About the service Randolph House Care Home is a care home providing accommodation for people requiring nursing or personal care for to up to 70 people in one adapted building over two floors. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 38 people using the service.
People’s experience of using this service and what we found
The provider had limited oversight of the safety and quality of the service which had led to widespread and significant concerns. Whilst delayed, the provider had identified shortfalls in their governance systems and had themselves identified a closed culture at the service. They had begun taking action to address this at the time of the inspection. During and after the inspection, the provider demonstrated transparency and took proactive steps to begin making improvements.
People were not protected from the risk of avoidable harm and abuse and staff were not confident in using the provider’s safeguarding process. Risks to people’s health were not properly assessed and people did not always receive their medicines on time or at all. Staff had not always received training in administering medicines or had their competency assessed and they did not always follow the prescribers’ instructions.
Staff did not have the skills and experience to care for people effectively. People’s care and support needs were not properly assessed, and their nutritional and hydration needs were not always met.
People did not always receive person-centred care and support and staff did not always treat people with dignity and respect. We have made recommendations in these areas.
Complaints were not always recorded or acted upon, unless escalated to the director. We have made a recommendation about this.
Despite our findings, we observed some positive interactions between staff and people and staff told us that following some recent staff changes, the culture at the service had improved.
Following the inspection, the provider had demonstrated a commitment to making improvements at the service.
The premises were undergoing a programme of refurbishment and redecoration. People told us they had been involved in choosing colour themes for their rooms.
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.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 12 February 2021 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the safety and quality of the service and the leadership and management. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to the safety and quality of the service, safeguarding, nutrition and hydration, staffing and the overall leadership and management of the service.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.