Rendlesham Care Centre

Rendlesham Care Centre is a residential care home providing personal and nursing care to 33 people at the time of the inspection. Some people using the service were living with dementia. The service can support up to 60 people in one adapted building. There are three units in the service, one on the first floor and two on the ground floor. At the time of our inspection one of the units on the ground floor was closed for refurbishment.

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

The provider had an action plan in place and was in the process of improving the service. This was not yet fully implemented and embedded in practice. The local authority was not placing new people into the service until improvements had been made. The provider and management team were working with the local authority to evidence how improvements were being implemented. There were systems in place to learn lessons and reduce future risks.

A new manager had been employed in the service in June 2021, we received positive feedback about the manager and improvements they were making. There had been no registered manager in post since June 2020, the provider had made attempts to address this in the period between that manager leaving and the new manager being appointed.

There were systems in place to reduce the risks to people living in the service, this included risks associated with their daily living and from abuse. Medicines were managed safely, and auditing systems supported the management team to identify shortfalls and reduce them.

Staffing levels were calculated to meet people’s needs and ongoing recruitment, which was done safely, was undertaken. Infection control processes in place reduced the risks to people living in the service. Staff were wearing personal protective equipment (PPE) appropriately and a programme of COVID-19 testing was done. The provider was following government guidance relating to people having visitors.

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

Rating at last inspection

The last rating for this service was good (published 3 March 2018).

We undertook a targeted inspection in January 2021, following an incident where a person was harmed, which is subject to investigation. We did not examine the circumstances of the incident at this inspection but checked how people were being supported to reduce the risks of pressure ulcers developing. CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Why we inspected

We received concerns in relation to safe care, recording and governance. The local authority had ceased to place people in the service until improvements are made. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The service was working on an improvement plan to address these concerns. We have found evidence that the provider needs to make improvement, because their improvement plan had not yet been fully implemented and embedded in practice. Please see the Well-led section of this report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

There was an ongoing investigation regarding a specific incident. This inspection did not examine the circumstances of the incident.

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.

The overall rating for the service has not changed and remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rendlesham Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rendlesham Care Centre is a residential care home providing personal and nursing care to 38 older people at the time of the inspection, some of these people were living with dementia. The service can support up to 60 people in one adapted building.

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

Risks were assessed relating to pressure ulcers developing or deteriorating. Systems were in place to guide staff on how risks were reduced. There were some inconsistencies in the recording and records relating to oral care provided. The management team assured us these would be addressed.

There were policies and procedures in place which provided guidance for staff in good infection control processed and how the risks associated with COVID-19 were reduced. Staff had also received training in these areas. Staff were following good infection prevention and control practices which helped to minimise risks to people.

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

Rating at last inspection

The last rating for this service was good (published 3 March 2018).

Why we inspected

The targeted inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks associated with pressure ulcers. This inspection examined those risks. We found no evidence during this inspection that other people living in the service were at risk of harm from this concern. Please see the Safe key question of this report.

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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rendlesham Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was 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.

Our unannounced focused inspection of 12 July 2016 was prompted in part by notification of an incident which a person had died. This incident, and previous incidents, are subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of choking. This inspection and the previous inspection of 26 and 27 October 2016 examined those risks.

At our last inspection of 26 and 27 October 2016 the service was rated overall Requires improvement. The key questions for Caring and Responsive were rated Good. The key questions for Safe, Effective and Well-led were rated Requires improvement. This was because the improvements made from our previous inspections needed to be embedded in practice and sustained over time to ensure that people were receiving good quality care at all times. During this inspection, we found that the improvements had been sustained and the service was now rated as Good overall.

You can read the reports from our previous inspection, by selecting the 'all reports' link for Rendlesham Care Centre on our website at www.cqc.org.uk.

There were systems in place to keep people safe from abuse. Staff were trained in safeguarding and understood their responsibilities. Risks to people were assessed and staff were provided with guidance on keeping people safe. Medicines were managed safely and people were provided with their medicines as prescribed.

The service was clean and hygienic and the policies and procedures in place supported good infection control processes. The environment was well maintained, accessible and suitable for the people who used the service.

