Randolph House Care Home

Randolph House is a care home providing personal care to up 56 people. The service provides support to older people some of whom may be living with dementia and younger adults. At the time of our inspection there were 41 people using the service.

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

People were safe. The service had effective safeguarding systems in place and there was a consistent approach to safeguarding. Staff had received safeguarding training and knew how to recognise abuse and report it.

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.

Care plans and risk assessments were person centred and staff were aware of risks to people’s wellbeing and how to manage them. Assessments of people’s needs were completed and regularly reviewed and updated. Referrals to external healthcare services were made to ensure people’s needs were met.

There was enough competent staff on duty. Recruitment systems were robust and ensured the right staff were recruited to keep people safe. Staff worked collaboratively across services to understand and meet people’s needs.

Medicines were managed consistently and safely. Medicines were stored correctly and disposed of safely. Staff had received training in medicine administration and their competencies were regularly assessed.

The service managed the control and prevention of infections well. Staff were trained and understood their responsibilities in maintaining high standards of cleanliness. Decorations and adaptations to the premises supported people to be as independent as possible.

People had genuine choice and access to sufficient food and drink. The dining environment was pleasant, and food was well presented.

The service was well-led. The provider had clear and effective governance systems in place that identified and managed risks through audits and action plans. The registered manager promoted a person-centred culture within the service.

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 22 December 2022)

Why we inspected

We received concerns in relation to the providers adherence to the Mental Capacity Act 2005. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe. Effective and well-led sections of this full report.

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

Follow up

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

Randolph House is a care home providing personal care to up to 70 people. The service provides support to older people some of whom may be living with dementia and younger adults. At the time of our inspection there were 37 people using the service.

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

People were supported to remain safe. Staff knew how to report allegations and concerns of abuse and understood their roles clearly and what was expected of them. People received their medication as required and staff were competent and trained in the administration of medication.

There was enough competent staff on duty and the service regularly reviewed staffing levels and adapted them to people’s changing needs. Staff understood their role in raising concerns and reporting accidents and incidents. Lessons were learned and communicated to support improvement in the service.

The service managed infection, prevention and control well. Staff were trained and understood their roles and responsibilities for maintaining high standards of cleanliness and hygiene.

Staff completed an induction and did not work unsupervised until they felt confident to do so. Staff had the right qualifications to carry out their duties and told us they would be supported to undertake further training to improve and enhance people’s care.

Complaints were listened to and responded to in good time. People and their relatives told us they felt confident if they complained they would be listened to and taken seriously. Comments from relatives included “I have no complaints we are happy with everything” and “I have no reason to complain now under the new management, they are very good.”

Assessments of people’s needs were completed and regularly reviewed and updated. Referrals to external services were made to ensure people’s needs were met.

People were treated with kindness and respect. People were consistently positive about the caring attitude of staff. Comments included, “The staff are lovely, kind and really caring”, “They know my relative well and treat them with respect” and “They are caring, professional and very good.”

People received person centred, responsive care. Care plans and risk assessments were detailed and provided staff with information to maintain people’s quality of life.

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.

The service has a positive culture that is person centred, open and empowering. People and their families are involved in the service in a meaningful way. The service engages and involves staff and ensure their views are acted on to shape the culture of the service.

The provider monitored performance and risk in the service to promote and deliver quality improvements. Staff were fully engaged in the quality improvement plan to ensure they understood their role in driving improvements in the service.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 22 August 2022) and there were breaches of regulations. Warning Notices were served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities).

This service has been in Special Measures since 22 August 2022. 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.

At our last inspection we recommended the provider made improvements to ensure people were respected and received dignified person-centred care. Systems required improving for managing complaints and guidance in relation to Accessible Information Standards (AIS). At this inspection we found the provider had acted on the recommendations and we were assured staff were treating people with respect and supporting them in a dignified way. Care plans were personalised and identified the needs of people. Processes had been improved for responding to complaints and the provider was meeting people’s communication needs.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and whether the Warning Notices we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) had been met.

The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

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.

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

Follow up

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

Randolph House Care Home is a care home providing accommodation for people requiring nursing or personal care for to up to 70 people in one adapted building over two floors. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 38 people using the service.

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

The provider had limited oversight of the safety and quality of the service which had led to widespread and significant concerns. Whilst delayed, the provider had identified shortfalls in their governance systems and had themselves identified a closed culture at the service. They had begun taking action to address this at the time of the inspection. During and after the inspection, the provider demonstrated transparency and took proactive steps to begin making improvements.

People were not protected from the risk of avoidable harm and abuse and staff were not confident in using the provider’s safeguarding process. Risks to people’s health were not properly assessed and people did not always receive their medicines on time or at all. Staff had not always received training in administering medicines or had their competency assessed and they did not always follow the prescribers’ instructions.

Staff did not have the skills and experience to care for people effectively. People’s care and support needs were not properly assessed, and their nutritional and hydration needs were not always met.

People did not always receive person-centred care and support and staff did not always treat people with dignity and respect. We have made recommendations in these areas.

Complaints were not always recorded or acted upon, unless escalated to the director. We have made a recommendation about this.

Despite our findings, we observed some positive interactions between staff and people and staff told us that following some recent staff changes, the culture at the service had improved.

Following the inspection, the provider had demonstrated a commitment to making improvements at the service.

The premises were undergoing a programme of refurbishment and redecoration. People told us they had been involved in choosing colour themes for their rooms.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 12 February 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the safety and quality of the service and the leadership and management. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety and quality of the service, safeguarding, nutrition and hydration, staffing and the overall leadership and management of the service.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.