robust in terms of meetings all the people’s individual nutritional needs. As a result the Registered Manager was unable to demonstrate that people had enough to eat and drink to support their overall health and wellbeing.

Although people told us that staff treated them with kindness and were caring, we found the way the service was provided was not consistently caring. Staff did not always demonstrate a caring attitude towards the people they supported and some failed to promote people’s dignity or show respect to individuals. The majority of interactions by staff were routine and task orientated and we could not be assured that people who remained in their bedroom received appropriate care to meet their needs. This also meant they were socially isolated as opportunities provided for people to engage in social activities were limited.

Whilst we were concerned that some staff did not always recognise poor practice, suitable arrangements were in place to respond appropriately where an allegation of abuse had been made. There was a system in place to deal with people’s comments and complaints however we found the service needed to be more open and transparent in their responses.

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

The inspection took place on 26 March 2015. Raymond House is care home for up to 39 older people who require support and personal care. People living at Raymond House may have care needs associated with living with dementia. At the time of our inspection 36 people were living at the service.

The service had a registered manager in post. 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. At Raymond House the registered manager is also the owner/provider of the service.

People felt safe. The provider had taken steps to identify the possibility of abuse happening through ensuring staff had a good understanding of the issues and had access to information and training. However, action to address any issues may not be appropriate or timely.

The manager has a good knowledge of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS.) DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. Although the provider understood the legislation we found that further work was needed to ensure that people’s rights were always fully protected.

The service ensured that people were cared for as safely as possible through assessing risk and having plans in place for managing people’s care. People were supported with their medication in a way that met their needs. There were safe systems in place for receiving, administering and disposing of medicines.

People were treated with kindness and respect by a sufficient number of staff who were available to them when they needed support. People and their friends and families were happy with the care that was provided at the service.

Staff demonstrated knowledge and skills in carrying out their role. Staff were properly recruited before they started work at the service to ensure their suitability for the role. They received initial and ongoing training and support to help ensure that they had the right skills to support people effectively.

Staff interacted with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff responded to their non-verbal requests and had an understanding of their individual care and support needs. People were supported to be able to eat and drink sufficient amounts to meet their needs. Most people told us they liked the food and were provided with a variety of meals.

People’s care needs were assessed and planned for. Care plans and risk assessments were in place so that staff would have information and understand how to care for people safely and in ways that they preferred. People’s healthcare needs were monitored, and assistance was sought from other professionals so that they were supported to maintain their health and wellbeing.

People had some opportunities to participate in activities but these were not geared towards people’s individual needs and interests. Care tasks were carried out in ways that respected people’s privacy and dignity.

Systems were in place to assess and monitor the quality of the service. People’s views were sought and some audits were carried out to identify any improvements needed.

At the time of our inspection there were 28 people living in Raymond House. We spoke with and spent time with people who used the service. We also spoke with a number of staff members, the management team of the service and the friends/relatives of two people who used the service. We looked at five people's care plans and records. Other records viewed included staff induction, supervision and training records, health and safety checks, quality monitoring information and staff meeting minutes.

We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identity and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Staff had received a range of training to ensure that they worked in ways that were safe. Training included fire safety, first aid, the safeguarding of vulnerable adults from abuse (SOVA) and the Mental Capacity Act (MCA) 2005. This assured people who used the service that staff had the knowledge to know how to care for them safely and protect them from harm.

During our inspection we assessed how the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were being implemented. Mental capacity assessments had been completed for people correctly to maintain the safety and rights of people who used the service.

People told us they were content living in the service and that they would speak with the staff if they had concerns.

People told us that they were satisfied with the level of cleanliness and hygiene in the service. We found that the provider had systems in place to ensure that cleanliness was maintained and monitored. When we identified an issue relating to the cleanliness and condition of commodes throughout the service, the provider took immediate action to address this and ensure that people had clean and hygienic equipment to use.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

Is the service effective?

People told us that they were generally happy with the service and that it met their needs. People made comments such as, "We like it here and are quite content at the moment," and, "You can't fault the staff here." People who were unable to verbally express their views were relaxed, interacted well with staff and were being well supported.

People's care was supported through assessments, care plans and risk assessments being in place. This ensured that staff understood people's needs and could care for them safely, effectively and consistently.

People were supported to eat and drink well. The service assessed people's nutritional needs and monitored this aspect of their care to ensure their wellbeing

Staff who worked in the service were supported through on-going training and supervision to offer people care and support that met their needs.

Is the service caring?

We saw and heard good interactions between the staff and people who used the service. Staff were respectful, caring, encouraging and supportive towards people.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken into account and listened to.

Staff were responsive to people's changing wishes and needs about where they went and what they did and supported them well.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from other health care professionals.

Is the service well-led?

The service had a registered manager in post. A senior staff team provided leadership on each shift. A general manager was available at times to oversee and monitor all aspects of the service. The provider had systems in place such as quality surveys and audits to monitor and improve the service. These things showed us that the service was being well led.

People we spoke with told us that they felt generally happy, safe and well cared for at Raymond House. People told us, "We have survived the changes and it is alright here," and, "I feel quite satisfied."

We saw that care and treatment for each person was planned and reviewed with their involvement where possible. We found however that improvements were needed to ensure the completeness and accuracy of people's care plans. This would ensure that people could feel confident that staff had a full and accurate picture of their care needs and choices.

People were given choices in their day to day lives and had opportunities for occupation.

Staff were trained and supported to care for people properly and to keep them safe. Risks to the health, welfare and safety of people using the service were identified and managed.

Medicines were stored, administered and disposed of safely and people's medicines were regularly reviewed to ensure that they were appropriate and effective.

The service was adequately managed and there were systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

We found that people were able to raise concerns or complaints about the service and have confidence that their concerns would be looked in to.

Archived: Raymond House

All Inspections

2 September 2015 & 3 September 2015

During a routine inspection

26 March 2015

During a routine inspection

29 May 2014

During a routine inspection

20 November 2013

During a routine inspection