Reinbek

We were assured that this service met good infection prevention. We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

We found the following examples of good practice:

• The provider supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely, such as video calls with friends and loved ones and dedicated support time from their assigned staff member.

• The provider had installed a visiting pod which was located on the ground floor and gave relative access to visit residents via a COVID-19 secure pod which avoided personal contact but allowed conversations to take place through a secure glass screen and via a two way speaker system.

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

People felt safe and well cared for in the home. The registered manager had systems in place for checking and auditing the safety of the home and the home was clean and tidy. Safe recruitment processes were in place and there were sufficient staff to meet people’s care needs. Accident and incidents were analysed, and action taken to reduce the potential of future risk where possible.

Staff felt they had appropriate training and support to undertake their role and development and progression was encouraged. The home worked closely with healthcare professionals to ensure people’s care needs were met in a timely manner and people and relatives told us communication was good. 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 home supported this practice.

People told us that staff were kind and caring. We noted that staff knew people and their care needs well. Staff promoted choice and people’s dignity and privacy was respected. We saw people were encouraged to be as independent as possible and care plans promoted this where possible.

There was a range of activities available for people who wished to engage, and the home had links to the community. People felt able to raise concerns and make complaints and these were investigated, and action taken. The home was continually working to make care plans person-centred and develop end of life care. We saw that care plans contained information to ensure people’s needs were met.

The registered manager was committed to driving improvement in the home. There were a range of systems to audit the quality of the service and actions taken in response to any concerns. Staff felt clear about their roles and able to contribute to service development. People and relatives were involved in meetings and were happy with the care and support they received at Reinbek.

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 following a focused inspection (Published 28 December 2017) and comprehensive inspection (published 04 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection was prompted by information we received about an incident following which a person using the service later died. This incident was subject to an investigation under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These Regulations require employers and those in control of premises to report specified workplace incidents. This inspection did not examine the circumstances of the incident. However, the information shared with CQC indicated potential concerns about how the service managed risks within the homes garden and surrounding external grounds.

This report only covers our findings in relation to these concerns. The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

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

Reinbek is registered with the Care Quality Commission (CQC) to provide 24 hour care and accommodation for up to 46 older people with a wide variety of conditions and frailties and some people who are living with dementia. People who used the service were cared for in accommodation over two floors. All rooms are single and 27 rooms have en-suite facilities The home also provides short stay and day care services. At the time of the inspection 46 people were using the service.

A general manager was in place and an application to become registered as manager with the Care Quality Commission (CQC) had been submitted. 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.

The provider had taken prompt action to help prevent a similar incident occurring by carrying out external ground work that ensured any identified garden risks were mitigated.

Care records, individual risk assessments/ risk management plans and appropriate garden monitoring/checking systems were in place. These systems ensured that where people wanted to spend time in the garden they would be enabled to do so safely.

A ‘Garden Policy’ was in place to ensure the safety and wellbeing of people using the service, visitors and staff when using the garden and external grounds

The provider had taken prompt action to help prevent a similar incident occurring. They had commissioned an independent external health and safety advisor to identify existing control measures, hazards and severity of potential risks within the garden and external grounds.

The provider had followed the principles of the Duty of Candour, following the incident. The Duty of Candour sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, truthful information and an apology.

We last inspected the service on 8 and 9 September 2015 where we rated the overall service as Requires Improvement. At that inspection we identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to the management of medicines the management of environmental risks, infection control and staff supervision.

This inspection was to check satisfactory improvements had been made and to review the ratings. We saw evidence to confirm that action required following our last inspection had been taken and the requirements of the regulations were being met.

Reinbek is registered with the Care Quality Commission (CQC) to provide 24 hour care and accommodation for up to 46 older people with a wide variety of conditions and frailties and some people who were living with dementia. People who used the service were cared for in accommodation over two floors. All rooms are single and 27 rooms have en-suite facilities The home also provides short stay and day care services.

A registered manager was in place at the home. 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 who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. They felt the overall care provided was good and their bedrooms were clean. People spoken with said, “The service is very good”, “The building is very clean; no complaints” and “Everything with the staff is perfect, they are very caring.”

During both days of the inspection we saw people were supported by sufficient numbers of staff. Care staff we spoke with told us they had undergone a thorough recruitment process. They told us they had undertaken an employee induction and training appropriate to the work they carried out was always available to them. Staff we spoke with had gained a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Staff confirmed they had received safeguarding and whistleblowing training, and knew who to report concerns to if they suspected or witnessed abuse or poor practice. We saw records to show staff received regular supervision to help make sure they were carrying out their duties safely and effectively.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review. Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act.

Care records were in place which reflected peoples identified health care and support needs. Information about how people wanted to be supported and their dietary requirements were also included in the care records we examined.

