Archived: Rastrick Hall & Grange

Rastrick Hall and Grange is a residential care home providing personal care to 60 people aged 65 and over at the time of the inspection. The service can support up to 79 people, some of whom are living with dementia. Accommodation is provided in two adjoining buildings Rastrick Hall and Rastrick Grange. Each building has three floors with ensuite bedrooms and communal areas on each floor.

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

People were happy with the care and support they received. Care records had improved, though some required more detail. Effective communication systems ensured staff knew people’s needs and how to meet them. Staff were aware of risks to people and knew how to keep them safe. Medicines management was safe though record keeping needed to improve. Staff knew the processes to follow to manage any allegations of abuse.

The home was clean and well maintained. The environment was decorated and furnished to a high standard with adaptations made to help people find their way around.

There were enough staff to meet people’s needs and keep them safe. Staff were trained and had the required skills to meet people’s needs. Staff told they felt well supported. Recruitment processes ensured staff were suitable to work in the care service.

Staff were kind, caring and compassionate. They treated people with respect and maintained their privacy and dignity. People enjoyed a wide range of activities and events, including spending time in the garden. People had access to healthcare services and their nutritional needs were met.

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.

Following the last inspection the provider had brought in an improvement team to work alongside the registered manager and staff providing support and guidance. This had resulted in improvements across the service and better outcomes for people. Leadership and management had improved; staff understood their roles and responsibilities. Quality assurance processes and regular reviews by senior managers ensured improvements were continuous. Although we found significant improvements at this inspection, we need to be assured these improvements are sustained and the leadership and management remains effective before we award a Good rating. The service has a history of making improvements and these not being sustained.

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 Inadequate (published 10 January 2019) and there were multiple breaches of regulation. We took enforcement action and issued warning notices. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Rastrick Hall and Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides nursing and personal care for up to 79 older people, some of whom may be living with dementia. Accommodation is provided in two adjoining buildings Rastrick Hall and Rastrick Grange. Each building has three floors with passenger lift access between floors. All bedrooms are single rooms with ensuite facilities. There are communal areas on each floor, including a lounge and dining room. There were 72 people in the home when we inspected.

At our last inspection on 10 May 2017 we rated the service as ‘Good’.

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.

Risks to people were not properly assessed or managed well, putting people at risk of harm or injury, particularly where people displayed behaviour that challenged others. Accidents and incidents were recorded, however, the analysis of these was poor with little evidence to show lessons had been learnt or actions taken to improve safety.

Some aspects of medicine management were safe. However, there were concerns about the storage of some medicines as fridge temperatures exceeded the recommended safety range and no action had been taken to resolve this.

We found there were not always enough staff to meet people’s needs and keep them safe.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staff completed induction and were up to date with most of their training. However, they lacked the skills and knowledge in how to manage behaviour that challenged which put people who used the service and staff at risk of harm and injury. Staff said they felt supported and received supervision and appraisals.

Staff had received training in safeguarding and understood the reporting systems. Safeguarding incidents were recorded and reported to the local authority safeguarding team.

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 care records were not personalised and did not reflect people’s needs or preferences. There was not enough detail to guide staff about the care and support people required. People’s nutritional needs were met, although the monitoring of people’s fluid intake needed to improve. People had access to healthcare services and systems were in place to manage complaints.

People and relatives told us activities were limited which our observations confirmed. Relatives told us staff were kind and caring. We saw some caring interactions but also practices which showed a lack of respect for people and compromised their privacy and dignity.

The registered manager acknowledged they had struggled to complete management tasks due to staff turnover and absences. The provider had arranged additional support however staff had only just started in these posts when we inspected. The provider’s systems and processes did not enable them to effectively assess, monitor and improve the service. They did not monitor and mitigate risk effectively.

We found shortfalls in the care and service provided to people. We identified five breaches in regulations; staffing, safe care and treatment, dignity and respect, person-centred care and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rastrick Hall and Grange provides accommodation and personal care for up to 79 older people, some of who may be living with dementia. There were 70 people using the service when we visited. Accommodation is provided over three floors with lift access to each level. All bedrooms are single occupancy with ensuite facilities. There are a variety of lounge and dining areas on each floor.

The home has 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. The registered manager was present on both days of this inspection.

Prior to the inspection we had received concerns about staffing levels, the food and the lack of supplies of personal protective equipment (PPE) such as gloves and aprons. We looked at all these areas during our inspection.

