Remyck House

Remyck House is a residential care home, which can accommodate up to 29 people. The service supports older people who may be living with a diagnosis of dementia. At the time of our inspection there were 16 people living at the service.

The building has been extended and adapted, it has 2 floors, with a lift to the first floor. There is a large lounge, a reception and a dining room. All of the bedrooms have a wash basin and some an ensuite toilet and shower. There are also communal bathrooms and shower rooms. There is a secure, outside space, where people can sit or tend to the plants being grown.

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

People and relatives reported they were cared for safely. Their feedback included, “I feel safe. I can’t really say why, but there are people around” and “I do feel safe. People were satisfied with the service provided overall but some felt further improvements could be made to the quality of the meals provided. Relatives reported the registered manager had been open and transparent with them about the issues identified at the last inspection and the actions they were taking to address them.

Processes were in place to keep people safe, and staff had updated their training. We observed the atmosphere in the home was calm and people were relaxed.

The registered manager and providers had taken actions to ensure people were adequately protected from the risk of fire and other required work was being completed. The environment of the home was clean and safe for people and items of equipment had been replaced where required. Staff completed checks for different aspects of people’s safety, but needed to ensure these were consistently recorded. Measures were in place to reduce the risk of people falling. The provider had made necessary improvements and medicines were now managed safely at the home. Processes were in place to protect people from acquiring an infection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 April 2023).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served on the providers and the registered manager in relation to Regulation 12 Safe Care and Treatment and Regulation 13 Safeguarding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check 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.

Recommendations

We have made a recommendation about the management of some medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Remyck House is a residential care home, which can accommodate up to 29 people. The service supports older people who may have a diagnosis of dementia. At the time of our inspection there were 21 residents living at the service.

The service has been extended and adapted. It has 2 floors, with a lift to access the upper floor. There is a communal lounge and a dining room. All bedrooms have a wash basin and some also have an ensuite toilet and shower. There is a paved, secure outside area.

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

People had not been kept safe from the risk of harm from other people. The registered manager had taken action to prevent the risk of repetition but there was an ongoing risk, whilst alternative accommodation was arranged for 1 person. Staff had not ensured people were always provided with safe care and people were at risk from unsafe aspects of the environment. People’s medicines were not always managed safely. People were not always protected from the risk of acquiring an infection. There were not sufficient skilled staff deployed at all times. Staff had not been required to complete all of the necessary pre-employment checks.

Staff had not all received sufficient training for their role or supervision of their work. The decoration of the home was not dementia friendly. People’s modified dietary needs were not always documented. It was not always clear the activities provided were sufficiently personalised.

We have made a recommendation about how people’s well-being is supported.

There was a lack of robust processes to monitor and audit the service, in order to identify emerging risks or areas for improvement. Staff liked working at the service, but the culture was not totally person centred or consistently achieving good outcomes for people. Some attempts had been made to seek people and relative’s feedback.

People told us overall they liked the service, but some aspects could be improved. People’s feedback included, “What’s missing here is strong team management,” “Staff, well some are excellent and I’d say, others are supportive” and “The staff do their job and help you when necessary and are considerate.”

Staff documented incidents and these were then reviewed to identify any actions required for the individual’s safety. People received sufficient food and drink for their needs. Staff worked together and with external professionals to ensure people’s healthcare needs were met. Staff had good working relationships with professionals.

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.

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 12 March 2019).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about safeguarding, staffing and admissions. A decision was made for us to inspect and examine those risks.

We inspected and found there were also concerns with people’s safety, the environment, medicines, governance and infection control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care, safeguarding, premises, medicines, infection control and governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Staff and people had been tested for COVID-19 in accordance with national guidance.

• During the outbreak, the provider ensured only people at the end of their lives received visitors indoors, in accordance with national policy. Any visitors to the service were required to complete a lateral flow test prior to entry. The provider was constructing an external pod with heating for when visits resumed.

• Staff had ensured alternatives to face to face visits during the outbreak were in place for people.

• Staff used a pulse oximeter, which is a non-invasive device. To monitor people’s oxygen levels to enable early warning of signs of deterioration in people. Risk assessments were in place for people who had tested COVID-19 positive, to guide staff.

• Processes were in place to ensure when the service resumed admissions, they were admitted safely and self-isolated for 14 days, in accordance with national guidance.

• Staff ensured the service was regularly cleaned and the environment was adequately ventilated.

• Staff had positive relationships with health care professionals and worked collaboratively with them.

Remyck House is a residential care home. The service was providing personal care for 26 people at the time of inspection. People supported included older people, and people living with dementia.

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

People’s experience of using the service:

People received a service that was safe. Systems and processes were in place to manage medicines safely and protect people from the risk of abuse.

• Staff had the right skills and were trained efficiently to support the people they cared for. People’s care and support led to good outcomes.

• Care workers had developed meaningful relationships with people they supported. They respected people’s dignity and privacy, and promoted their independence.

• People’s care and support met their needs and reflected their preferences.

• Management processes were in place to monitor and improve the quality of the service. There was an empowering, positive and open culture.

Rating at last inspection:

• At the last inspection the service was rated Good (19 October 2016).

