Rakewood House Care Home

Updated 25 January 2023

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 Care Act 2014.

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 an inspector and an Expert by Experience on the first day and an inspector on second day. 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

Rakewood House Care Home 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. Rakewood House Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used this information to plan our inspection. The provider was not asked to complete a provider information return (PIR) prior to this inspection. A PIR is information providers send to us to give us key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 7 people who lived at the home and 3 visiting relatives, to gain their feedback about the care provided. We spoke with the registered manager, the regional manager, 2 nurses, 8 care staff, 1 housekeeping staff member and a visiting health professional. We also spoke with the nominated individual, who is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records, including two people’s care records in detail, and a selection of medicines records. We looked at two staff recruitment files and staff supervision and appraisal records.

After the inspection

We reviewed a variety of records related to the management of the service, including policies and audits. We contacted 2 community health care professionals who visited the service regularly for their feedback about the care and support provided.

Updated 25 January 2023

About the service

Rakewood House Care Home is a residential care home which provides personal care and nursing care for up to 30 older people, people with a physical disability and people living with dementia. Accommodation is provided on the ground floor. At the time of the inspection 24 people were living at the home.

This service was previously part of Carders Court Care Home, a residential care home which provided personal and nursing care for up to 150 older people, people with a physical disability and people living with dementia. In September 2022, the provider split Carders Court Care Home into five separate care homes which were registered with the Care Quality Commission (CQC) individually. Rakewood House Care Home is one of those services. The last inspection of Carders Court Care Home took place in in February 2021.

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

During the inspection we received a number of concerns regarding staffing levels at the home and most people we spoke with told us they had experienced delays when they needed support from staff. Risks to people’s health and safety were not always managed well, we have made a recommendation about this. Staff did not always follow safe infection control practices, which meant people were not always protected from the risk of infection, we have made a recommendation about this. Staff were recruited safely and knew the action to take if people were at risk of abuse. People’s medicines were managed safely, in line with national guidance. The safety of the home environment was checked regularly.

People did not always receive support which reflected their needs and risks. There were gaps in some people’s care records, which meant we could not be sure people had received appropriate support. Most people and relatives were happy with staff at the home and felt they were competent. Staff were happy with the induction and training provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Most people expressed dissatisfaction with the meals provided at the home and we found people’s dietary needs were not always met, we have made a recommendation about this. People received support with their healthcare needs and were referred for specialist support when they needed it. Feedback from visiting community healthcare professionals advised that the provider needed to improve support that people received with their healthcare needs and care documentation. The home environment was purpose built to enable people to remain as independent as possible. The provider had an improvement plan in place for the home environment.

People were not always well treated. They sometimes had to wait for support with personal care, did not always receive support that reflected their needs and preferences and were not always provided with good quality meals. There were limited processes to enable people to share their views about the support they received. Most people told us staff were caring and kind. We observed staff supporting people sensitively and treating people with respect. Staff encouraged people to be independent. Care plans included information about people’s backgrounds and diversity. However, we noted people’s cultural dietary needs were not always met.

People did not always receive care that reflected their needs and preferences. There were gaps in some people’s care records so it was difficult to know if care had been provided as it should have been. People’s care needs were reviewed regularly but there were inconsistencies in some people’s care documentation about their needs. Concerns and complaints were investigated and responded to appropriately. Most people were happy with the range of activities available at the home. Care documentation included detailed information about people’s end of life care wishes.

A variety of audits were completed by management, but they were not always effective in ensuring appropriate standards of quality and safety were maintained at the home. People did not always receive individualised care which achieved good outcomes. Staff were clear about their roles and responsibilities but told us that due to staffing levels, they were not always able to provide the standard of care that should be provided. The service worked in partnership with a variety of community agencies. There were limited processes in place to seek people’s views about the service and we have made a recommendation about this.

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

Rating at last inspection

This service was registered with us on 29 September 2022 and this is the first inspection.

Why we inspected

We had planned to complete an inspection of Carders Court Care Home due to the rating at the last inspection and concerns we had received. When the provider changed the registration to split Carders Court Care Home into 5 separate care home services, a decision was made for us to inspect Rakewood House Care Home, as some of the concerns we had received related to that home.

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

We have identified breaches in relation to staffing levels, people not always being treated with dignity and respect and the provider’s oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will 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.