Background to this inspection
Updated
4 November 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 3 inspectors, 1 inspection manager, 1 pharmacist inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Rushes House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Rushes House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
The care home was owned and managed by the registered individual and was not required to have a registered manager. During the inspection, the registered individual submitted their application to deregister from this service. A staff member from the newly employed care team has applied to be the new registered manager for the service.
Notice of inspection
This inspection was unannounced on day one.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We reviewed recent information of concern shared with us by the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 3 people who used the service and 3 visitors about their experience of the care provided. We spoke with 6 members of staff including care staff, the chef and administrator. We reviewed a range of records. This included 7 people's care documents and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed. After the inspection we reviewed additional information sent through to us by the administrator.
Updated
4 November 2022
About the service
Rushes House is a residential care home providing accommodation and personal care to up to 17 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service. The home is an older building providing single and double occupancy rooms and some rooms have en-suite facilities.
People’s experience of using this service and what we found
Prior to this inspection a newly employed staff team had raised concerns with the local authority about the care and treatment of people living at the home. This information had led to an investigation by the local authority who took immediate steps to safeguard people living at the home and prevent the current registered individual accessing the home, whilst their investigations were ongoing. The local authority also shared information with The Care Quality Commission. During this inspection we found that the new staff team were providing people with kind and compassionate care and had begun to make improvements to care and support delivery. The local authority had provided a package of on and off-site support to the new team. The following statements are related to the care and treatment people were experiencing prior to the arrival of the new staff team and ongoing issues that were still in the process of being addressed.
People had not always been protected from the risk of abuse. We received allegations that people had been subject to institutional abuse by the registered individual. This included visiting and other restrictions, lack of choice, inappropriate use of control and verbal abuse. The local authority safeguarding teams were carrying out several investigations relating to abuse and poor care.
People were at risk from unsafe medicine management and administration. Staff had not had up to date training or competency checks and people did not always receive their medicines as prescribed. People had not had their risks appropriately assessed and safely managed. We found concerns with infection prevention and control, and some people’s bedrooms were unclean and malodourous. We identified concerns with the safety of the environment.
People had not always been supported to eat enough food and have a balanced diet. Appropriate advice had not been sought from the dietician regarding the management of some people who were at risk of malnutrition. 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.
People had not always been treated in a kind, caring and compassionate way and relationships with family were not always respected. People’s autonomy and independence to make their own choices and decisions about their care was restricted.
There was a lack of working together with external agencies to deliver effective care and treatment and support people's access to healthcare services. This meant their needs were not being met and had a negative impact on people's well-being. People had not received personalised care that was responsive to their needs.
The management and leadership of the home by the registered individual was inadequate. There were widespread and significant shortfalls in the quality and safety of the service. Systems to monitor, assess and improve the service being provided were ineffective or not in place. There was a negative culture and people’s equality and human rights were not respected.
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
The last rating for this service was good (published 24 July 2019).
Why we inspected
The inspection was prompted due to concerns received from the local authority about allegations of institutional abuse, unsafe management of medicines, unsafe and unclean environment and staffing. A decision was made for us to inspect and examine those risks.
The registered individual agreed to have no contact with people living at the home, relatives and staff. The local authority and a new staff team provided support to people living at the home and a new provider commenced their registration with CQC to ensure people could remain living in their home.
Enforcement
We have identified breaches in relation to safeguarding people from abuse, person-centred care, people being treated with dignity and respect, consent to provide care and treatment, management of people’s risks, safe medicine management and administration, safe environment, infection control, poor nutrition and hydration, staff training and support and poor governance of the home.
The registered individual for the service applied to deregister the service at the time of the inspection. An application to register the service with a new provider has been submitted.
Follow up
We will re-inspect the service under the new registration arrangements.