The staffing levels in the service provided people with care and support when they needed it. Recruitment of staff was done safely and checks were undertaken to ensure they were suitable to care for the people using the service. Staff were trained and supported to meet people’s needs effectively.

People’s holistic needs were assessed, planned for and met. Care plans and risk assessments provided staff with guidance about how to meet the needs and preferences of people. People’s decisions about their end of life care were documented and respected. People were provided with the opportunity to participate in meaningful activities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s dietary needs were assessed and there were systems in place to meet them effectively. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were treated with respect and care by the staff working in the service.

The quality assurance systems in place supported the provider and management team to identify shortfalls, address and learn from them. There was a complaints procedure and people’s complaints and concerns were investigated and addressed in a timely manner. There was an open and empowering culture in the service. People, relatives and staff were asked for their views about the service and these were used to improve.

There were 58 people living in the service when we inspected on 26 and 27 October 2016. This was an unannounced inspection. There are four units in the service, on the ground floor Oak 1 accommodates people living with dementia and Oak 2 which accommodates people living with dementia and who may also require nursing care. On the first floor Chestnut 1 and 2 provide both personal and nursing care.

There was 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.

At our comprehensive inspection of 25 November 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 12 Safe care and treatment, Regulation 18 Staffing and Regulation 17 Good governance. We set requirement notices relating to these breaches, the provider wrote to us and told us how they were taking action to improve.

An unannounced focused inspection carried out on 12 July 2016 was prompted in part by notification of an incident following which a person had died. This incident, and previous incidents, are subject to an investigation and as a result this inspection did not examine the circumstances of the incident. We found that the provider had not taken appropriate and swift action to ensure that people were safeguarded following incidents of choking. We took enforcement action to ensure the provider took the necessary actions to protect people.

You can read the reports from our last comprehensive and focused inspection, by selecting the 'all reports' link for Rendlesham Care Centre on our website at www.cqc.org.uk.

This unannounced comprehensive inspection on 26 and 27 October 2016 found that improvements had been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were identified in our last comprehensive inspection of 25 November 2015 and the focused inspection of 12 July 2016.

Improvements had been made in relation to assessing and managing risk for people at risk choking and associated training for staff.

Improvements were needed in the staffing levels in the service. This had been identified by the registered manager and they were in the process of addressing it.

Improvements had been made in the quality assurance processes which were used to identify shortfalls and address them. The improvements made need to be sustained over time and embedded in practice to ensure that people are provided with good quality care at all times.

Improvements had been made to ensure that people were supported safely to eat and drink. Detailed risk assessments and care plans were in place for people who were at risk of choking. These improvements needed to be sustained over time. People’s fluid intake was monitored to reduce the risks associated with dehydration.

Improvements had been made in people’s care plans and risk assessments and these guided staff in how people were provided with person centred care which was tailored to meet their specific needs. People were provided with the opportunity to participate in meaningful activities. There had been recent changes in the activities staff in the service and they were in the process of seeking people’s preferences in preparation for developing an activities programme that would include people’s interests.

Improvements had been made in the systems in place to store, obtain, dispose of and administer medicines safely and maintaining records relating to medicines management.

However to improve the rating to 'Good' would require a longer term track record of sustainability and embedded staff practice.

There were systems in place to keep people safe and this included how to report abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. The recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were treated with respect and care by the staff working in the service.

There was a system in place to manage complaints and use them to improve the service.

This report only covers our findings in relation to this topic.

Rendlesham Care Centre is a residential home that provides care to up to 60 people who are elderly and frail with complex needs, including dementia and nursing related needs.

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.

During our comprehensive inspection of 25 November 2015 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 12, Safe care and treatment, Regulation 18(1) Staffing and Regulation 17 Good governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rendlesham Care Centre on our website at www.cqc.org.uk.

During this focused inspection we found continuing breaches of Regulation 12, 17 and 18. You can see what action we told the provider to take at the back of the full version of the report.

Arrangements were insufficient for managing risks and improving the safety of individuals who have swallowing/eating/drinking difficulties (dysphagia).

Risk assessments were not personalised and relevant to the individual. They did not consider associated signs and symptoms specific to the person that could indicate potential or actual risk of choking. Plans in place for managing risk were not detailed, informative or specific to the individual. Therefore staff did not have sufficient information to guide them on how to monitor and review those people, recognise when symptoms were worsening and identify emerging increase to their risk of choking.

