The Care Quality Commission (CQC) has taken action to protect people living at Rawreth Court following an inspection in September that sees them rated as requires improvement again.
Rawreth Court is part of Essex Partnership University NHS Foundation Trust and provides nursing and residential care for up to 35 people in Rayleigh, Essex. This unannounced inspection was prompted by a review of the information CQC held about this service and to follow up on action the provider was told to take at a previous inspection.
Rawreth Court has been again rated as requires improvement as have the ratings for safe, effective and responsive. How well-led the service is has dropped from requires improvement to inadequate and caring has declined from good to requires improvement.
CQC has issued two warning notices to focus the provider’s attention on making rapid and widespread improvements. CQC will closely monitor the service during this time to keep people safe and will inspect again to assess if improvements are made.
Hazel Roberts, CQC deputy director of operations in the East of England, said:
“When we inspected Rawreth Court, it was disappointing to find care was not always delivered in a way which respected the person being supported or maintained their dignity. Leaders didn’t have the oversight to provide a culture which could deliver consistent, high-quality care.
“There were signs of a closed culture at the service. We found blanket restrictions in place. For example, all of the toilet doors were locked so that nobody could access the facilities unless they were accompanied by a staff member. There was nothing recorded to demonstrate people living in the service or their relatives had given their consent for this arrangement or that this decision was in their best interest.
“At a previous inspection, we found people's bedrooms doors were alarmed. We were told this was used to alert staff when a person's door was opened. At this inspection, this remained the same. Again, there was no information to confirm people living in the service or their loved ones had given their consent to this or that it was in their best interest. This is not a dignified way for people to live.
“There was very little information in people’s care plans about how staff should support them with their medicines. In one case there was no specific detail about diabetes management for staff, which meant people were at risk of not receiving the correct dose of insulin. There was also no information on medical records to demonstrate if people received an extra dose of insulin when their blood sugar readings were above safe levels. This meant there was a significant risk people weren’t receiving medicine as intended.
“Leaders lacked oversight of the service and, where they completed their own checks, weren't identifying the problems we saw, meaning they were unable to develop solutions. This is meant to be people’s home and they deserve the same good quality of life that many of us take for granted.
“We have issued two warning notices to the provider to focus their attention on the areas where we want to see significant improvements. In the meantime, we’ll continue to monitor the service closely to ensure improvements are made and won’t hesitate to take further action if we’re not assured people are receiving safe and dignified care.”
Inspectors also found:
- Care plans didn’t always contain enough information, meaning staff couldn’t always deliver person centred care based on people’s needs
- Not all risks to people's safety and wellbeing were recorded. Where risks were recorded there was not enough detail as to how the risks should be managed
- Personal Emergency Evacuation Plans [PEEPs] documented the level of staff support needed to evacuate safely. But these failed to identify the equipment required, people's needs which would affect their ability to evacuate or their ability to communicate and understand instructions, and where they could be anxious and distressed
- Some people told us staff were too busy to chat with them
- Not all staff were able to demonstrate good dementia or person-centred care to meet the needs of people using the service
- People were not always given a choice of drinks and snacks. Inspectors saw one person have a request for a drink refused by a member of staff
- Inspectors saw a member of staff rush one person while supporting them to eat. The member of staff did not allow enough time for the person to chew and swallow their food. This could have placed them at risk of choking.
However:
- People had the opportunity to feedback on the service through regular meetings
- The service worked with others, for example, the Local Authority, healthcare professionals and services to support care provision.
The report will be published on CQC’s website in the next few days.