Rawreth Court

Rawreth Court is a residential care home providing the regulated activities of accommodation, personal and nursing care to up to 35 people. The service provides support to older people living with dementia and who may also be living with mental health needs. At the time of our inspection there were 34 people using the service.

People’s experience of using this service and what we found

The delivery of care for people was not always safe. Information relating to people's individual risks was not always recorded. Suitable arrangements were not in place to ensure the proper and safe use of medicines. Lessons were not learned, and improvements made when things went wrong.

Staff training was not embedded in their everyday practice. We have made a recommendation about staff training. People at risk of poor nutrition and hydration were not properly monitored to ensure their fluid intake met their needs. People were not always treated with dignity and respect. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people's needs and preferences. Where information was recorded this was not always accurate or up to date. The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. There was a lack of understanding of the risks and issues and the potential impact on people using the service.

Staffing levels and the deployment of staff were suitable. Recruitment practices at the service were safe. Most people and their relatives told us they or their family member were treated with care and kindness. People were supported or enabled to take part in regular social activities. People were protected by the prevention and control of infection. Staff had received an induction and formal supervision. The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement [published 9 March 2019].

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider top take at the last inspection.

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.

Enforcement and Recommendations

We have identified breaches in relation to consent, restrictive practices, risk, medicines management, nutrition and hydration, dignity and respect, care planning and quality assurance arrangements at this inspection. We have made a recommendation about staff training.

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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rawreth Court is a large single storey building in a quiet residential area in Rawreth, near to Rayleigh and close to all amenities. The premises provide each person using the service with their own individual bedroom and adequate communal facilities available for people to make use of within the service. The service is divided into zones according to people’s needs.

This inspection was completed on 21 and 22 November 2018 and was unannounced. This was the service’s first inspection since being newly registered as a care home on 23 November 2017. There were 33 people 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.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. The current arrangements had not identified the issues we found during our inspection.

Care plans did not fully reflect people’s holistic care and support needs or provide sufficient guidance for staff as to how these were to be met. Care plans did not adequately address people’s mental healthcare needs and the impact this had on their overall health and wellbeing. People’s end of life care needs were not recorded. Not all risks to people’s safety and wellbeing had been identified, and suitable control measures had not always been considered and put in place to mitigate the risk or potential risk of harm for people using the service. Improvements were required to the service’s medication arrangements as discrepancies relating to staff’s practice and medication records were found.

Although the deployment of staff was suitable to meet people’s needs, staffing levels as told to us were not always maintained and this impacted on people using the service. The principles of the Mental Capacity Act 2005 to make a specific decision had not always been assessed and best interest assessments completed. Staff did not always support people in the least restrictive way possible.

Not all staff employed at the service had received a robust and comprehensive induction. Staff received regular training opportunities, though improvements were required as not all staff had completed relevant training relating to mental health conditions. Appropriate arrangements were in place to recruit staff safely in line with regulatory requirements. Staff felt supported and received appropriate formal supervision at regular intervals and an appraisal of their overall performance. Safeguarding concerns were reported to the Local Authority.

Staff worked well with other organisations to ensure they delivered good joined-up care and support. Individuals were complimentary about the care and support they received and about the staff team and received good person-centred care. People’s healthcare needs were met and people were supported to have access to a variety of healthcare professionals and services as required. The dining experience was positive and people had their nutrition and hydration needs met. People were supported to have their social care needs met and relationships with family and friends maintained.

Staffs’ practice was suitable, with staff following the service’s policies and procedures to maintain a reasonable standard of cleanliness and hygiene within the service.