The service did not have a pro-active approach to staff learning and development in line with the home's stated purpose and the needs of people using the service. Staff had not received training in the wider risks related to dementia, including dysphagia. They therefore did not understand how difficulties associated with dysphagia are caused, exacerbated or how to recognise any change or deterioration in swallowing difficulties.

People’s safety and welfare were compromised because the provider did not have a robust and effective system in place for identifying and remedying deficits in care to improve the safety of individuals who have or are susceptible to swallowing difficulties, and prevent recurrence of serious untoward events.

Our inspection was done over two days with a pharmacy inspector on the first day. We spoke with 16 of the 41 people who were using the service at the time of our inspection. We observed the care and support provided to people. We spoke with two peripatetic managers, who were covering the management of the service in the registered manager's absence, two area managers and five staff members. We looked at seven people's care records. Other records viewed included staff training and supervision records, meeting minutes and medication administration records (MAR). We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we showed staff our identification and we were asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been submitted, staff had been trained to understand when an application should be made, and how to submit one. The service was aware of the recent changes in the law, following the supreme court ruling in March 2014. They told us that they were considering making applications, if appropriate, in this respect.

People's capacity to make decisions had been assessed, however this was not robust enough to ensure that people were not unlawfully deprived of their liberty. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded. The service had taken action to ensure that the safeguarding systems were effective following recent concerns raised by the local authority.

We had received a report about a medicine that had been missing and unaccounted for in the service. During our inspection we looked for evidence that people were receiving their medicines safely. We found appropriate arrangements for the recording, handling and safe administration of medicines. We found that overall records about medicine administration were accurate and showed that people received their medicines in line with the intentions of prescribers. Managers told us a more detailed daily audit of medicines would soon be implemented.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. There were systems in place to minimise the risks of cross infection. However we found shortfalls in the hygiene of the kitchens in all of the three units. This was addressed during our inspection, which minimised the risks to people. However we were not assured that the systems were robust enough to ensure that people were provided with a clean and hygienic environment to live in. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service. One person said, "I am satisfied." Another person said, "I like it here." Another person said, "We have a lovely time."

We found that there were shortfalls in people's care records which did not show that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The service was in the process of reviewing and updating all care records. However, these improvements had not been completed at the time of our inspection. Therefore we were not assured that people were provided with the care and support that they needed effectively and safely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff had been provided with the training that they needed to meet the needs of the people who used the service.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, "They (staff) are very good."

Staff offered people choices throughout our inspection, including what they ate and drank. We saw that the staff listened and acted on what people said. However, we saw that not all people were supported in a way that respected their dignity and privacy. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

People completed activities in and outside the service regularly. The service had its own adapted minibus, which helped to keep people involved with their local community. However, the activities were not ongoing throughout the day and suitable for people living with dementia. In the units where people with dementia lived there was little to engage them in meaningful activities in their usual daily living routines. For example, there were rummage boxes in the two units, but these were piled up in the corner of the lounges and not readily available for people.

People told us that they knew how to make a complaint if they were unhappy. Records showed that where people had raised concerns action had been taken to address them.

Is the service well-led?

The service had a quality assurance system. However, we were not assured that these systems were robust enough to ensure that people were provided with a safe and effective service that met their needs. Following shortfalls identified by the local authority the service had responded by starting to make improvements and an area manager told us about the improvements that were planned. However at the time of our inspection we not assured that the service was well-led and that the quality assurance systems were robust. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The minutes of meetings showed that people and their relatives were asked for their views about the service provided and they were kept updated with issues in the service. People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed. This meant that people's views were valued, listened to and acted on.

People told us that the staff treated them with respect. One person said, "They (staff) always call me by my name, which shows they know who I am." Another person said, "They (staff) are all very kind, always pleasant." This was confirmed in what we saw during our inspection, staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of five people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff training records showed that they were provided with the training that they needed to meet the needs of the people who used the service.

We found that people were provided with their medication at the prescribed times and in a safe manner. However, we suggested areas for the provider to consider and develop this area of medicine management further to enhance safety.