Archived: Rakelands

We told the provider to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that improvements had been made with regard to each of the breaches identified and the provider was now meeting the legal regulations.

Rakelands provides accommodation and nursing care for up to 16 people with a learning disability. At the time of our inspection there were 13 people living in the home.

Rakelands has 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.

Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. Staff were aware of the safeguarding policy which was easily accessible to them and knew how to report abuse.

Risk assessments were in place for each person based on their individual needs. People using the service were living with a learning disability, had complex needs and required nursing care. This meant that people were living with risks such as choking or at risk of suffering seizures. Risk assessments were detailed and demonstrated how these risks were managed to keep people safe.

The provider ensured staff were safely recruited to meet people’s needs. Where staff performance issues had been identified the provider had taken appropriate action to ensure that fit and proper persons were employed to keep people safe.

There were enough staff on duty to meet people’s needs. Everyone had their physical needs met, including their daily physiotherapy requirements and everyone was able to access and participate in activities. Some people visited a local activities centre a short distance away supported by staff.

Medicines were administered safely by staff who had been trained to do so. Medicines were administered by trained nurses, however all staff had undertaken training in medicines administration. Staff had also received epilepsy training in order to administer emergency medicines in relation to seizures.

Medicines were stored safely. Medicines storage temperatures were monitored on a daily basis to ensure medicines were kept at a safe temperature. Storage arrangements met the additional legal requirements for the safe storage of controlled drugs.

Staff had received appropriate training to deliver the care and support for people living in the home. Records showed that training covered all essential areas such as infection control, food hygiene and fire safety. There was also training in relation to nutrition awareness and specific training around epilepsy awareness. Staff had regular supervision meetings and annual appraisals and said they felt supported.

People were asked for consent before care and support was provided. Communication support plans made it clear how people communicated so that staff understood when people were consenting. Most people were not able to communicate verbally and the communication support plans made it clear to staff, the ways in which people were able to communicate.

Where people lacked capacity to make specific decisions, the home acted in accordance with the principles of the Mental Capacity Act 2005 (MCA). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Relevant applications had been submitted for people to ensure they were not being deprived without the appropriate legal authority.

People received sufficient nutrition and hydration in line with their requirements and were supported by staff to receive their nutrition if required. A large proportion of people received all or the majority of their nutritional intake through a percutaneous endoscopic gastrostomy (PEG). Staff were aware of each person’s individual requirements which were clearly documented in their support plans. Some people received additional supplements through their PEG if they had insufficient oral intake to meet their nutritional and hydration needs People’s weight was monitored on a monthly basis to ensure that appropriate action could be taken if they lost weight.

Health professionals were appropriately involved in people’s care. People had complex conditions and needed support from a variety of health professionals. Each person had a health action plan which recorded the support required and the outcomes of any visits.

Staff were supportive and caring. Staff were observed to respond individually to people, enjoying fun and playful conversations appropriately. Relatives gave positive feedback about the quality of the care delivered in the home and one person told us they were happy and that staff were kind to them.

People were involved in day to day decisions about their care such as what to eat and what to wear. Staff knew people and understood their needs and preferences to offer appropriate choices and people chose using their individual method of communication.

Staff explained how they respected people’s dignity by knocking on their bedroom doors before entering and ensuring doors were closed when personal care was being received. Staff treated people in a dignified and respectful way and addressed them with their preferred names.

People were supported to be as independent as possible. Where people were able to carry out activities such as holding a spoon or a flannel, they were supported by staff to be as independent as they were able.

Support plans were well evidenced, cross referenced with risk assessments, included details of decision making, displayed joint working and showed good involvement of multi-disciplinary team working. Plans were detailed, specific and individualised. People received personalised care that was responsive to their needs and there had been co-ordination between different services when people moved to ensure a consistency of care.

People took part in a variety of activities and photographs of these activities were depicted throughout the home. Activities included golf (which was the activity on one of the days of the inspection), music, creative art, life skills, Indian head massage and storytelling. People also took regular holidays which included taking part in a variety of external activities.

The provider listened and responded to feedback about people’s experiences, concerns and complaints. People, staff and relatives had all been given the chance to provide feedback and the provider had responded appropriately taking action to improve the quality of the service people received.

There was an open and transparent culture within the home. Staff were able to raise any issues or concerns with the manager and relatives told us they had a good relationship with the registered manager.

The registered manager submitted relevant notifications to the Care Quality Commission (CQC) in a timely way. A notification is an important event which the provider is required to tell us about. The registered manager was aware of the provider’s vision and values, which included passion for care and positive energy. She said she wanted to make sure the home looked homely and encouraged parents and relatives to be part of life in the home.

Checks were undertaken to ensure the quality of the service. A health and safety monitoring tool ensured that window restrictors were checked weekly. Other checks carried out included hot water temperature, fire system, weekly inspection of bath chairs and wheelchairs to ensure they remained suitable for use.

Checks in relation to the overall running of the home had been undertaken such as a fire safety audit and an environment audit. A quarterly audit was carried out by the operations manager. An annual audit was undertaken by the provider’s in house audit team. These ensured that the quality of care was monitored and actions taken to make improvements where appropriate.