Archived: Rainscombe Bungalow

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People, relatives and advocates were not always involved in assessments around people’s care, meaning their contributions could be missed. People’s rights were not always protected due to staff not understanding the principles of The Mental Capacity Act (2005). Records around mental capacity and best interest decisions were also lacking important information to ensure the least restrictive practices were used to deliver care. People received varied experiences in accessing specialist care to meet their health needs. During our assessment we found concerns around people not receiving person centred, evidence-based care, specific to their needs.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were mixed responses from relatives and advocates about being involved in the review of their loved one’s care. One relative told us they were always kept updated however we found they were not always updated of incidents involving their loved one. Another told us, “I want to be involved more.” In each person’s care plan, there was no reference to any relatives of advocates being asked to contribute to reviews of care.

Staff lacked knowledge of how to review people’s care in an effective way. The registered manager also lacked knowledge of the changing needs of people. They were not aware of recent incidents of 1 person and subsequently the person’s care plan had not been updated to reflect the increase in the person’s anxiety.

Where care was being assessed by staff, they were not considering any updates in people’s care. They were routinely recording there were no changes. For example, 1 person was no longer being supported to walk and remained in their wheelchair each day. However, their risk assessment in relation to falls still contained information relating to them walking with a handling belt: their most recent assessment just stated there was no change. One person, who had Type 2 diabetes, had put on weight and was now above average on their BMI. This had not been identified on their most recent Nutrition Assessment where it just stated there was no change.

People were not supported appropriately in line with current evidence-based good practice and standards. As such people were at risk of declining health.

Staff had a lack of understanding of the guidance around Right Care, Right Support, Right Culture. They were unable to tell us how people's diagnosis and health conditions may impact on how they presented their anxiety.

Where staff were updating and reviewing people’s nutritional tools to determine if they were nutritionally at risk, staff were not identifying concerns. For example, 1 person’s nutritional tool showed they had put weight and were now above average BMI. This could indicate the person is overweight. The person was also Type 2 diabetic and guidance in their care plan states the person needed to be supported to eat healthily. Despite this, staff had not recorded any action in relation to this weight increase. Another person was no longer being supported to walk and remained in their wheelchair for the majority of the day. However, staff had not completed a skin integrity assessment tool in relation to this. This would be used to determine if they were at increased risk of developing pressure sores.

Staff told us they felt they worked well together. However, from we observed there was no leadership or any senior directing the shift. On the second day we asked staff who the shift leader was, and they were not clear on this. One member of staff told us at the start of shift they were not allocated their jobs for the day. They said, “When I come, I know what to do.” The registered manager told us on each day there was a shift leader, and they were expected to plan the shift along with being responsible for people’s medicines, finances and, “Planning who is doing what with who.” However, we did not see this in practice.

External professionals fed back communication from staff and between staff was poor. Comments included, “There are times I have turned up for appointment that has been pre-booked and up and staff have not had knowledge of me coming that day” and “I find staff don’t seem confident in talking to professionals particularly concerning when they are the person’s key worker.” External professionals told us they were not always advised when a safeguarding incident occurred. One told us when they were informed of safeguarding concerns, “The quality of what they send me is ok but sometimes their investigations are not clear. The quality is inconsistent.”

We saw from the handovers that staff completed for the Provider at the end of each shift, there was no information for the oncoming staff around people’s needs. We noted staff were recorded as going off and on shift at the same time which would indicate staff did not have the opportunity to discuss handover information. This meant staff coming on duty may not have important information about people’s care.

People were not always being supported with their health care needs. One relative said their loved one had been helped to reverse their family members health concern. However, another fed back they had to alert staff to a health issue with their loved one which had not been identified by staff.

Staff and the registered manager were not aware of all of people’s health conditions. For example, when asked about 1 person’s diabetes diagnosis, staff and the registered manager told us they were not aware the person had this. This meant they may not provide the most appropriate care or be aware of the any decline in their health as a result of their diabetes.

We saw from care records that when staff supported people with health appointments, they were not always following up on the guidance provided by health professionals. There was also a lack of records of any updates on people’s appointments with external professions. For example, 1 person visited a professional in January 2024 in relation to a build-up of ear wax. The person at the time, did not want to the professional to treat this, however it was recorded that a further appointment needed to take place to address this. There was no record in the care notes or care plan that this had now been addressed. According to their health record, a chiropodist recommended cream to be applied to a person’s feet as they were very dry. They also suggested in the meantime to soak their feet in a homely remedy. However, the person’s medicine administration record has not been updated to reflect staff needed to apply cream to the person’s feet. There was also no record in care notes staff were following the recommendations on the homely remedy.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were not always being consulted in relation to their care. There was a mixed response from relatives and advocates regarding whether they were consulted when decisions needed to be made. We did not see that relatives and advocates were always consulted when capacity assessments and best interest decisions were undertaken.

There was a mixed response from staff around their understanding of the principles of the Mental Capacity Act [MCA]. The registered manager told us a member of staff undertook some of the capacity assessment but had not had specific training on how to do this.

We saw from care records, where people’s capacity was in doubt the capacity assessments were not being completed accurately. For example, 1 person’s care plan stated they lacked capacity to make the majority of decisions in relation to care being delivered. However, 1 assessment then stated the person was able to consent to photos of them being taken for the newsletter. However, there was no record of any discussion the person was also consenting to photos of them being used on the providers public website. The person had a capacity assessment in relation to going to activities and it was deemed they had capacity. However, it then recorded in the best interest meeting that they lacked capacity, and they were being taken to activities in their ‘best interest.’ Another person was now being kept in their wheelchair due to the risk of falls. They were also wearing a falls helmet all the time they were in their wheelchair. However, we saw the person constantly trying to get out of their wheelchair and taking the helmet off. This was also confirmed by the registered manager. However, no capacity assessment or best interest decisions had been undertaken in relation to this to determine if this restriction was in their best interest. There was also no deprivation of liberty safeguarding referral in relation to this.