4 and 5 August 2015
During an inspection looking at part of the service
The inspection took place on 4 and 5 August 2015 and was unannounced. Randell House provides residential accommodation and respite care for up to 39 older people, including people living with dementia. At the time of our inspection 36 people were living in the home.
The home is an old two storey building, with stairs and lift access between floors. Corridors were narrow, with hand rails fitted to aid people’s mobility. Passing areas ensured wheelchair users and equipment trolleys could navigate corridors safely.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
At the last inspection on 20 and 21 October 2014 we asked the provider to take action to make improvements to ensure staff had the skills to meet people’s dementia care needs, and to ensure falls risks were managed safely. At this inspection we found these improvements had been made.
Although people’s dependency needs had been assessed and reviewed monthly to ensure staffing levels were sufficient to meet their identified needs, staff had not always been deployed appropriately to ensure people were supported safely at all times. People’s dignity and preferences had been affected by insufficient staff to attend to their needs promptly.
Recruitment processes were not sufficiently robust to ensure people were protected from the risks of unsuitable staff. Some checks, such as identity and criminal records checks, had been completed satisfactorily. However, the provider had not ensured that gaps in applicants’ employment history had always been identified or investigated, or explanations recorded. Evidence of suitable conduct in previous relevant employment positions had not always been requested. There was a risk that staff employed may not be of suitable character to safely support people.
People were protected from risks to their health, because risks had been identified and actions put into place to remove or control them. For example, staff training and implementation of the provider’s falls protocol ensured people at risk of falling were supported to safely mobilise. Other risks, such as fire and water safety, were managed appropriately though checks and servicing.
People were protected from the risk of abuse, because staff understood the actions required to identify and report safeguarding concerns. Management acted robustly to safeguarding incidents to ensure people were protected from potential harm.
People’s medicines were administered safely by trained and competent staff. Medicines were stored and disposed of safely, and people were given time-specific medicines at the correct times to promote their health and wellbeing.
People were supported by staff with the skills and knowledge to meet their needs effectively. Training ensured staff developed and retained the skills required to support people. Staff had opportunities to raise concerns, and were supported to develop skills and progress their careers.
People were supported to make informed decisions about their care. When they had been assessed as lacking capacity to make specific decisions about their care, or people’s liberty had been restricted to protect them from identified risks, the process of mental capacity assessment and best interest decision-making was documented. Applications for Deprivation of Liberty Safeguards had been appropriately submitted.
People’s meal preferences and nutritional needs were known, and nutitonal risks such as choking were effectively managed. People were supported to eat and drink sufficient amounts to ensure their nutritional needs were met.
People were supported to attend appointments to maintain their health and wellbeing. Staff worked effectively with health professionals to ensure health issues and conditions were safely managed.
People were supported by staff who understood how to provide them with reassurance and comfort. Staff treated people with kindness and respect. They supported people to maintain their independence, and respected their privacy. People’s social relationships were supported to ensure they were able to maintain friendships that were important to them.
People’s changing care needs were identified and met. Care reviews with people and their representatives ensured their care was planned in accordance with their wishes. Activities were planned to encourage people’s diverse interests, and opportunities provided to ensure people’s views influenced the support they experienced.
Staff spoke positively about the support they received from the managers. The provider’s values of empathy, individual care and respect for people were demonstrated by staff, and rewarded by the provider. Individual skills and interests were encouraged and developed in people and staff.
The registered manager and deputy manager worked as a team to provide support for people, relatives and staff and meet managerial demands to run the home. Systems were in place to monitor and drive improvements to the quality of care people experienced.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.