Systems to make sure the safekeeping and administration of medicines were followed and monitored were in place and reviewed regularly. Medicines were stored safely and administered by designated trained staff. Any specific requirements or risks in relation to people taking particular medicines were clearly documented.

Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives were addressed by the registered manager. People who used the service and their relatives told us they knew how to make a complaint and felt confident to approach any member of the staff team if they needed to.

Systems were in place to monitor the quality of the service. Surveys to ascertain people’s views and opinions about their satisfaction of the service provided had been undertaken. Any feedback received was noted and used to make improvements to the service and the care and support being provided.

We considered the evidence collected under this outcome and addressed the following question, is the service safe and is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

Senior care staff had been made aware of the shortfalls identified during our previous inspection and measures had been put in place to improve medication management at the home. We saw that medication was stored securely and staff had received refresher training in the safe handling, administration and recording of controlled drugs. Action had been taken to improve recording of controlled drugs stored by the home and administered by district nurses.

Is the service well led?

We saw that following our last inspection robust quality assurance checks had still not been carried out by the home. However we found that this shortfall had been identified by the provider. We saw that the provider had taken decisive action to introduce robust leadership to the home to rectify this. The provider had assessed the shortfalls in the service provided and potential risks to people who used the service. We saw that an action plan had been drawn up and work had commenced by the provider to carry out quality assurance checks at the home.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We spoke with people who lived at the home, visitors and staff. Everyone told us they though people cared for at Reinbek were safe and no one had concerns about the care people received. One visiting relative told us they had 'peace of mind' and added 'I feel she [their relative living at Reinbek] is safe and settled'. One member of staff commented 'I'd be happy for my mum and dad to be looked after here'.

Although the people we spoke with told us they had no concerns about the way their medication was managed, we saw that medication was not always securely stored and the home did not keep appropriate records of controlled drug medication used by District Nurses.

We saw that people's needs were met by the staff deployed within the home.

Is the service effective?

Care staff told us they were given enough information and guidance to deliver appropriate care. People were provided with balanced, nutritious meals, which the people we spoke with told us they enjoyed. People's dietary preferences and needs were catered for.

Is the service caring?

We saw people were treated with respect. The care we observed was provided in a patient, warm and sensitive way and people were provided with reassurance by staff. One person commented 'they [staff] don't come into your room unless they ask'. Another person described staff as 'very helpful' and 'very understanding', they also told us 'I'm very comfortable here'.

Is the service responsive?

During our inspection we spoke with a visiting GP. They told us that the home was pro-active in referring people to them when needed and followed up on medical advice. They also told us communication with the home was good and staff 'know what they are talking about', and 'they [staff] know the patients [people living at the home] well'.

Is the service well led?

Everyone we spoke with told us they thought the management team in place was approachable and people felt comfortable to raise any concerns they might have.

There had been a period of absence within the management team at Reinbek prior to our inspection. Although resolved there had been some impact on the systems in place to monitor the quality of the service provided by Reinbek. Regular quality checks (audits) across the service, in areas such as medication, care plan records and infection control had not been effectively completed over recent months. Although we did not identify any concerns with the care that people received, we found that the quality of people's care records were not monitored as effectively they could have been.

On arrival at the home we found most people were up, dressed and having breakfast. We were told some people were still in bed having a lie in.

We found the home to be warm, clean and tidy. We looked on all four units and found the home to be sufficiently staffed.

We saw people who used the service were well presented and we observed staff interacting with them in a friendly, polite manner and respecting their dignity and privacy.

We spoke with four people who used the service and with three relatives. One person told us, 'I can't remember how long I have been here but it's very good'. Another said, 'I am happy here'. A relative told us, 'My X has not been here very long but they seem to have settled well'. Another told us, 'It's very good. I can visit at any time, everything is very open and the staff always make you welcome'.

We saw staff had access to relevant policies and procedures including safeguarding procedures and contact details.

We saw a number of compliment cards from relatives displayed on the units. Some of the comments included: 'To all the staff for the care provided. X certainly enjoyed her time with you'. Another read, 'We are delighted with the level of care my X received. We can't praise the staff enough'. The home offers respite care and one relative wrote, 'Thanks for looking after X she felt she had lost something when she came home and they missed your company'.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives where possible to ensure people received the right care and support. This was confirmed when we spoke to two visiting relatives. One told us, "The staff are always keeping me up to date with mums care and what she needs."

When asked about routines in the home residents told us it was relaxed and one said, "staff are very attentive."

We spent time in various parts of the home throughout the inspection where we witnessed staff talking to people in a respectful mannner. We saw staff spent time with people on an individual basis. One staff member told us, "It's important for us to spend time with people, they like the attention."