Why we inspected:

• This was a planned inspection to check that this service remained Good.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

Remyck House is registered to provide care (without nursing) for up to 29 older people. There were 26 people resident on the day of the visit. The building offers accommodation over two floors in 23 single and three double rooms. The double rooms were used for single occupancy, therefore the service had no vacancies on the day of the inspection. The second floor was accessed via a staircase or lift. The shared areas within the service were adequate to meet the needs and wishes of people who live in the home.

The service has a registered manager running the service. 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.

People, staff and visitors to the service were generally kept safe. However, we have made a recommendation about areas of safety that required review to ensure people were as safe as possible. Most risks were identified and managed to make sure that people and others were kept safe. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. They were able to describe how they kept people safe from all forms of abuse and harm.

There were enough staff to safely support people. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and deprivation of liberties applications had been made, as was appropriate.

People were supported by staff that were given training and were skilled enough to provide safe and effective care. People were assisted to receive health and well-being care from appropriate professionals. Staff were trained in any necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built relationships with people so that they were able to provide caring and compassionate support. People were encouraged to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences

The service was led by an experienced registered manager. The registered manager was described by staff as approachable and supportive. The provider and registered manager assessed and reviewed the quality of care provided. Some improvements were needed with regard to effective record keeping.

The registered manager told us, "Every aspect of each person's care is reviewed every month when they are resident of the day. At that time I ensure that only up to date, relevant documents are in people's care plans. Everything else is archived in the manager's office and kept under lock and key. Staff now sign regularly to confirm that they have read the file and understand the person's care needs". This meant that the provider had introduced a process designed to ensure that staff were working only with current information which had been regularly updated.

We saw that staff records had been filed alphabetically, were structured and easy to navigate. The records indicated that effective recruitment checks and procedures had been carried out. This meant that people were likely to receive safe care because the provider had clearly documented care records and staff records which were current, easily located and fit for purpose.

We found that people who used the service felt they were safe and had confidence in the staff to protect them from abuse. One person we spoke with told us, 'I'm very happy here and wouldn't want to move now. I'm very settled and I feel safe with the staff and manager here to look after me'.

The four people and one relative that we spoke with all thought that staff numbers were adequate. One person said, 'The staff know what they're doing and look after our needs very well. I never have to wait long and they always have a smile on their faces'. A relative told us, 'I drop in quite often, sometimes at odd hours and as far as I can see there are always enough staff.

We reviewed the registered manager's action plan produced in response to feedback from people, their relatives and staff. This demonstrated that the management had reviewed some working practices affecting the care and welfare of people and had made adjustments.

We found that because old material had not been archived and that all notes relating to each person were not stored in a central location there was potential for confusion and increased risk of inappropriate care being provided.

Although in need of some cosmetic redecoration we found that the property was suitable in design and layout for the purpose to which it was being put and was safely maintained.

We found that staff were trained and supported in their professional development. One member of staff told us, 'I just had my first annual appraisal here. I found it very good because you get told what you do well and not so well, so you can work on it. This encourages you to improve'.

People who used the service, their relatives and staff confirmed that their feedback was sought regarding care and support provided by the service. We found that the provider had processes in place to assess this information and act on it to make improvements.

We found that an effective and accessible complaints system was in place and staff were aware of their responsibility to support people to make complaints if they wished to. A care worker told us, 'It's much better now. We keep complaints forms at the nursing station. People don't have to ask for one, they can just pick it up'.

We found that systems had been implemented to ensure staff received regular supervisions and personal development planning; however these were not fit for purpose. A number of yearly appraisals had taken place; however, there were not appropriate systems in place to monitor appraisal scheduling or recording. We saw no evidence that action plans relating to the outcome of supervisions and appraisals had been created or that actions taken had been recorded.

We found that the service's complaints policy had been updated to include the details of the local government ombudsman; however, details of the registered manager and the service provider had been removed. We saw copies of the reviewed complaints policy had been placed within 'service user guides' and placed in people's rooms. Previous complaints had not been acknowledged and staff did not have access to the complaints policy.

We found the accidents and incidents folder had been brought up to date and any notifiable incidents had been referred to the correct parties.

We found people looked well groomed and we observed staff following good manual handling practices when they assisted people. We saw the home had systems in place for the hygenic management of waste.

We saw staff rotas had been completed a month in advance and ensured sufficient staff were on duty throughout the day and night to meet people's needs. We found the service had ensured the Care Quality Commission (CQC) were notified of a number of notifiable incidents however we were unable to determine whether all notifiable incidents had been correctly notified as the service's incident book was out of date.

One person we spoke with told us, 'They look after us very well here'. Relatives that we spoke with told us that Remyck House had a happy atmosphere and welcoming staff.

We saw that people who used the service had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support.

We observed that people looked well cared for and that those who wished to were engaged in group or one to one activities with staff.

We noted that guidance regarding safeguarding people from abuse was available to staff and that they had received recent relevant training.

A relative that we spoke with after the inspection visit told us, 'I have no concerns about my relative's safety here. They are very happy'.

Staff, relatives and people who used the service that we spoke with told us that staff were able to meet people's care needs safely. We found that there were enough qualified, skilled and experienced staff to meet people's needs.

However, we found that the performance and professional development of staff was not being supported.

We reviewed the procedure for handling, storage and administration of medicines and found this to be compliant.

We noted that there was a complaints system in place but that it was not easily accessible to people using the service.