Although some staff were not happy with the staffing levels, people and relatives felt there were enough staff and this was confirmed in our observations. We saw staff were available and responded promptly to people. Staffing levels had increased on days and nights over the last 12 months and the use of agency staff had decreased which had resulted in a more stable staff team who knew people well and how to meet their needs.

Safe medicines management systems were in place and were being monitored through regular audits. This helped to ensure people received their medicines when they needed them. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

People told us they enjoyed the food. We saw at lunch and breakfast people were offered choices and given the support they required from staff. A choice of meals, snacks and drinks were provided throughout the day. However, staff told us although people never went without food, the quantity and quality of food varied. They described times when they had run out of essentials such as bread and milk which meant the registered manager had to go and buy supplies from a local shop. They also said the quality of some of the foods had reduced for example people were now being given pollack instead of salmon which they did not like. We have made a recommendation about the food supplies. People's weights were monitored to ensure they received enough to eat and drink.

The environment was clean and well maintained. We saw plentiful supplies of PPE throughout the home, although staff told us there were times in recent months when supplies had run out. The registered manager confirmed this had happened however they assured us systems were now in place to make sure there were ample supplies of PPE at all times.

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 told us they liked their rooms. People and relatives praised the staff who were described as kind, caring and considerate. People told us they were treated with respect and this was confirmed in our observations. People looked clean, comfortable and well groomed. We saw people enjoyed activities taking place during the inspection and people told us of other activities they had taken part in.

People and relatives told us they felt able to raise any issues or concerns and were confident these would be dealt with appropriately. Records showed complaints received had been investigated and the outcome communicated to the complainant.

We saw people received care tailored to meet their needs however the registered manager recognised the care plans needed more work to fully reflect the person centred care being delivered. We saw people had access to healthcare professionals such as GPs and district nurses. A healthcare professional who visited the home daily told us it was ‘a really good home’. They said staff communicated well, reported any issues promptly and appropriately and acted on any advice they gave.

People, relatives and staff spoke highly of the registered manager and care manager who they described as approachable and friendly. Effective quality assurance systems were in place and we saw actions had been taken when issues had been identified.

Rastrick Hall is a purpose built home. It offers residential care for 40 older people. The accommodation is arranged over three floors. All of the bedrooms are single and have en-suite toilets and showers. There are lounges and dining rooms on each floor. There is a garden area at the side of the building that can be used in fine weather and a car park to the front of the building.

At the time of this inspection there were 40 people using the service.

The service has 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.

There were not always enough staff on duty to care for people safely or to make sure their needs were met in a timely way. People told us they liked most the staff and found them kind and caring.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

People’s views about the meals were mixed. Some people thought they were good whilst others thought they could be improved. Staff told us they felt the quality and variety of meals could be improved.

The general poor condition of the communal areas, some bedrooms and furnishings showed a lack of regard for people using the service. Some people’s independence was restricted because the armchairs were too low for them.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s healthcare needs were met. Safe systems were in place to manage medicines; however, people did not always receive their medicines at the correct times.

We found the service was meeting the legal requirements relating to the Deprivation of Liberty Safeguards (DoLS).

People told us their visitors were made to feel welcome and if they had any concerns they would speak to the registered manager or another member of staff.

We found some of the audits which were in place were effective. However, there was a lack of environmental audits or use of a tool to calculate staffing levels. This meant the service was not monitoring its quality in these areas and responding where improvements were needed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we told the provider to take at the back of the full version of the report.

We also found that the communal kitchenette areas of the home required improvements. We saw that cupboard doors were broken, the plinths around the bottom of the cupboards were split, grouting on tiled areas was discoloured, skirting boards around the areas looked dirty and wallpaper was coming off in places.

We said that improvements were needed.

We returned on this inspection to check whether improvements had been made.

We looked at the monthly audit system in place and found that these had been completed. We saw that audits of people's medication, weights, pressure sores, infection, use of invasive devices, skin tears and falls had been completed for October 2013, November 2013 and December 2013.

We saw the kitchenette areas of the home had not been updated. However, we saw that dates for the work were scheduled and due to be completed by the end of February 2014.

'The home is kept clean and tidy and I have a nice bedroom.'

'The staff are very kind and caring.'

'I've got no complaints whatsoever.'

'Some of the meals aren't to my liking, I've told the manager and I'm sure she will sort this out.'

'I get on well with most of the staff and find them helpful and caring.'