The Radley Care Home

About the service

The Radley Care Home is a residential care home providing personal care to 36 people at the time of the inspection. The service can support up to 37 people. Care and support was provided to older people living with dementia as well as and people with a learning disability. The building was designed across two floors and purpose built to support people living with dementia. Each person had their own ensuite facilities and access to various shared spaces and gardens.

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

Right Support:

Staff did not always support people to monitor their medicines safely in a way that achieved the best possible health outcomes.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to pursue their interests. The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.

People had a choice about their living environment and were able to personalise their rooms. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

The building design was not typical for accommodating people with a learning disability as it was larger and focused primarily on supporting older people and people living with dementia. However, this was appropriate for the people with a learning disability who were living at the service as learning disability services had not been able to support their needs.

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.

Staff supported people to play an active role in maintaining their own health and wellbeing. Staff enabled people to access specialist health and social care support in the community.

We made a recommendation about reviewing auditing systems to ensure they were effective in identifying any ongoing monitoring requirements for people’s health conditions and medicines.

Right Care:

Senior staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse. However, not all staff had a full understanding of what different forms of abuse looked like or who they could report concerns to external to the organisation.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. One person told us, “This is a lovely place to be if you need help, because you will get it. I feel very happy here and well looked after. The food is also very good. The place is clean. I would recommend it if somebody asked because the care is very good. I love all [staff]. I don’t know where they find them, but they are all very kind and work very hard.”

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Staff and people worked together to assess risks people might face and agree ways of reducing the likelihood or harm.

Right Culture:

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability may have. This meant people received compassionate and empowering care that was tailored to their needs.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

People and those important to them, including advocates, were involved in planning their care.

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 11 April 2018).

Why we inspected

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.

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider responded immediately and took action to make the required improvements and ensure people were safe.

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

Enforcement

We have identified a breach in relation to the safe management of medicines 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.

We found the following examples of good practice.

The provider was following the current Government National Guidance regarding care home visiting. People had three named visitors and an essential care giver. Information was available for visitors to follow. Visitors were supported to test for COVID 19 prior to entering the home and instructed how to use PPE.

The home had adapted the garden to facilitate socially distanced outdoor visits for friends and relatives.

The layout of the home and communal areas supported social distancing. The premises looked clean and hygienic throughout. There were cleaning schedules in place and adequate ventilation.

The home had sufficient supplies of personal protective equipment (PPE). There were PPE stations available throughout the premises. Staff had received training in infection prevention and control and how to don and doff PPE.

Staff had provided PPE for people who carried out activities outside of the home.

The staff were aware of who to contact should they have a outbreak of COVID 19 and the protocols to follow.

The manager explained the home ensured residents were tested for COVID-19 prior to admission to the home and if appropriate supported them to isolate in their rooms.

We have also signposted the provider to resources to develop their approach.

The Radley Care centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Radley Care centre can accommodate up to a maximum of 37 people. On the day of our inspection, there were thirty people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

This was the first inspection since the service was registered with The Care Quality Commission on 30 June 2017. We found there was no evidence or information from our monitoring that demonstrated serious risks or concerns.

The service had a registered manager. 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 were protected from the risk of potential harm. Staff had received safeguarding training and there were effective safeguarding processes in place.

Individual risks associated with people’s care and support had been assessed and personalised risk assessments were in place. The assessments provided staff with clear guidance on how individual risks to people could be mitigated and or reduced.

People received their medicines safely, from staff who had been trained and had their competencies checked. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

Safe recruitment practices were followed to help ensure that staff were of good character and suitable to work in this type of service. There were sufficient numbers of staff deployed to meet people's needs.

Staff received regular support from their line managers. This included attending team meetings, individual supervisions and an annual appraisal.

Staff received training relevant to their roles. Staff completed an induction when they commenced work at the service followed by an on-going programme of training. Staff were positive about the training they received.

Consent was obtained from people before any care or support was provided. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

People interacted well with staff and appeared comfortable engaging with staff and managers. Staff were positive about their work and the support provided. People were treated with dignity and respect.

People received care and support which was personalised. People and or their relatives had been involved in the development and review of their care plans. Care plans and risk assessments gave clear guidance to staff and had been regularly reviewed and updated.

Staff were responsive to people's changing needs. There was an effective complaints procedure in place. Relatives were aware of the complaints procedure and knew who they needed to speak with should they wish to raise any concerns.

The registered manager operated an open, transparent and inclusive culture at the service. The staff worked well as a team and were positive about the support they received from the management team.

Quality monitoring systems and processes were in place and used effectively to make continual improvements in the service. People’s views were sought and a quality assurance survey had recently been completed and analysed to help determine areas that could be developed.

Further information is in the detailed findings below